Dosimetric analysis of patients receiving volumetric-modulated arc palliative radiotherapy to the thoracic spine: A comparison with conventional mono-isocentric parallel opposed pair treatment.

PURPOSE: Volumetric modulated arc therapy (VMAT) has allowed for dose escalation and a decrease in radiation-induced toxicities for a variety of treatment sites, including spinal metastases. This article will compare the dosimetric impacts on normal lung tissue in patients treated with both VMAT and conventional treatment to the thoracic spine and determine if any significant difference exists among patient reported Edmonton Symptom Assessment System (ESAS) scores. METHODS: This retrospective quality assurance study identified 288 patients who received palliative radiotherapy to the thoracic spine using VMAT or conventional planning techniques with various palliative dose fractionation schemes. V5 lung dose levels, treated planning target volume (PTV) cord length, patient-reported ESAS scores at the time of radiation oncology consultation, 3 months' post-treatment, and 6 months' post-treatment were analyzed. All symptoms on the ESAS survey were investigated, but shortness of breath (SOB) scores were the main focus of this study. Date of death for each patient was also included for analysis. RESULTS: Patients treated with a VMAT technique had significantly higher V5 lung dose levels compared to those treated conventionally (right lung: p = 1.67e-14; left lung: p = 1.33e-6). Despite this, no significant differences were observed for SOB scores at all time points between groups and conventionally treated patients reported significantly worse pain, tiredness, depression, and wellbeing scores. A moderate correlation was observed between PTV length and nausea, SOB, appetite, and drowsiness scores in the VMAT group. Treatment technique was not found to have a significant impact on patient lifespan. CONCLUSIONS: Despite higher V5 lung dose levels associated with a VMAT technique, no significant differences were found in patient-reported ESAS scores compared to patients treated with conventional techniques. This demonstrates that palliation of thoracic spinal metastases is feasible and safe using a VMAT technique.

RTT advanced practice and how it can change the future of radiotherapy.

The radiation therapy (RT) landscape is continuously evolving, necessitating adaptation in roles and responsibilities of radiation therapists (RTTs). Advanced Practice Radiation Therapists (APRTs) have taken on a proactive role in expanding services and assuming responsibilities within multi-professional teams. A European Society for Radiotherapy and Oncology (ESTRO) brought geographically diverse and experienced RTTs together, to discuss how advanced practice (AP) in the RTT profession should be future-proofed and create a global platform for collaboration. Challenges in achieving consensus and standardisation of APRT was identified across jurisdictions, emphasising the importance of international collaboration. Whilst highlighting the pivotal role of APRTs in driving innovation, improving patient care, and navigating the complexities of modern RT practice, this position paper presents outcomes and recommendations from the workshop. Discussions highlighted the need for standardised role definitions, education frameworks, regulatory support, and career development pathways to enable the advancement of APRT effectively. Increasing networks and collaboration is recommended to ensure APRTs can shape the future of RT.

The palliative clinical specialist radiation therapist: A CAMRT White Paper.

Palliative radiation therapy (pRT) is an effective tool for people with incurable cancer, in the treatment of many cancer-related symptoms such as pain, bleeding and dyspnea. As utilization rates for palliative radiation therapy increase, the demands on the healthcare system continue to grow. Radiation Therapists with advanced knowledge, skills and judgements began demonstrating their ability to practice autonomously in 2004, with the development of the Clinical Specialist Radiation Therapist (CSRT) role. Since this time, CSRTs with a specific focus in pRT (pCSRT) have been increasing in both numbers as well as their positive effects on the cancer care system. Integrating a pCSRT into the existing pRT system has resulted in increased access to and quality of pRT being delivered to palliative cancer patients. The benefits of the addition of pCSRTs to the cancer care system include increasing system capacity and increasing quality of care. This white paper provides information related to the improvements that can be realized in a RT program related to the care and treatment of its palliative patients by adding a pCSRT to the interprofessional healthcare team and suggest it as one of many strategies that can be undertaken to make improvements to access and quality of care.

A Canadian experience of palliative advanced practice radiation therapy TIPS: Training, implementation, practice and sustainability.

The concept of the Advanced Practice Radiation Therapist (APRT) was created in 2004, in response to pressures on the radiation treatment sector in Ontario. This led to development, piloting and integration of the Clinical Specialist Radiation Therapist (CSRT) into Ontario's cancer care framework. A national certification process, competency profile and protected title of APRT(T) were established in 2017, under the Canadian Association of Medical Radiation Technologists (CAMRT), in collaboration with Cancer Care Ontario/Ontario Health. This report describes the approach to development, validation and measuring impact of the CSRT role in Ontario, specifically in palliative care (pCSRT). It also presents information to assist jurisdictions interested in developing a pCSRT position, describing competency development, assessment, and assumption of practice, and providing some keys to success. This is foundational for consistent expansion of the pCSRT role to other regions to continue to increase system capacity while improving the quality of cancer care.

Collaborating with the Community: Improving Patient Access to Palliative Radiation Therapy.

PURPOSE: Palliative radiation therapy (PRT) has an essential role in cancer symptom control but is underutilized in Ontario. This initiative aimed to implement an educational outreach intervention to improve knowledge of and access to PRT among interprofessional palliative health care teams across an Ontario Local Health Integration Network. METHODS AND MATERIALS: A needs assessment was completed from June to September 2018 with interprofessional palliative health care teams. Participants completed a survey to identify perceived opportunities, barriers, and enablers to recommending or referring patients for PRT. Thematic analysis informed content of the educational outreach intervention and included how to access PRT, common indications, case studies, and side-effect management after completing PRT. The educational outreach intervention was completed from October 2018 to January 2019. Participants completed a survey, and results were analyzed using descriptive statistics. The number of patients who received PRT was determined by cross-referencing the regional database with the radiation oncology information system. RESULTS: Although 22.9% of participants had previously recommended or referred patients, 96.2% of participants agreed or strongly agreed that they are likely to recommend or refer patients for PRT after the educational outreach intervention (n = 131). An increase was observed in the number of patients receiving PRT from the community during the intervention period. CONCLUSIONS: The educational outreach intervention improved knowledge and the likelihood of interprofessional palliative health care teams providing access to PRT for patients in the community. More patients now receive PRT, conveying improved symptom control and quality of life.

Palliation of Vertebral Metastases with Radiotherapy: Exploration of Volumetric-Modulated Arc Therapy From Development to Implementation in Routine Clinical Practice.

The development of volumetric-modulated arc therapy (VMAT) in radiation therapy has allowed for improved dose escalation and a decrease in radiation-induced toxicities for patients. This article will describe a single centre's experience in development and implementation of VMAT for palliation of vertebral metastases. A retrospective planning analysis of 10 cases identified that utilization of VMAT decreases overall planning time with a statistically significant improvement in target coverage when compared with the current conventional technique. PTV Dmax (P = .02), PTV V9519Gy (95%) (P = .01), dose conformation (P = 1.8e-004), and the homogeneity index (P = .019) were all superior for VMAT plans with an average PTV length of 22.46 cm. Another benefit of VMAT utilization is a significant decrease in treatment delivery time, which reduced treatment times from 9.95 minutes to 2.98 minutes. Immobilization was also carefully considered, and rotational errors were measured and fell within institutional tolerances when VMAT was delivered using simple immobilization devices. Clinical implementation of this technique, utilizing a highly conformal target volume to decrease radiation-induced toxicities and minimizing the length of time patients are required to maintain their treatment positions, aims to improve the palliative radiotherapy experience for patients with painful spinal metastases.

Cancer patients acceptance, understanding, and willingness-to-pay for pharmacogenomic testing.

BACKGROUND: Pharmacogenomics is gaining increasing importance in the therapeutics of cancer; yet, there is little knowledge of cancer patients' attitudes toward the use of pharmacogenomic testing in clinical practice. We carried out this study to explore cancer patients' acceptance, understanding, and willingness-to-pay for pharmacogenomic testing. MATERIALS AND METHODS: A broad cross-section of gastrointestinal, lung, breast, and other cancer patients were interviewed in terms of their acceptance of pharmacogenomic testing using hypothetical time, efficacy, and toxicity trade-off and willingness-to-pay scenarios. RESULTS: Among the 96% of 123 adjuvant patients accepting chemotherapy under optimal conditions, 99% wanted pharmacogenomic testing that could identify a subset of patients benefiting from chemotherapy, accepting median incurred costs of $2000 (range $0-25,000) and turnaround time for test results of 16 days (range 0-90 days). Among the 97% of 121 metastatic patients accepting chemotherapy, 97.4% wanted pharmacogenomic testing that could detect the risk of severe toxicity, accepting median incurred costs of $1000 (range $0-10,000) and turnaround time for results of 14 days (range 1-90 days). The majority of patients wanted to be involved in decision-making on pharmacogenomic testing; however, one in five patients lacked a basic understanding of pharmacogenomic testing. CONCLUSION: Among cancer patients willing to undergo chemotherapy, almost all wanted pharmacogenomic testing and were willing-to-pay for it, waiting several weeks for results. Although patients had a strong desire to be involved in decision-making on pharmacogenomic testing, a considerable proportion lacked the necessary knowledge to make informed choices.