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Radiation Oncology

Radiation Oncology Organisations and Resources
Specialist Journals
Latest Research Publications

Radiation Oncology Organisations and Resources (26 links)

    Link to Website
    Link to Directory
    American Brachytherapy Society USA
    American College of Radiation OncologyACRO USA
    American Society for Radiation OncologyASTRO USA
    Belgian Association of Oncological RadiotherapyABRO   Belgium
    Association of Radiation Oncologists of IndiaAROI India
    Italian Association of Radiation OncologyAIRO   Italy
    Canadian Association of Radiation OncologyCARO Canada
    German Society of Radiation OncologyDEGRO   Germany
    European Society for Therapeutic Radiation and OncologyESTRO Europe
    Hungarian Society for Radiation OncologyHUSRO Hungary
    Northern Territory Radiation OncologyNTRO Australia
    Paediatric Radiation Oncology SocietyPROS International
    Radiation Therapy Oncology GroupRTOG USA
    RadOnc Weekly USA
    Romanian Society for Radiotherapy and Medical OncologyRSRMO   Romania
    Scientific Association of Swiss Radiation OncologySASRO Switzerland
    French Society of Radiation OncologySFRO France
    Society for Radiation Oncology AdministratorsSROA USA
    South African Society for Clinical and Radiation OncologistsSASCRO South Africa
    Southern Association of Therapeutic Radiation OncologySATRO USA
    Společnost radiační onkologie biologie a fyzikySROBF Czech Republic
    Stanford University School of Medicine - Department of Radiation Oncology USA
    Turkish Society for Radiation OncologyTROD Turkey
    University of Southern California - Department of Radiation Oncology   USA
    Iranian Society of Radiation OncologyISRO   Iran
    Korean Society for Radiation OncologyKOSRO Republic of Korea

    Specialist Journals (6 links)

    See also: Oncology Journals

    Latest Research Publications

    Lustberg T, van Soest J, Jochems A, et al.
    Big Data in radiation therapy: challenges and opportunities.
    Br J Radiol. 2017; 90(1069):20160689 [PubMed] Related Publications
    Data collected and generated by radiation oncology can be classified by the Volume, Variety, Velocity and Veracity (4Vs) of Big Data because they are spread across different care providers and not easily shared owing to patient privacy protection. The magnitude of the 4Vs is substantial in oncology, especially owing to imaging modalities and unclear data definitions. To create useful models ideally all data of all care providers are understood and learned from; however, this presents challenges in the guise of poor data quality, patient privacy concerns, geographical spread, interoperability and large volume. In radiation oncology, there are many efforts to collect data for research and innovation purposes. Clinical trials are the gold standard when proving any hypothesis that directly affects the patient. Collecting data in registries with strict predefined rules is also a common approach to find answers. A third approach is to develop data stores that can be used by modern machine learning techniques to provide new insights or answer hypotheses. We believe all three approaches have their strengths and weaknesses, but they should all strive to create Findable, Accessible, Interoperable, Reusable (FAIR) data. To learn from these data, we need distributed learning techniques, sending machine learning algorithms to FAIR data stores around the world, learning from trial data, registries and routine clinical data rather than trying to centralize all data. To improve and personalize medicine, rapid learning platforms must be able to process FAIR "Big Data" to evaluate current clinical practice and to guide further innovation.

    Nicholls L, Gorayski P, Poulsen M, et al.
    Maintaining prostate contouring consistency following an educational intervention.
    J Med Radiat Sci. 2016; 63(3):155-60 [PubMed] Free Access to Full Article Related Publications
    INTRODUCTION: The aim of this study was to assess variation in prostate contouring 12 months following a structured interactive educational intervention (EI) and to test the hypothesis that EIs positively impact on prostate contouring accuracy and consistency long term.
    METHODS: A common set of computed tomography (CT) and magnetic resonance imaging (MRI) data sets were used to assess prostate contouring consistency before, immediately after and 12 months following an EI. No further EIs were provided after the initial EI. Contour variation was assessed using the volume ratio (VR), defined as the ratio of the encompassing volume to common volume.
    RESULTS: Of the original five radiation oncologists (ROs) at baseline, four completed all assessments, and one was unavailable at 12 months follow-up. At 12 months, mean VR deteriorated by 3.2% on CT and 1.9% on MRI compared to immediately post EI. Overall, compared to the pre-EI baseline VR, an improvement of 11.4% and 10.8% was demonstrated on CT and MRI, respectively.
    CONCLUSION: Good retention of applied knowledge 12 months following an EI on prostate contouring was demonstrated. This study advocates for EIs to be included as part of continuing medical education to reduce contour variation among ROs and improve knowledge retention long term.

    Bell LJ
    Increasing consistency and accuracy in radiation therapy via educational interventions is not just limited to radiation oncologists.
    J Med Radiat Sci. 2016; 63(3):145-7 [PubMed] Free Access to Full Article Related Publications
    This editorial is advocating that increasing consistency and accuracy in radiation therapy via educational interventions is important for radiation therapist. Education and training with ongoing refreshers is the key to maintaining consistency throughout the radiotherapy process, which in turn will ensure all patients receive accurate treatment.

    Zaorsky NG, Ricco AG, Churilla TM, et al.
    ASTRO APEx(®) and RO-ILS™ are applicable to medical malpractice in radiation oncology.
    Future Oncol. 2016; 12(22):2643-2657 [PubMed] Related Publications
    AIM: To analyze malpractice trials in radiation oncology and assess how ASTRO APEx(®) and RO-ILS™ apply to such cases.
    METHODS: The Westlaw database was reviewed using PICOS/PRISMA methods. Fisher's exact and Mann-Whitney U tests were used to find factors associated with outcomes.
    RESULTS: Of 34 cases identified, external beam was used in 26 (77%). The most common factors behind malpractice were excessive toxicity (80%) and lack of informed consent (66%). ASTRO APEx pillars and ROI-LS had applicability to all but one case. Factors favoring the defendant included statute of limitations (odds ratio: 8.1; 95% CI: 1.3-50); those favoring the plaintiff included patient death (odds ratio: 0.7; 95% CI: 0.54-0.94).
    CONCLUSION: APEx and RO-ILS are applicable to malpractice trials in radiation oncology.

    Dionisi F, Guarneri A, Dell'Acqua V, et al.
    Radiotherapy in the multidisciplinary treatment of liver cancer: a survey on behalf of the Italian Association of Radiation Oncology.
    Radiol Med. 2016; 121(9):735-43 [PubMed] Related Publications
    PURPOSE: To report the results of the first Italian survey investigating the role of liver-directed radiotherapy in the multidisciplinary approach of primary and metastatic liver cancer.
    MATERIALS AND METHODS: A 21-item, two-section questionnaire was sent to all Italian radiotherapy centers on June 2014. The two sections aimed at: (1) evaluating the presence of a multidisciplinary liver tumor board and describing the role of radiation oncologists within the latter, (2) analyzing Radiotherapy treatment details and differences between centers.
    RESULTS: A total of 37 centers completed the survey. A multidisciplinary liver tumor board was available in most centers (73 %), with a radiation oncologist routinely attending the latter in the majority of cases (85 %). Most of the respondents considered liver-directed Radiotherapy as the third line choice when other therapies were not indicated or technically suitable. 18 centers reported the use of liver-directed radiotherapy. The majority of centers started liver irradiation after 2010. The most adopted motion management strategy was abdominal compression. The most adopted GTV-CTV expansion was 0 and 5 mm for metastases and hepatocellular carcinoma, respectively. Stereotactic body radiotherapy was the technique of choice; several treatment schedules were registered, being 45 Gy in three fractions the most reported fractionation scheme. Dose was prescribed at the PTV margin in most cases.
    CONCLUSION: Liver-directed radiotherapy represents a new field of interest which is currently adopted by 10 % of all Italian Centers. The technical equipment seems adequate. The variations observed in the treatment regimens reflect the lack of a well-established standard schedule.

    Knisely J, Sahgal A, Lo S, et al.
    Stereotactic radiosurgery/stereotactic body radiation therapy-reflection on the last decade's achievements and future directions.
    Ann Palliat Med. 2016; 5(2):139-44 [PubMed] Related Publications
    Stereotactic radiosurgery (SRS) and its extracranial first cousin, stereotactic body radiation therapy (SBRT) have become increasingly important in the palliative treatment of cancer patients over the past decade. Appropriately designed and adequately powered clinical trials have in many clinical scenarios amply justified the time, effort, and expense associated with the development and delivery of these highly conformal and complex radiation treatment plans. Ongoing trials are anticipated to provide further confirmatory documentation of the benefits that have been readily observed by caregivers, patients, and their families. It may be predicted that future directions for palliative radiosurgery will include simplification, through greater automation, of the detailed steps that are still required for safe treatment, and thereby increase the chances for patients to receive these advanced palliative interventions at local institutions, from local caregivers.

    Lam KO, Lee AW, Choi CW, et al.
    Global Pattern of Nasopharyngeal Cancer: Correlation of Outcome With Access to Radiation Therapy.
    Int J Radiat Oncol Biol Phys. 2016; 94(5):1106-12 [PubMed] Related Publications
    PURPOSE: This study aimed to estimate the treatment outcome of nasopharyngeal cancer (NPC) across the world and its correlation with access to radiation therapy (RT).
    METHODS AND MATERIALS: The age-standardized mortality (ASM) and age-standardized incidence (ASI) rates of NPC from GLOBOCAN (2012) were summarized, and [1-(ASM/ASI)] was computed to give the proxy relative survival (RS). Data from the International Atomic Energy Agency (IAEA) and the World Bank were used to assess the availability of RT in surrogate terms: the number of RT equipment units and radiation oncologists per million population.
    RESULTS: A total of 112 countries with complete valid data were analyzed, and the proxy RS varied widely from 0% to 83% (median, 50%). Countries were categorized into Good, Median, and Poor outcome groups on the basis of their proxy RS (<45%, 45%-55%, and >55%). Eighty percent of new cases occurred in the Poor outcome group. Univariable linear regression showed a significant correlation between outcome and the availability of RT: proxy RS increased at 3.4% (P<.001) and 1.5% (P=.001) per unit increase in RT equipment and oncologist per million population, respectively. The median number of RT equipment units per million population increased significantly from 0.5 in the Poor, to 1.5 in the Median, to 4.6 in the Good outcome groups, and the corresponding number of oncologists increased from 1.1 to 3.3 to 7.1 (P<.001).
    CONCLUSIONS: Nasopharyngeal cancer is a highly treatable disease, but the outcome varies widely across the world. The current study shows a significant correlation between survival and access to RT based on available surrogate indicators. However, the possible reasons for poor outcome are likely to be multifactorial and complex. Concerted international efforts are needed not only to address the fundamental requirement for adequate RT access but also to obtain more comprehensive and accurate data for research to improve cancer outcome.

    Baumann M, Krause M, Overgaard J, et al.
    Radiation oncology in the era of precision medicine.
    Nat Rev Cancer. 2016; 16(4):234-49 [PubMed] Related Publications
    Technological advances and clinical research over the past few decades have given radiation oncologists the capability to personalize treatments for accurate delivery of radiation dose based on clinical parameters and anatomical information. Eradication of gross and microscopic tumours with preservation of health-related quality of life can be achieved in many patients. Two major strategies, acting synergistically, will enable further widening of the therapeutic window of radiation oncology in the era of precision medicine: technology-driven improvement of treatment conformity, including advanced image guidance and particle therapy, and novel biological concepts for personalized treatment, including biomarker-guided prescription, combined treatment modalities and adaptation of treatment during its course.

    Nabavizadeh N, Elliott DA, Chen Y, et al.
    Image Guided Radiation Therapy (IGRT) Practice Patterns and IGRT's Impact on Workflow and Treatment Planning: Results From a National Survey of American Society for Radiation Oncology Members.
    Int J Radiat Oncol Biol Phys. 2016; 94(4):850-7 [PubMed] Related Publications
    PURPOSE: To survey image guided radiation therapy (IGRT) practice patterns, as well as IGRT's impact on clinical workflow and planning treatment volumes (PTVs).
    METHODS AND MATERIALS: A sample of 5979 treatment site-specific surveys was e-mailed to the membership of the American Society for Radiation Oncology (ASTRO), with questions pertaining to IGRT modality/frequency, PTV expansions, method of image verification, and perceived utility/value of IGRT. On-line image verification was defined as images obtained and reviewed by the physician before treatment. Off-line image verification was defined as images obtained before treatment and then reviewed by the physician before the next treatment.
    RESULTS: Of 601 evaluable responses, 95% reported IGRT capabilities other than portal imaging. The majority (92%) used volumetric imaging (cone-beam CT [CBCT] or megavoltage CT), with volumetric imaging being the most commonly used modality for all sites except breast. The majority of respondents obtained daily CBCTs for head and neck intensity modulated radiation therapy (IMRT), lung 3-dimensional conformal radiation therapy or IMRT, anus or pelvis IMRT, prostate IMRT, and prostatic fossa IMRT. For all sites, on-line image verification was most frequently performed during the first few fractions only. No association was seen between IGRT frequency or CBCT utilization and clinical treatment volume to PTV expansions. Of the 208 academic radiation oncologists who reported working with residents, only 41% reported trainee involvement in IGRT verification processes.
    CONCLUSION: Consensus guidelines, further evidence-based approaches for PTV margin selection, and greater resident involvement are needed for standardized use of IGRT practices.

    Lin CC, Bruinooge SS, Kirkwood MK, et al.
    Association Between Geographic Access to Cancer Care and Receipt of Radiation Therapy for Rectal Cancer.
    Int J Radiat Oncol Biol Phys. 2016; 94(4):719-28 [PubMed] Article available free on PMC after 15/03/2017 Related Publications
    PURPOSE: Trimodality therapy (chemoradiation and surgery) is the standard of care for stage II/III rectal cancer but nearly one third of patients do not receive radiation therapy (RT). We examined the relationship between the density of radiation oncologists and the travel distance to receipt of RT.
    METHODS AND MATERIALS: A retrospective study based on the National Cancer Data Base identified 26,845 patients aged 18 to 80 years with stage II/III rectal cancer diagnosed from 2007 to 2010. Radiation oncologists were identified through the Physician Compare dataset. Generalized estimating equations clustering by hospital service area was used to examine the association between geographic access and receipt of RT, controlling for patient sociodemographic and clinical characteristics.
    RESULTS: Of the 26,845 patients, 70% received RT within 180 days of diagnosis or within 90 days of surgery. Compared with a travel distance of <12.5 miles, patients diagnosed at a reporting facility who traveled ≥50 miles had a decreased likelihood of receipt of RT (50-249 miles, adjusted odds ratio 0.75, P<.001; ≥250 miles, adjusted odds ratio 0.46; P=.002), all else being equal. The density level of radiation oncologists was not significantly associated with the receipt of RT. Patients who were female, nonwhite, and aged ≥50 years and had comorbidities were less likely to receive RT (P<.05). Patients who were uninsured but self-paid for their medical services, initially diagnosed elsewhere but treated at a reporting facility, and resided in Midwest had an increased the likelihood of receipt of RT (P<.05).
    CONCLUSIONS: An increased travel burden was associated with a decreased likelihood of receiving RT for patients with stage II/III rectal cancer, all else being equal; however, radiation oncologist density was not. Further research of geographic access and establishing transportation assistance programs or lodging services for patients with an unmet need might help decrease geographic barriers and improve the quality of rectal cancer care.

    Able CM, Baydush AH, Nguyen C, et al.
    A model for preemptive maintenance of medical linear accelerators-predictive maintenance.
    Radiat Oncol. 2016; 11:36 [PubMed] Article available free on PMC after 15/03/2017 Related Publications
    BACKGROUND: Unscheduled accelerator downtime can negatively impact the quality of life of patients during their struggle against cancer. Currently digital data accumulated in the accelerator system is not being exploited in a systematic manner to assist in more efficient deployment of service engineering resources. The purpose of this study is to develop an effective process for detecting unexpected deviations in accelerator system operating parameters and/or performance that predicts component failure or system dysfunction and allows maintenance to be performed prior to the actuation of interlocks.
    METHODS: The proposed predictive maintenance (PdM) model is as follows: 1) deliver a daily quality assurance (QA) treatment; 2) automatically transfer and interrogate the resulting log files; 3) once baselines are established, subject daily operating and performance values to statistical process control (SPC) analysis; 4) determine if any alarms have been triggered; and 5) alert facility and system service engineers. A robust volumetric modulated arc QA treatment is delivered to establish mean operating values and perform continuous sampling and monitoring using SPC methodology. Chart limits are calculated using a hybrid technique that includes the use of the standard SPC 3σ limits and an empirical factor based on the parameter/system specification.
    RESULTS: There are 7 accelerators currently under active surveillance. Currently 45 parameters plus each MLC leaf (120) are analyzed using Individual and Moving Range (I/MR) charts. The initial warning and alarm rule is as follows: warning (2 out of 3 consecutive values ≥ 2σ hybrid) and alarm (2 out of 3 consecutive values or 3 out of 5 consecutive values ≥ 3σ hybrid). A customized graphical user interface provides a means to review the SPC charts for each parameter and a visual color code to alert the reviewer of parameter status. Forty-five synthetic errors/changes were introduced to test the effectiveness of our initial chart limits. Forty-three of the forty-five errors (95.6 %) were detected in either the I or MR chart for each of the subsystems monitored.
    CONCLUSION: Our PdM model shows promise in providing a means for reducing unscheduled downtime. Long term monitoring will be required to establish the effectiveness of the model.

    Mattonen SA, Palma DA, Johnson C, et al.
    Detection of Local Cancer Recurrence After Stereotactic Ablative Radiation Therapy for Lung Cancer: Physician Performance Versus Radiomic Assessment.
    Int J Radiat Oncol Biol Phys. 2016; 94(5):1121-8 [PubMed] Related Publications
    PURPOSE: Stereotactic ablative radiation therapy (SABR) is a guideline-specified treatment option for early-stage lung cancer. However, significant posttreatment fibrosis can occur and obfuscate the detection of local recurrence. The goal of this study was to assess physician ability to detect timely local recurrence and to compare physician performance with a radiomics tool.
    METHODS AND MATERIALS: Posttreatment computed tomography (CT) scans (n=182) from 45 patients treated with SABR (15 with local recurrence matched to 30 with no local recurrence) were used to measure physician and radiomic performance in assessing response. Scans were individually scored by 3 thoracic radiation oncologists and 3 thoracic radiologists, all of whom were blinded to clinical outcomes. Radiomic features were extracted from the same images. Performances of the physician assessors and the radiomics signature were compared.
    RESULTS: When taking into account all CT scans during the whole follow-up period, median sensitivity for physician assessment of local recurrence was 83% (range, 67%-100%), and specificity was 75% (range, 67%-87%), with only moderate interobserver agreement (κ = 0.54) and a median time to detection of recurrence of 15.5 months. When determining the early prediction of recurrence within <6 months after SABR, physicians assessed the majority of images as benign injury/no recurrence, with a mean error of 35%, false positive rate (FPR) of 1%, and false negative rate (FNR) of 99%. At the same time point, a radiomic signature consisting of 5 image-appearance features demonstrated excellent discrimination, with an area under the receiver operating characteristic curve of 0.85, classification error of 24%, FPR of 24%, and FNR of 23%.
    CONCLUSIONS: These results suggest that radiomics can detect early changes associated with local recurrence that are not typically considered by physicians. This decision support system could potentially allow for early salvage therapy of patients with local recurrence after SABR.

    Shaitelman SF, Lin HY, Smith BD, et al.
    Practical Implications of the Publication of Consensus Guidelines by the American Society for Radiation Oncology: Accelerated Partial Breast Irradiation and the National Cancer Data Base.
    Int J Radiat Oncol Biol Phys. 2016; 94(2):338-48 [PubMed] Related Publications
    PURPOSE: To examine utilization trends of accelerated partial breast irradiation (APBI) in the American College of Surgeons' National Cancer Database and changes in APBI use after the 2009 publication of the American Society for Radiation Oncology (ASTRO) guidelines.
    METHODS AND MATERIALS: A total of 399,705 women were identified who were diagnosed from 2004 to 2011 with nonmetastatic invasive breast cancer or ductal carcinoma in situ who were treated with breast-conserving surgery and radiation therapy to the breast. Patients were divided by the type of treatment received (whole breast irradiation or APBI) and by suitability to receive APBI as defined by the ASTRO guidelines. Logistic regression was applied to study APBI use overall and within guideline categorization, and a multivariable model was created to determine predictors of treatment with brachytherapy-based APBI based on guideline categorization.
    RESULTS: For all patients, APBI use increased, from 3.8% in 2004 to 10.6% in 2011 (P<.0001). Overall rates of APBI utilization were higher among "suitable" than "cautionary"/"unsuitable" patients (14.8% vs 7.1%, P<.0001). The majority of APBI treatment was delivered using brachytherapy, for which use peaked in 2008. Starting in 2009, among "suitable" patients, utilization of APBI via brachytherapy plateaued, whereas for "cautionary"/"unsuitable" patients, treatment with brachytherapy-based APBI declined and then plateaued.
    CONCLUSION: Use of APBI across all patient groups increased from 2004 through 2008. After publication of the ASTRO APBI guidelines in 2009, rates of brachytherapy-based APBI treatment plateaued among "suitable" patients and declined and then plateaued among "cautionary"/"unsuitable" patients. Our study highlights how large national databases can be used to assess national trends in radiation use in response to the publication of guidelines.

    Nabavizadeh N, Burt LM, Mancini BR, et al.
    Results of the 2013-2015 Association of Residents in Radiation Oncology Survey of Chief Residents in the United States.
    Int J Radiat Oncol Biol Phys. 2016; 94(2):228-34 [PubMed] Related Publications
    PURPOSE: The purpose of this project was to survey radiation oncology chief residents to define their residency experience and readiness for independent practice.
    METHODS AND MATERIALS: During the academic years 2013 to 2014 and 2014 to 2015, the Association of Residents in Radiation Oncology (ARRO) conducted an electronic survey of post-graduate year-5 radiation oncology residents in the United States during the final 3 months of training. Descriptive statistics are reported.
    RESULTS: Sixty-six chief residents completed the survey in 2013 to 2014 (53% response rate), and 69 completed the survey in 2014 to 2015 (64% response rate). Forty to 85% percent of residents reported inadequate exposure to high-dose rate and low-dose rate brachytherapy. Nearly all residents in both years (>90%) reported adequate clinical experience for the following disease sites: breast, central nervous system, gastrointestinal, genitourinary, head and neck, and lung. However, as few as 56% reported adequate experience in lymphoma or pediatric malignancies. More than 90% of residents had participated in retrospective research projects, with 20% conducting resident-led prospective clinical trials and 50% conducting basic science or translational projects. Most chief residents reported working 60 or fewer hours per week in the clinical/hospital setting and performing fewer than 15 hours per week tasks that were considered to have little or no educational value. There was more than 80% compliance with Accreditation Council for Graduate Medical Education (ACGME) work hour limits. Fifty-five percent of graduating residents intended to join an established private practice group, compared to 25% who headed for academia. Residents perceive the job market to be more competitive than previous years.
    CONCLUSIONS: This first update of the ARRO chief resident survey since the 2007 to 2008 academic year documents US radiation oncology residents' experiences and conditions over a 2-year period. This analysis may serve as a valuable tool for those seeking to improve training of the next generation of oncology leaders.

    Messiou C, Bonvalot S, Gronchi A, et al.
    Evaluation of response after pre-operative radiotherapy in soft tissue sarcomas; the European Organisation for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group (EORTC-STBSG) and Imaging Group recommendations for radiological examination and reporting with an emphasis on magnetic resonance imaging.
    Eur J Cancer. 2016; 56:37-44 [PubMed] Related Publications
    At present, there is no standardised approach for the radiological evaluation of soft tissue sarcomas following radiotherapy (RT). This manuscript, produced by a European Organisation for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group (EORTC-STBSG) and Imaging Group endorsed task force, aims to propose standardisation of magnetic resonance imaging techniques and interpretation after neoadjuvant RT for routine use and within clinical trials.

    Chen RC, Hoffman KE, Sher DJ, et al.
    Development of a standard survivorship care plan template for radiation oncologists.
    Pract Radiat Oncol. 2016 Jan-Feb; 6(1):57-65 [PubMed] Related Publications
    PURPOSE: In response to a need expressed by members of the American Society for Radiation Oncology (ASTRO), the ASTRO Board of Directors approved an initiative to create a radiation oncology-specific survivorship care plan (SCP) template.
    METHODS AND MATERIALS: Members of the ASTRO Health Services Research Committee (which was subsequently renamed the Clinical, Translational, and Basic Science Advisory Committee) were charged with this task. Creation of the ASTRO SCP template was informed by existing SCP templates published by other organizations and modified to add radiation treatment details felt to be important by committee members. An emphasis was placed on describing diagnostic and treatment details in ways that patients and referring physicians can understand. The resulting template subsequently underwent ASTRO committee review, public comment, and was ultimately approved by the ASTRO Board of Directors.
    RESULTS: The standardized template includes 2 components: the first 2 pages represent an SCP that is to be given to the patient and referring physicians, whereas page 3 includes additional technical radiation therapy details which are usually included in a traditional radiation treatment summary. That is, the template serves two purposes - obviating the need for radiation oncologists to create an SCP for patients and a separate treatment completion note.
    CONCLUSIONS: The standardized ASTRO SCP template serves an immediate need of practicing radiation oncologists to have a template that is radiation-specific and meets current requirements for SCP and radiation treatment summary. Potential future work may include development of disease-specific templates that will include more granular details regarding expected toxicities and follow-up care recommendations and working with electronic medical record system vendors to facilitate autocreation of SCP documents to reduce the burden on physicians and other staff. These future developments can make this intervention more helpful to patients, and further reduce the burden of creating SCPs.

    Lacombe J, Phillips SL, Zenhausern F
    Microfluidics as a new tool in radiation biology.
    Cancer Lett. 2016; 371(2):292-300 [PubMed] Free Access to Full Article Related Publications
    Ionizing radiations interact with molecules at the cellular and molecular levels leading to several biochemical modifications that may be responsible for biological effects on tissue or whole organisms. The study of these changes is difficult because of the complexity of the biological response(s) to radiations and the lack of reliable models able to mimic the whole molecular phenomenon and different communications between the various cell networks, from the cell activation to the macroscopic effect at the tissue or organismal level. Microfluidics, the science and technology of systems that can handle small amounts of fluids in confined and controlled environment, has been an emerging field for several years. Some microfluidic devices, even at early stages of development, may already help radiobiological research by proposing new approaches to study cellular, tissue and total-body behavior upon irradiation. These devices may also be used in clinical biodosimetry since microfluidic technology is frequently developed for integrating complex bioassay chemistries into automated user-friendly, reproducible and sensitive analyses. In this review, we discuss the use, numerous advantages, and possible future of microfluidic technology in the field of radiobiology. We will also examine the disadvantages and required improvements for microfluidics to be fully practical in radiation research and to become an enabling tool for radiobiologists and radiation oncologists.

    Smilowitz JB, Das IJ, Feygelman V, et al.
    AAPM Medical Physics Practice Guideline 5.a.: Commissioning and QA of Treatment Planning Dose Calculations - Megavoltage Photon and Electron Beams.
    J Appl Clin Med Phys. 2015; 16(5):5768 [PubMed] Related Publications
    The American Association of Physicists in Medicine (AAPM) is a nonprofit professional society whose primary purposes are to advance the science, education and professional practice of medical physics. The AAPM has more than 8,000 members and is the principal organization of medical physicists in the United States. The AAPM will periodically define new practice guidelines for medical physics practice to help advance the science of medical physics and to improve the quality of service to patients throughout the United States. Existing medical physics practice guidelines will be reviewed for the purpose of revision or renewal, as appropriate, on their fifth anniversary or sooner. Each medical physics practice guideline represents a policy statement by the AAPM, has undergone a thorough consensus process in which it has been subjected to extensive review, and requires the approval of the Professional Council. The medical physics practice guidelines recognize that the safe and effective use of diagnostic and therapeutic radiology requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guidelines and technical standards by those entities not providing these services is not authorized. The following terms are used in the AAPM practice guidelines:• Must and Must Not: Used to indicate that adherence to the recommendation is considered necessary to conform to this practice guideline.• Should and Should Not: Used to indicate a prudent practice to which exceptions may occasionally be made in appropriate circumstances.

    Zaorsky NG, Shaikh T, Handorf E, et al.
    What Are Medical Students in the United States Learning About Radiation Oncology? Results of a Multi-Institutional Survey.
    Int J Radiat Oncol Biol Phys. 2016; 94(2):235-42 [PubMed] Related Publications
    PURPOSE: The purposes of this study were to assess the exposure that medical students (MSs) have to radiation oncology (RO) during the course of their medical school career, as evidenced by 2 time points in current medical training (ie, first vs fourth year; MS1s and MS4s, respectively) and to assess the knowledge of MS1s, MS4s, and primary care physicians (PCPs) about the appropriateness of RT in cancer management in comparison with RO attendings.
    METHODS: We developed and beta tested an electronic survey divided into 3 parts: RO job descriptions, appropriateness of RT, and toxicities of RT. The surveys were distributed to 7 medical schools in the United States. A concordance of >90% (either yes or no) among RO attendings in an answer was necessary to determine the correct answer and to compare with other subgroups using a χ(2) test (P<.05 was significant).
    RESULTS: The overall response rate for ROs, MS1s, MS4s, and PCPs was 26%; n (22 + 315 + 404 + 43)/3004. RT misconceptions decreased with increasing level of training. More than 1 of 10 MSs did not believe that RT alone could cure cancer. Emergent oncologic conditions for RT (eg, spinal cord compression, superior vena cava syndrome) could not be identified by >1 of 5 respondents. Multiple nontoxicities of RT (eg, emitting low-level radiation from the treatment site) were incorrectly identified as toxicities by >1 of 5 respondents. MS4s/PCPs with an RO rotation in medical school had improved scores in all prompts.
    CONCLUSIONS: Although MS knowledge of general RT principles improves from the first to the fourth year, a large knowledge gap still exists between MSs, current PCPs, and ROs. Some basic misconceptions of RT persist among a minority of MSs and PCPs. We recommend implementing formal education in RO fundamentals during the core curriculum of medical school.

    Gómez Caamaño A, Zapatero A, López Torrecilla J, Maldonado X
    Management of prostate cancer patients following radiation therapy after radical surgery referred from urology to radiation oncology departments in Spain.
    Clin Transl Oncol. 2016; 18(9):884-92 [PubMed] Related Publications
    PURPOSE: To define usual clinical management of prostate cancer (PCa) patients following postoperative radiation therapy (RT) (adjuvant or salvage) and its evolution over time in radiation oncology (RO) departments in Spain.
    METHODS: An epidemiological, cross-sectional, multicentre study was conducted. 567 PCa patients that had undergone radical prostatectomy (RP) and received postoperative RT between February and December of both 2006 and 2011 participated in the study. In patients from 2006, health-related quality of life (HRQoL) was assessed using the EPIC questionnaire. Investigators completed a specific survey on two clinical cases of adjuvant and salvage RT.
    RESULTS: 70.6 % of patients received salvage RT versus 29.4 % who received adjuvant RT; no significant differences were found in terms of frequency for each procedure between both the years. Regarding the survey, a positive surgical margin was the main criteria used in adjuvant RT decision making. In terms of salvage RT scenario, 85.7 % of the investigators stated that adjuvant RT should have been offered instead, 81.4 % of the investigators agreed on a PSA score >0.2 ng/mL as the main criteria for identifying biochemical recurrence after RP, and 67.4 % of investigators did not consider any PSA score for ruling out salvage RT treatment.
    CONCLUSIONS: Most patients are referred to RO departments to receive salvage RT. Despite the publication of three IA evidence level randomized clinical trials, the patterns for using adjuvant and salvage RT did not change from 2006 to 2011, although patients' profile did. A consensus regarding postoperative RT indications should be reached in order to correct this controversial situation.

    Harkenrider MM, Grover S, Erickson BA, et al.
    Vaginal brachytherapy for postoperative endometrial cancer: 2014 Survey of the American Brachytherapy Society.
    Brachytherapy. 2016 Jan-Feb; 15(1):23-9 [PubMed] Related Publications
    PURPOSE: Report current practice patterns for postoperative endometrial cancer emphasizing vaginal brachytherapy (VBT).
    METHODS AND MATERIALS: A 38-item survey was e-mailed to 1,598 American Brachytherapy Society (ABS) members and 4,329 US radiation oncologists in 2014 totaling 5,710 recipients. Responses of practitioners who had delivered VBT in the previous 12 months were included in the analysis. Responses were tabulated to determine relative frequency distributions. χ(2) analysis was used to compare current results with those from the 2003 ABS survey.
    RESULTS: A total of 331 respondents initiated the VBT survey, of whom 289 (87.3%) administered VBT in the prior 12 months. Lymph node dissection and number of nodes removed influenced treatment decisions for 90.5% and 69.8%, respectively. High-dose-rate was used by 96.2%. The most common vaginal length treated was 4 cm (31.0%). Three-dimensional planning was used by 83.2% with 73.4% of those for the first fraction only. Doses to normal tissues were reported by 79.8%. About half optimized to the location of dose specification and/or normal tissues. As monotherapy, the most common prescriptions were 7 Gy for three fractions to 0.5-cm depth and 6 Gy for five fractions to the surface. As a boost, the most common prescriptions were 5 Gy for three fractions to 0.5-cm depth and 6 Gy for three fractions to the vaginal surface. Optimization points were placed at the apex and lateral vagina by 73.1%. Secondary quality assurance checks were performed by 98.9%.
    CONCLUSIONS: VBT is a common adjuvant therapy for endometrial cancer patients, most commonly with HDR. Fractionation and planning processes are variable but generally align with ABS recommendations.

    Koontz BF, Benda R, De Los Santos J, et al.
    US radiation oncology practice patterns for posttreatment survivor care.
    Pract Radiat Oncol. 2016 Jan-Feb; 6(1):50-6 [PubMed] Related Publications
    PURPOSE: Increasing numbers of cancer survivors have driven a greater focus on care of cancer patients after treatment. Radiation oncologists have long considered follow-up of patients an integral part of practice. We sought to document current survivor-focused care patterns and identify barriers to meeting new regulatory commission guidelines for survivorship care plans (SCPs) and provide guidance for survivorship care.
    METHODS AND MATERIALS: A 23-question electronic survey was e-mailed to all practicing US physician American Society of Radiation Oncology members. Responses were collected for 25 days in March 2014. Survey data were descriptively analyzed.
    RESULTS: A total of 574 eligible providers responded, for a response percentage of 14.7%. Almost all providers follow their patients after treatment (97%). Length of follow-up was frequently extensive: 17% followed up to 2 years, 40% for 3-5 years, 12% for 6-10 years, and 31% indefinitely. Ancillary services, particularly social work and nutrition services, are commonly available onsite to patients in follow-up. Fewer than half of respondents (40%) indicated that they currently use SCPs for curative intent patients and those who do generally use internally developed templates. SCPs typically go to patients (91%), but infrequently to primary care providers (22%). The top 3 barriers to implementation of SCPs were cost (57%), duplicative survivorship care plans provided by other physicians (43%), and lack of consensus or professional guidelines (40%). Eighty-seven percent indicated that SCPs built into an electronic medical record system would be useful.
    CONCLUSIONS: A significant part of radiation oncology practice includes the care of those in the surveillance of follow-up phase of care. SCPs may be beneficial in improving communication with the patient and other care but are not widely used within our field. This survey identified key barriers to use of SCPs and provides specialty guidance for important information to be included in a radiation oncology oriented SCP.

    Shakespeare TP
    Effect of prostate-specific membrane antigen positron emission tomography on the decision-making of radiation oncologists.
    Radiat Oncol. 2015; 10:233 [PubMed] Free Access to Full Article Related Publications
    BACKGROUND: Positron emission tomography (PET) imaging is routinely used in many cancer types, although is not yet a standard modality for prostate carcinoma. Prostate-specific membrane antigen (PSMA) PET is a promising new modality for staging prostate cancer, with recent studies showing potential advantages over traditional computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine bone scan imaging. However, the impact of PSMA PET on the decision-making of radiation oncologists and outcomes after radiotherapy is yet to be determined. Our aim was to determine the impact of PSMA PET on a radiation oncologist's clinical practice.
    FINDINGS: Patients in a radiation oncology clinic who underwent PSMA PET were prospectively recorded in an electronic oncology record. Patient demographics, outcomes of imaging, and impact on decision-making were evaluated. Fifty-four patients underwent PSMA PET between January and May 2015. The major reasons for undergoing PET included staging before definitive (14.8%) or post-prostatectomy (33.3%) radiotherapy, and investigation of PSA failures following definitive (16.7%) or post-prostatectomy (33.3%) radiotherapy. In 46.3% of patients PSMA was positive after negative traditional imaging, in 9.3% PSMA was positive after equivocal imaging, and in 13.0% PSMA was negative after equivocal imaging. PSMA PET changed radiotherapy management in 46.3% of cases, and hormone therapy in 33.3% of patients, with an overall change in decision-making in 53.7% of patients.
    CONCLUSIONS: PSMA PET has the potential to significantly alter the decision-making of radiation oncologists, and may become a valuable imaging tool in the future.

    Kang J, Schwartz R, Flickinger J, Beriwal S
    Machine Learning Approaches for Predicting Radiation Therapy Outcomes: A Clinician's Perspective.
    Int J Radiat Oncol Biol Phys. 2015; 93(5):1127-35 [PubMed] Related Publications
    Radiation oncology has always been deeply rooted in modeling, from the early days of isoeffect curves to the contemporary Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) initiative. In recent years, medical modeling for both prognostic and therapeutic purposes has exploded thanks to increasing availability of electronic data and genomics. One promising direction that medical modeling is moving toward is adopting the same machine learning methods used by companies such as Google and Facebook to combat disease. Broadly defined, machine learning is a branch of computer science that deals with making predictions from complex data through statistical models. These methods serve to uncover patterns in data and are actively used in areas such as speech recognition, handwriting recognition, face recognition, "spam" filtering (junk email), and targeted advertising. Although multiple radiation oncology research groups have shown the value of applied machine learning (ML), clinical adoption has been slow due to the high barrier to understanding these complex models by clinicians. Here, we present a review of the use of ML to predict radiation therapy outcomes from the clinician's point of view with the hope that it lowers the "barrier to entry" for those without formal training in ML. We begin by describing 7 principles that one should consider when evaluating (or creating) an ML model in radiation oncology. We next introduce 3 popular ML methods--logistic regression (LR), support vector machine (SVM), and artificial neural network (ANN)--and critique 3 seminal papers in the context of these principles. Although current studies are in exploratory stages, the overall methodology has progressively matured, and the field is ready for larger-scale further investigation.

    Grover S, Chadha M, Rengan R, et al.
    Education and Training Needs in Radiation Oncology in India: Opportunities for Indo-US Collaborations.
    Int J Radiat Oncol Biol Phys. 2015; 93(5):957-60 [PubMed] Related Publications
    PURPOSE: To conduct a survey of radiation oncologists in India, to better understand specific educational needs of radiation oncology in India and define areas of collaboration with US institutions.
    METHODS AND MATERIALS: A 20-question survey was distributed to members of the Association of Indian Radiation Oncologists and the Indian Brachytherapy Society between November 2013 and May 2014.
    RESULTS: We received a total of 132 responses. Over 50% of the physicians treat more than 200 patients per day, use 2-dimensional or 3-dimensional treatment planning techniques, and approximately 50% use image guided techniques. For education needs, most respondents agreed that further education in intensity modulated radiation therapy, image guided radiation therapy, stereotactic radiation therapy, biostatistics, and research methods for medical residents would be useful areas of collaboration with institutions in the United States. Other areas of collaboration include developing a structured training module for nursing, physics training, and developing a second-opinion clinic for difficult cases with faculty in the United States.
    CONCLUSION: Various areas of potential collaboration in radiation oncology education were identified through this survey. These include the following: establishing education programs focused on current technology, facilitating exchange programs for trainees in India to the United States, promoting training in research methods, establishing training modules for physicists and oncology nurses, and creating an Indo-US. Tumor Board. It would require collaboration between the Association of Indian Radiation Oncologists and the American Society for Radiation Oncology to develop these educational initiatives.

    Schubert L, Liu A, Gan G, et al.
    Practical implementation of quality improvement for high-dose-rate brachytherapy.
    Pract Radiat Oncol. 2016 Jan-Feb; 6(1):34-43 [PubMed] Related Publications
    PURPOSE: High-dose-rate (HDR) brachytherapy is a high-risk procedure with serious errors reported in the medical literature. Our goal was to develop a quality improvement framework for HDR brachytherapy using a multidisciplinary approach. This work describes the time, personnel, and materials involved in implementation as well as staff-reported safety benefits of quality improvement checklists.
    METHODS AND MATERIALS: Quality improvement was achieved using a department-wide multidisciplinary approach. Process mapping of the entire HDR program, from initial scheduling through follow-up, was performed. The scope of the project was narrowed to the point of treatment delivery. Two types of multidisciplinary checklists were created: a safety-timeout checklist to ensure safety-critical actions were performed before treatment initiation; and detailed procedure checklists that served as written procedures for physicians, physicists, dosimetrists, and nurses. Implementation was carried out through initial training led by various staff members, creation of visual training guides, piloting and use of checklists for all treatments, and auditing of checklist compliance.
    RESULTS: Process maps of the entire HDR program were generated and used to guide subsequent changes in the treatment delivery process. A single safety-timeout checklist and the individual procedure checklists were created and used at the time of treatment delivery. The 3-month audit showed that the safety-timeout checklist was used for 100% of treatment fractions. Individual procedure checklists were used for 85% of fractions. All cross-covering physicians and physicists continued to use these checklists 100% of the time. Staff survey results indicated improvements in safety and increased benefits for cross-covering staff.
    CONCLUSIONS: In using a multidisciplinary approach to quality improvement, process mapping and comprehensive checklists for HDR treatment delivery have been implemented. This has resulted in improved practices that are optimal in our department. This experience can provide others with practical strategies toward implementing such changes in their own facilities.

    Margalit DN, Schoenfeld JD, Tishler RB
    Radiation Oncology--New Approaches in Squamous Cell Cancer of the Head and Neck.
    Hematol Oncol Clin North Am. 2015; 29(6):1093-106 [PubMed] Related Publications
    The many advances in radiotherapy for squamous cell cancer of the head and neck described in this article will have significant effects on the ultimate outcomes of patients who receive this treatment. The technological and clinical advances should allow one to maintain or improve disease control, while moderating the toxicity associated with head and neck radiation therapy.

    Piva C, Genovesi D, Filippi AR, et al.
    Interobserver variability in clinical target volume delineation for primary mediastinal B-cell lymphoma.
    Pract Radiat Oncol. 2015 Nov-Dec; 5(6):383-9 [PubMed] Related Publications
    PURPOSE: The purpose of this study was to evaluate interobserver variability among radiation oncologists with experience in the field of lymphoma radiation therapy in the delineation of clinical target volume (CTV) in a challenging case of primary mediastinal B-cell lymphoma.
    METHODS AND MATERIALS: Ten experienced radiation oncologists were invited to a 1-day contouring session. The case of a 56-year-old man with primary mediastinal B-cell lymphoma with complete metabolic response after chemotherapy was chosen as the sample for the study. A brief presentation of his clinical history was given, together with guidelines for contouring. The 10 CTVs obtained were then compared in terms of variation in total volume and in craniocaudal, laterolateral, and anteroposterior diameters. The CTV with the best Dice similarity coefficient (DSC) between the union of all 10 CTVs and the individual CTV was considered the reference CTV, and the DSC and the Hausdorff distance (HD) for each volume compared with the reference CTV were then calculated.
    RESULTS: A significant variability was found in total volume (mean, 498.3 cm(3); range, 181.8-1003 cm(3)) and craniocaudal (median, 144.7 mm; range, 80.6-159 mm), laterolateral (median, 133.5 mm; range, 83.7-149.5 mm), and anteroposterior diameters (median, 136.2 mm; range, 84-150.5 mm). Analysis of the DSC and the HD showed a mean DSC of 0.53 (range, 0.31-0.74) and a mean HD of 6.4 cm (range, 1.8-14.8 cm).
    CONCLUSIONS: Results of this study strongly indicate the need to develop and share appropriate contouring guidelines among experts and suggest the promotion of specific educational activities to improve radiation therapy quality in both clinical trials and routine clinical practice.

    Marks LB
    "Error Bars" in Medical Imaging: Stealth and Treacherous.
    Radiology. 2015; 277(2):318-28 [PubMed] Related Publications
    Given the critical role that diagnostic radiology has in patient care, it is important for providers and patients to understand the level of certainty associated with imaging. Over-reliance on imaging and failure to appreciate its limitations can lead to unforeseen consequences. Further, there are uncertainties and inconsistencies in the manner in which imaging-based information is considered, communicated, and applied. There are opportunities to alter practice to maximize comprehension of radiologic reports and thus optimize the manner in which imaging-based information is applied clinically.

    Manterola A, Asin G, Arias F, et al.
    Current Status of Radiotherapy for the Management of Regional Nodes in Breast Cancer.
    Clin Breast Cancer. 2016; 16(1):1-7 [PubMed] Related Publications
    Worldwide, breast cancer is the most common invasive cancer in women. Breast cancer constitutes about 23% of invasive cancers in women. The management of breast cancer depends on various factors, including the cancer stage and patient age. Breast cancer is usually treated with surgery, which can be followed by chemotherapy or radiation therapy, or both. Until recently, the standard procedure for axillary study was axillary dissection. Sentinel lymph node biopsy has been validated as a less-aggressive axillary treatment without an impact on survival. In the present report, we review the current management of the axillary lymph nodes, especially from the viewpoint of an oncology radiotherapist.

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