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To promote legal decisions in favor of the radiation oncologist, we recommend: accreditation by the American Society for Radiation Oncology (ASTRO) Accreditation Program for Excellence (APEx); use of the ASTRO Radiation Oncology Incident Learning System (RO-ILS); and physician-patient discussion about treatment toxicity (eg, timing, etiologies, and risk of morbidity and mortality), with diligent documentation.
Academic radiation oncology chairs have high emotional Intelligence, and increased emotional Intelligence correlates significantly with decreased rates of self-reported burnout. In the future, emotional Intelligence scores may be of increasing importance when it comes to recruitment and retention of academic medical leadership.
QOL preservation in patients with terminal illnesses, such as brain metastasis, must remain paramount as healthcare technology continues to progress. In the present investigation, 72% of patients maintained their QOL following GKRS, with 24% of patients experiencing clinically significant improvement.
The results suggest that G3 EAC has a slightly more favorable survival than UPSC and CC but predictably does poorer than G1–2 EAC. Further research is warranted to determine if G3 EAC should be reclassified as a type 2 cancer.
There is no significant difference between D2cc%, D1cc%, and D0.1cc% to the rectum and sigmoid colon for VBs and RRs. There was a significant difference in ICRU% rectal point dose between VBs and RRs, but differences in clinical outcome, if present, will require additional investigation.
Using a large hospital-based dataset, adjuvant RT was associated with improved OS for patients with stage IB endometrial adenocarcinoma.
Receipt of EBRT for CTCL varies by sociodemographic factors and the centers where patients receive their care. Among those receiving EBRT, there are variations in dose, and median survival may vary by race. Further research is needed to assess differences in receipt, outcomes, and dose.
The number of new trials examining treatment of oligometastatic disease has risen since 2011, signifying a paradigm shift in the local treatment of oligometastatic disease. RT continues to be the primary intervention in RCTs evaluating oligometastatic disease.
Patients with early-stage papillary BCA are less likely to receive lumpectomy + XRT compared with IDC, although lumpectomy + XRT was associated with superior OS.
From logistic modeling of 625 major vessels, the Radiation Therapy Oncology Group 0813 trial limit of Dmax = 52.5 Gy in five fractions was found to have a 1.2% risk of grade 3–5 toxicity, and the 2008 Timmerman limit of Dmax = 45 Gy in three fractions had a 2.3% risk. Further investigation is warranted, especially for the pulmonary artery, which might not have a dose tolerance as high as other major vessels.
For patients with low-risk disease, LRFS and LRRFS were not significantly different for mastectomy techniques. For this patient population, SSM and NSM appear to be safe and equivalent to TM at 8 years of follow-up.
These data provide evidence that irradiated hEPCs can induce strong bystander killing in A549 and MIA PaCa-2 cancer cells that is mediated by TNF-α and TGF-β.
Using these criteria, about 6% of patients preoperatively meeting no ASTRO APBI consensus cautionary or unsuitable risk factors are recommended for WBRT after IORT. This rate is much higher for patients meeting cautionary criteria before resection.
This analysis demonstrates that significant interfractional target variation exists in the treatment of GMZL; this variation could lead to difficulties in target localization and/or reproducibility of treatment. MRIgRT is a promising method to evaluate and allow for adaptation to these variations.
This retrospective study showed that lower WBC, ANC, and ALC nadirs during CCRT for LSCLC were associated with worse treatment outcomes.
Outcomes for head and neck NHL were maintained using ISRT with IMRT, with no marginal failures. ISRT reduces dose to normal tissues, and our results suggest that further reductions can be achieved with IMRT. This approach may be most valuable for definitive treatment of early-stage NHL, as the excellent prognosis highlights the importance of minimizing RT sequelae.
We present demographics and factors associated with slow trial accrual at MDACC. We believe that this analysis serves as a baseline and highlights areas of weakness to aid in the development of evidence-based trial guidelines.
While treatment at an academic center and increasing the time interval from chemoradiation to surgery were associated with a higher pCR rate, only treatment at an academic center improved survival. Overall, these data do not support routinely increasing the time interval between neoadjuvant chemoradiation and surgery.
Delayed PORT (> 10 wk) with sequential chemotherapy was associated with improved survival in patients with NSCLC and pN2 nodes.
Specialty-specific differences were identified for both upfront management and management after biochemical recurrences for high-risk prostate cancer, with specialists more likely to recommend the treatments they could deliver for nearly all clinical scenarios, whether these recommendations were based on high-level evidence or not.
On univariate and multivariate competing risks analysis, sarcoma histology and larger preoperative tumor volumes were significantly associated with worse local control. Radioresistant histology and Karnofsky performance status were significant predictors for OS on multivariate analysis.
SRS is effective in treating BMs from breast cancer, and multiple courses of SRS are feasible and safe in select patients. Since this population can have a prolonged survival, aggressive local treatment with SRS can lead to improved survival and prevention of neurologic deficits.
This is the largest series of long-term GBM survivors (≥ 5 yr), emphasizing the importance of patient selection and maximizing the extent of resection.
GammaKnife radiosurgery appears to be safe regardless of whether it is delivered before or after checkpoint inhibitor immunotherapy. Conversely, WBRT delivered after immunotherapy was associated with heightened rates of grade ≥ 3 toxicity, including life-threatening cerebral edema, in approximately one-quarter of courses in this sample.
SRS, in the setting of systemic immunotherapy, may provide improved intracranial control compared with WBRT in patients with ≥ 3 melanoma brain metastases. Future prospective studies may expand the utility of SRS and spare selective patients with large intracranial disease burdens from toxicities associated with WBRT.
Our findings suggest that differential treatment access alone does not explain racial disparities and that sociodemographic forces, such as referral patterns and provider biases, may heavily influence what should be a clinical decision regarding treatment provision and receipt.
The rate of recurrence was comparable between patients undergoing APBI and whole-breast radiation. Acute side effects were significantly decreased in the APBI group.
Equal heart sparing can be achieved in left WBRT in either the prone or supine position with deep inspiration breath hold or free breathing when planning is individualized and driven by appropriate dose constraints.
While respiratory-gated RT can reduce the dosimetric parameters for lungs and heart compared with non-gated ER, the results of this study demonstrated a marked further reduction in pulmonary doses for tangentially treated left-sided breast cancer patients, without compromising target coverage.
In this series, we note good local control with an adequate toxicity profile for brain metastases reirradiated with fractionated stereotactic radiation therapy.
