Comparison of survival and prognostic factors in patients treated with stereotactic body radiotherapy for oligometastases or oligoprogression.

BACKGROUND AND PURPOSE: Clinical challenges arise in the oligoprogressive (OP) state with little evidence to support the use of ablative strategies. Our aim is to report on outcomes and prognostic variables following stereotactic body radiotherapy (SBRT) for OP and oligometastases (OM). MATERIAL AND METHODS: Overall (OS) and progression-free survivals (PFS) were calculated for 163 patients for 209 lesions (106 OM and 57 OP) treated with SBRT over 9 years. OS and PFS comparisons were calculated using the Kaplan-Meier actuarial survival and log rank methods. Uni, multi-variate analyses and cumulative incidences of local failure were performed using the Cox modelling and Gray's test respectively. RESULTS: The median OS and PFS was 37 and 15 months versus 21.7 and 6.4 months in the OM and OP groups respectively (P = 0.02 and P = 0.01). Performance status (⩾2 HR 2.95) and number of metastases (1/2 vs ⩾3 HR 1.88) were independent prognosticators for survival. The 1/2-year PFS were 55%/25% versus 22%/6% in the OM and OP cohorts. Patterns of first relapse were four times higher outside the irradiated field and OP status (p = 0.03), ⩾3 metastasis (p = 0.002) and concurrent systemic therapy (p = 0.001) conferred a greater risk. Time to second-line treatment was 20 vs 11 months in the OM and OP groups (P = 0.001). CONCLUSION: Survival and distant relapse following SBRT to OM/OP is determined by the extent of metastatic disease and performance status. Future research should address the benefit of integrating SBRT with systemic therapies to allow deferral or continuation of therapeutic agents.

Creation of an educational quality improvement program for radiation oncology residents.

PURPOSE: Quality improvement (QI) is a pillar of good clinical governance and is at the center of modern health care. The Royal College of Physicians and Surgeons of Canada mandated, in CanMeds 2015, that QI should be taught and the competencies assessed in all postgraduate residency programs. The objective is to report on the feasibility and impact of teaching QI to radiation oncology residents at a single institution. METHODS AND MATERIALS: A QI team consisting of a clinical fellow, 3 staff physicians, and an expert in QI methods was created within our Department of Radiation Oncology. QI teaching took place in a longitudinal manner, with approximately 12 hours of direct faculty teaching. A mandatory curriculum divided into foundation and intermediate and advanced competencies was devised. Phase 1 teaching, delivered during 2 academic half-days, consisted of didactic lectures, practical workshops, and self-directed online modules. Phase 2 required intermediate-year residents to complete a 9-month QI project. A QI day hosted by the department invited QI experts to teach and enabled residents to present their work, with merit prizes awarded. Our program evaluation used validated assessment tools (self-assessment, QI knowledge-based assessments, and balanced score cards) before and after curriculum implementation and answers quantified using satisfaction indices (SI). RESULTS: Subjective and objective assessments demonstrated improvements in residents' QI knowledge acquisition following curriculum implementation. Those who had completed a project (n = 4) had greater confidence with QI methodology compared with those who had completed phase 1 alone (n = 2) (mean SI, 53% precurriculum to 66.5% and 90%). The majority lacked previous QI teaching and knowledge, but learner attitudes improved (SI, 50%-70%) and 91% of colleagues were enthusiastic about the program being implemented. CONCLUSION: We have demonstrated that implementation of a QI curriculum for radiation oncology residents is feasible and that early results suggesting improvements of attitude and knowledge are positive. We anticipate that the QI skills gained will enable the residents to elevate the quality of their practice throughout their subsequent careers.

Persistent unilateral facial pain in lung cancer patients with mediastinal nodal involvement.

Persistent idiopathic facial pain associated with mediastinal involvement in non-small cell lung cancer (NSCLC) may occur at presentation or at relapse. It is often under-recognised, leading to prolonged symptoms, distress and sometimes inappropriate interventions. We present three case histories and a review of the published literature to highlight this important symptom.