A retrospective evaluation of inter-fraction motion in prostate cancer patients with involved nodes receiving prostate and pelvic ± para-aortic nodal irradiation.

INTRODUCTION: The inter-fraction motion of pelvic ± para-aortic (PA) nodal volumes in prostate cancer patients with involved nodes is yet to be quantified and the optimal IGRT strategy for these patients is currently unknown. METHODS: A single-centre retrospective evaluation was performed investigating inter-fraction motion in the prostate and involved nodal volumes of patients receiving pelvic ± PA nodal irradiation. Patients were selected for inclusion if they; were undergoing prostate + pelvic node +/- PA node radiation for prostate cancer with involved lymph nodes and had received daily online CBCT scans. The planning CT and subsequent CBCT images from each treatment fraction were selected for analysis. RESULTS: Out of 567 CBCTs, from 20 patients, there were no incidences where independent lymph node displacement was >0.5 cm from planning volumes. Lymph node motion relative to prostate was >0.5 cm on 15 occasions out of 567 scans (2.6%). Where the difference between prostate and lymph nodes was >0.5 cm, this was always a result of the rectum causing variation in the prostate position, not a change in nodal position. DISCUSSION: These results suggests that there is limited independent displacement between the involved pelvic ± PA nodal volumes and bony anatomy. Therefore, bony anatomy could be used as a lymph node match surrogate for prostate patients receiving nodal irradiation for active disease. The results also suggest additional emphasis should be placed on bowel preparation in these patients to reduce the risk of geographical miss. CONCLUSION: In conclusion, the results of this evaluation suggests that there is limited independent displacement between the involved pelvic ± PA nodal volumes and bony anatomy. This provides evidence to trials investigating the role of pelvic ± PA nodal irradiation to ensure appropriate margins and IGRT strategies are used when investigating this further.

The management of sexual dysfunction resulting from radiotherapy and androgen deprivation therapy to treat prostate cancer: A comparison of uro-oncology practice according to disease stage.

OBJECTIVES: To establish current uro-oncology practice in the management of sexual dysfunction (SD) following radiotherapy (RT) and/or androgen deprivation therapy (ADT) to treat prostate cancer. To identify differences in approach to the management of SD according to disease stage. SUBJECTS AND METHODS: A 14-question mixed methods survey was designed to assess the current UK practice. Closed- and open-ended questions were used to quantify results while allowing participants to expand on answers. The survey was distributed to members of the British Uro-Oncology Group at the 2019 annual meeting. RESULTS: Surveys were completed by 63 uro-oncologists attending the annual meeting of the British Uro-Oncology Group (response rate 66%). The major issue highlighted was a difference in approach to managing SD according to disease stage. More than half of the participants (56%) said 'advanced stage of disease' was a barrier to discussing SD. Clinicians were less likely to discuss SD, take baseline assessments, refer to a specialist clinic or offer rehabilitation when dealing with patients with advanced disease. Only a minority said that the management of SD was primarily their responsibility (11%). Nearly all clinicians (92%) had access to SD clinics; however, the majority of clinicians did not routinely refer patients. CONCLUSIONS: This study shows that men with advanced prostate cancer need better support in managing SD. Patients receiving long-term ADT are less likely to be offered any kind of help or intervention. Specific guidance on managing SD in this cohort may result in improvements in sexual function, emotional well-being, quality of life, mental health and confidence.

A systematic approach for providing concrete services and discharge planning based on using information handouts.

While information handouts are commonly used in healthcare education, this paper is about social workers systematically developing and using them to provide timely, efficient, and ultimately better patient care for concrete services and discharge planning. How to identify topics and suggestions for composing user-friendly handouts are discussed. Many clinical uses for handouts are considered including: engaging, assessing, and empowering patients, groups, and families. Related uses are considered such as educating the treatment team and students. How handouts can be a crucial bridge to developing a comprehensive, focused social resource database is considered. Follow-up survey results with an inner city VA social work staff (N= 41) confirm that social work discharge planners and non-discharge planners find systematically developed handouts valuable for providing efficient, better patient care.