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Overall, outcomes in patients diagnosed with HL in pregnancy in the modern era of chemotherapy and radiation are good. As in HL not diagnosed during pregnancy, outcomes are better in patients with a complete response following initial therapy. Delaying all therapy until the postpartum period is appropriate in properly selected patients and is not associated with poorer outcomes.
Both R-CHOP/R-VACOP-B with RT and DA-EPOCH-R demonstrate excellent outcomes. Long-term follow-up will be required to assess potential complications of contemporary RT. Our data support use of standard immunochemotherapy with RT or DA-EPOCH-R as monotherapy.
Pregnancy and parenthood are common during residency. Women are responsible for more childcare duties than men but have similar research productivity and career aspirations. Further follow-up is necessary to determine the relationship between pregnancy and parenthood over time.
This is the largest reported series of AFX treated with radiation therapy in the literature. No contraindication to the use of radiation is found in the literature. Prior series all utilized surgery, likely due to the clinically rapid progression of this tumor. Risk of recurrence is mitigated with surgical debulking prior to brachytherapy. Electronic brachytherapy appears to be a safe and effective treatment for AFX.
ROs in practice less than 5 years, with academic appointments, or with an FT status had statistically significant associations with WBRT/SRS choice. In poor-prognosis patients, consideration of best supportive care measures is done, and short-course RT is often recommended. For patients with good KPS and limited small brain metastases, SRS with or without WBRT is recommended by most practitioners in accordance with ASTRO guidelines.
SABR is an effective treatment modality for patients with pulmonary metastases, with excellent local control. Further studies are warranted to elucidate which patients with pulmonary metastases would benefit from the local control with SABR and determine when to treat with systemic therapy due to quick progression of distant metastases.
Veterans with brain metastases treated at VHA radiation oncology centers receive appropriate care. Still, the use of prognostic indices in treatment decision-making is statistically significantly more likely in cases treated by recent training program graduates. Given the relatively recent development of these scoring systems, educational efforts need to be devoted to increasing their use in the clinic.
For patients with brain metastases, long-term survival is possible, but the majority of long-term survivors will still experience intracranial progression and require salvage therapies after initial treatment. While salvage therapies may control disease, the development of new metastasis seems to adversely affect survival. RN risk increases over time and may affect a significant portion of long-term survivors.
Our data suggest that SSRS is an effective, safe, and durable treatment option. Given the robust tumor control of SSRS and the possibility for metastatic foci to serve as sources for further systemic spread, proactive treatment of spinal metastasis earlier in the disease course may offer therapeutic benefit to these patients.
We observed an increase in the use of SFRT for bone metastases over the time period covered. Tracking the encounters by ICD codes and CPT codes, when properly coded, served as a useful tool in providing a snapshot view of SFRT usage. Additionally, physician education is a prerequisite for the proper use of a CPT 77431 to capture the true rate of usage of SFRT in clinical practice.
IGRT use is widespread, without standardization of pretreatment imaging modality, frequency, or verification process. Additionally, PTV margin size selection does not appear to be based on IGRT frequency or method of verification. Further research aimed at optimizing IGRT techniques is needed to ensure accurate, safe, timely, and cost-effective treatment delivery.
Religion and particularly the use of religious songs are important aspects of coping with the cancer experience among older African Americans. During diagnosis and treatment, a religious song is likely to be a viable complement to therapies for symptom reduction and mood elevation among this population.
By applying Lean thinking, we were able to reduce the time for CT image acquisition for prostate cancer patients requiring radiotherapy planning by 22%. By reducing the time for CT SIM, veterans’ experiences and satisfaction were improved, flow through the radiation oncology department was optimized, and capacity for CT SIMs was increased.
In pediatric patients with intrathoracic involvement, IMPT produced significantly lower doses to the lung and heart compared with 3DPRT. Additional studies will be needed to determine the clinical benefit of these findings.
This is the first report to directly compare pediatric and adult patients with GBM. Pediatric patients had significantly superior OS and CSS when compared with adults, and these differences remained significant over time and on multivariate analysis. The underlying cause of these survival differences between pediatrics and adults requires exploration, with attention to molecular biological tumor differences.
Pediatric patients with PAs can have extended survival following proton beam radiotherapy. This volumetric study illustrates that responders are declared within 6 months, but vigilant surveillance is necessary due to the potential need for postradiotherapy interventions.
SAPBI via CyberKnife is a suitable platform for partial breast irradiation, offering improvements over existing APBI techniques, with excellent normal tissue-sparing. Our early findings indicate that CyberKnife SAPBI delivered in five fractions is a feasible, well-tolerated, and reliable platform for delivering PBI.
An accurate and robust calibration curve using the green channel of Gafchromic film can be easily created for use in validating HDR planning systems.
Bone marrow aspiration under CT guidance is a safe procedure that has become commonplace at our institution. Pain is minimal, even in the absence of sedation. All biopsies performed at our institution with participation from the pathology department have resulted in diagnostic specimens, and relationships with healthcare stakeholders have improved.
UPR is a novel technique that has been developed in a preclinical tumor model and that is potentially applicable in HNCs. This exploratory study appears consistently to identify subvolumes within the GTV that may have therapeutic implications and that may be promising areas for further research (eg, correlation with hypoxia and clinical outcome).
We have developed a novel TCDR-based approach to improve prostate delineation utilizing intraoperative TRUS-based prostate volume in prostate HDR brachytherapy and demonstrated its improvement in prostate volume accuracy over the standard CT-defined prostate volumes. Integration of TRUS into the HDR brachytherapy treatment planning workflow has the potential to enable accurate dose planning and delivery and enhance prostate HDR treatment outcome.
Skin dose is dependent on patient anatomy, the incident beam geometry, and planning techniques. For example, RapidArc plans with tissue expanders should be monitored for skin dose coverage. In conclusion, the skin dose should be measured to ensure that the clinically desired dose is obtained for the various bolus applications in patients undergoing PMRT.
These data suggest that the use of a CT myelogram with simulation significantly underestimates the spinal cord maximum and mean doses. The clinical significance of this finding is uncertain, and this study is limited by its small sample size. Density correction should be further investigated in a larger study, given the high doses used in SBRT and potential morbidity of spinal cord injury.
The Edge RS system possesses the high-accuracy localization and delivery requirements for safely treating patients with tumors in the CNS and other sites using SRS/SBRT-based techniques.
The impact of obesity on adjuvant treatment is poorly understood. Increasing BMI was associated with increased frequency of gynecologic and cutaneous radiation-associated toxicities. Additional studies to critically evaluate the radiation treatment dosing and treatment fields in obese EC patients are warranted to identify strategies to mitigate the radiation-associated toxicities in these women.
Expert agreement for definitive-case volumes was exceptionally high, although significantly lower agreement was noted postoperatively. Technique and dose prescription between experts were substantively consistent, and these preliminary results will be utilized to create an expert-consensus contouring atlas to aid the nonexpert radiation oncologist in the planning of these challenging, rare tumors.
MLs exhibit favorable clinical responses to NeAT by size criteria; however, this may not account for biological tumor changes. We present a technique for quantifying changes in contrast enhancement that may better predict biological tumor response.
The system has been used since January 2014 to treat patients. Based on the results of ongoing machine and patient-specific tests and with independent confirmation, the treatments are being delivered accurately and safely.
Clinicians who choose to cover C2 with WBRT should be aware of the increased radiation dose delivered to the parotid glands. NTCP modeling predicts an increased rate of treatment-associated xerostomia as a result.
Long-term CaP-specific survival is equally high after RT + ADT and RP + RT in clinically high-risk CaP patients. Further investigation should be aimed at integrating quality of life measures when considering the optimal treatment for men with high-risk CaP.
