Rapid Access Palliative Radiotherapy Programmes.

One of the greatest successes of radiotherapy has been its ability to palliate symptoms from advanced and metastatic cancers. Unfortunately, patients face barriers to accessing care and the demand for treatment is rising. Rapid access palliative radiotherapy programmes were created in response to these concerns, and over time they have proliferated and succeeded internationally. This narrative review provides an overview of programmes that have published their experiences, and discusses how they have improved access to care, increased evidence-based practice, met the needs of vulnerable populations, advanced the roles of multidisciplinary team members, collaborated across medical specialties, educated trainees and referring physicians, and developed new treatment platforms using advanced technologies.

Negative religious coping as a correlate of suicidal ideation in patients with advanced cancer.

OBJECTIVE: The purpose of this study is to examine the relationship between negative religious coping (NRC) and suicidal ideation in patients with advanced cancer, controlling for demographic and disease characteristics and risk and protective factors for suicidal ideation. METHODS: Adult patients with advanced cancer (life expectancy ≤6 months) were recruited from seven medical centers in the northeastern and southwestern USA (n = 603). Trained raters verbally administered the examined measures to patients upon study entry. Multivariable logistic regression analyses regressed suicidal ideation on NRC controlling for significant demographic, disease, risk, and protective factors. RESULTS: Negative religious coping was associated with an increased risk for suicidal ideation (OR, 2.65 [95% CI, 1.22, 5.74], p = 0.01) after controlling for demographic and disease characteristics, mental and physical health, self-efficacy, secular coping, social support, spiritual care received, global religiousness and spirituality, and positive religious coping. CONCLUSIONS: Negative religious coping is a robust correlate of suicidal ideation. Assessment of NRC in patients with advanced cancer may identify patients experiencing spiritual distress and those at risk for suicidal ideation. Confirmation of these results in future studies would suggest the need for interventions targeting the reduction of NRC to reduce suicidal ideation among advanced cancer patients.

Treatment of oropharyngeal squamous cell carcinoma with IMRT: patterns of failure after concurrent chemoradiotherapy and sequential therapy.

BACKGROUND: The optimal management of oropharyngeal squamous cell carcinoma (OPSCC) is controversial. Modern radiotherapy typically employs intensity-modulated radiation therapy (IMRT), and herein, we report the Dana-Farber Cancer Institute (DFCI) experience with IMRT-based treatment of OPSCC. DESIGN: Retrospective study of all patients treated at DFCI for OPSCC with definitive or adjuvant IMRT between 8/04 and 8/09. The primary end point was overall survival (OS); secondary end points were locoregional control (LRC) and freedom from distant metastases (FFDM). Propensity score matching was used to create concurrent chemoradiotherapy (CCRT) and sequential therapy (ST) cohorts equally balanced for patient and disease characteristics. RESULTS: One hundred and sixty-three patients were included with 75% presenting with stage IV disease. Fifty-six patients (34%) were treated with ST. The three-year actuarial OS, LRC, and FFDM rates for the entire cohort/ST subset were 86%/89%, 86%/87%, and 88%/93%, respectively. There were no differences in OS, LRC, or FFDM between CCRT and ST in the propensity-matched cohort. CONCLUSIONS: IMRT was associated with excellent OS, LRC, and FFDM. Although the results following ST were superb, there was no obvious benefit to ST after adjustment for selection bias. We recommend that ST be reserved for medically fit patients with a high risk of distant metastases.

SU-E-T-401: Evaluation of Initial Setup Accuracy and Intra-Fraction Motion for Spine SBRT Using Stereotactic Body Frames.

PURPOSE: Quantify initial setup accuracy and intra-fraction motion using stereotactic body frames (SBF) for spine SBRT. METHODS: 10 patients (11 sites, 31 fractions) treated with spine SBRT using SBF immobilization were evaluated for initial setup accuracy and intra-fraction motion. Either the commercial Elekta SBF or an in-house developed SBF (BHS-SBF) were used. The BHS-SBF uses the same setup/immobilization principle as the Elekta but with increased interior space and couch indexing. Both frames include sidewalls to conform the vac-loc rigidly to the patient's sides. All patients were setup using the Brainlab ExacTrac system which includes IR and stereoscopic kV x-ray based positioning. Patients were initially positioned in the frame using skin tattoos then shifted to treatment isocenter based on IR markers affixed to the frame with known geometry relative to isocenter. kV imaging was acquired and automatic 6-D bony fusion performed. Resulting translations and rotations give the initial setup accuracy. Calculated shifts and rotations were performed using a robotic couch and verification imaging acquired. The imaging/fusion process was repeated multiple times during treatment providing intra-fraction motion data. RESULTS: Mean initial setup error in the VRT, LNG and LAT directions was 0.1+/-3.0 mm (0.1+/-0.6 deg), 0.5+/-5.2 mm (0.1+/-1.1 deg) and -0.3+/- 3.7 mm (0.4+/-0.8 deg) respectively. Mean 3-D error magnitude was 6.6 mm with a 95% certainty of 11.2 mm. Mean intra-fraction shifts observed in the VRT, LNG and LAT directions were -0.1+/-0.4 mm, -0.1+/-0.4 mm and 0.1+/-0.3 mm respectively. Mean 3-D intra-fraction shift magnitude was 0.6 mm with a 95% certainty of 1.4 mm. No significant difference was observed between the SBFs. CONCLUSIONS: Patient positioning is not sufficiently reproducible with the evaluated SBF to allow non-image guided treatment. However, provided image guidance is used for patient positioning, these frames provide excellent immobilization which is on par with mask based cranial radiosurgery.