Comparison of Physician-recorded Toxicities and Patient-reported Outcomes of Five Different Radiotherapy Methods for Prostate Cancer.

BACKGROUND/AIM: To compare five radiotherapy methods for prostate cancer. PATIENTS AND METHODS: During 2005-2018, the data of patients with non-metastatic prostate cancer were retrospectively analysed. Patients were treated with high-dose-rate brachytherapy (HDR-BT); low-dose-rate brachytherapy (LDR-BT); or external-beam radiotherapy (EBRT), including conventionally fractionated radiotherapy (CFRT), moderate-hypofractionated radiotherapy (MHRT), and ultra-hypofractionated radiotherapy (UHRT). RESULTS: In total, 496 patients (149, HDR-BT; 100, LDR-BT; 100, CFRT; 97, MHRT, and 50, UHRT) with a median follow-up of 4.3 years were enrolled. The incidence of grade ≥2 acute genitourinary toxicities was significantly lower with HDR-BT (p<0.001) than with any other radiotherapy. The cumulative incidence of late grade ≥2 genitourinary toxicities was the highest with UHRT and significantly higher (p=0.005) with UHRT than with HDR-BT. Higher symptom score peaks were noted 4 weeks after therapy for LDR-BT than for EBRT. CONCLUSION: Physician-recorded toxicities were slightly lower with HDR-BT and patient-reported outcomes tended to be worse with LDR-BT.

Does Travel Time to a Radiation Facility Impact Patient Decision-Making Regarding Treatment for Prostate Cancer? A Study of the New Hampshire State Cancer Registry.

PURPOSE: We sought to determine whether further distance from a radiation center is associated with lower utilization of external beam radiation therapy (XRT). METHODS: We retrospectively identified patients with a new diagnosis of localized prostate cancer (CaP) within the New Hampshire State Cancer Registry from 2004 to 2011. Patients were categorized by age, D'Amico risk category, year of treatment, marital status, season of diagnosis, urban/rural residence, and driving time to the nearest radiation facility. Treatment decisions were stratified into those requiring multiple trips (XRT) or a single trip (surgery or brachytherapy). Multivariable regression analysis was performed. RESULTS: A total of 4,731 patients underwent treatment for newly diagnosed CaP during the study period, including 1,575 multitrip (XRT) and 3,156 single-trip treatments. Of these, 87.6% lived within a 30-minute drive to a radiation facility. In multivariable analysis, time to the nearest radiation facility was not associated with treatment decisions (P = .26). However, higher risk category, older age, married status, and winter diagnosis were associated with XRT (P < .05). More recent year of diagnosis and urban residence were associated with single-trip therapy (primarily surgery) (P < .05). There was a significant interaction between travel time and season of diagnosis (P = .03), as well as a marginally significant interaction with urban/rural status (P = .07). CONCLUSION: Overall, further travel time to a radiation facility was not associated with lower utilization of XRT. These data are encouraging regarding access to care for CaP in New Hampshire.

Accelerated hypofractionated radiation therapy (AHRT) for non-small-cell lung cancer: can we leave standard fractionation?

Purpose. To report interim results from a single-institution study conducted to assess accelerated hypofractionated radiotherapy (AHRT) delivered with 3D conformal radiotherapy in two groups of patients with non-small cell lung cancer: (1) patients with early stage disease unable to tolerate surgery and ineligible for stereotactic body radiation therapy, and (2) patients with locally advanced disease unsuitable for concurrent chemoradiotherapy. Methods/patients. A total of 83 patients (51 stage I-II, 32 stage III) were included. Radiotherapy targets included the primary tumor and positive mediastinal areas identified on the pre-treatment PET-CT. Mean age was 77.8 ± 7.8 years. ECOG performance status (PS) was ≥2 in 50.6 % of cases. Radiotherapy was delivered in daily fractions of 2.75 Gy to a total dose of 66 Gy (BED10 84 Gy). Acute and late toxicities were evaluated according to NCI CTC criteria. Results. At a median follow-up of 42 months, median overall survival (OS) and cause-specific survival (CSS) were 23 and 36 months, respectively. On the multivariate analysis, PS [HR 4.14, p = 0.0001)], stage [HR 2.51, p = 0.005)], and maximum standardized uptake values (SUVmax) [HR 1.04, p = 0.04)] were independent risk factors for OS. PS [HR 5.2, p = 0.0001)] and stage [HR 6.3, p = 0.0001)] were also associated with CSS. No cases of severe acute or late treatment-related toxicities were observed. Conclusions. OS and CSS rates in patients treated with AHRT for stage I-II and stage III NSCLC were good. Treatment was well tolerated with no grade three or higher treatment-related toxicity. PS, stage, and SUV max were predictive for OS and CSS (AU)

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Medical Devices; Radiology Devices; Classification of the Rectal Balloon for Prostate Immobilization. Final order.

The Food and Drug Administration (FDA or we) is classifying the rectal balloon for prostate immobilization into class II (special controls). The special controls that apply to the device type are identified in this order and will be part of the codified language for the rectal balloon for prostate immobilization's classification. We are taking this action because we have determined that classifying the device into class II (special controls) will provide a reasonable assurance of safety and effectiveness of the device. We believe this action will also enhance patients' access to beneficial innovative devices, in part by reducing regulatory burdens.

El curioso efecto abscopal / The strange abscopal effect

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An ontology design for visualizing implicit knowledge of the radiotherapy risk.

Knowledge sharing of radiotherapy risk contributes to keep the safety practice between the oncologists, medical physicists, and therapists. But the mechanisms of risks tend to complex because of its diversities. Recently, an ontological analysis is tried to share knowledge in the various domains. Therefore, the aim of this study is to construct Radiotherapy Risk Ontology (RRO) and clarify the implicit structures of risks towards knowledge sharing. The method of this study is below. First, the classes and relations were extracted from the risk categorization of the publications. Second, these classes and relationships were connecting and mapping by the ontology editor. Third, the total relationships of classes were verified using paired comparison chart. This paper distinguishes between publication-oriented relationships and the other relationships. And these relationships was defined the explicit and implicit relationships. RRO was constructed 789 classes and 14 types of the explicit relationships. The 22 types of the implicit relationships were clarified using paired comparison. RRO provided the conceptual mapping and the implicit knowledge. The result of this study assisted the knowledge sharing.

Comparisons of 5-aminolevulinic acid photodynamic therapy and after-loading radiotherapy in vivo in cervical cancer

OBJECTIVE: To compare the differences between 5-aminolevulinic acid photodynamic therapy (5-ALA-PDT) with traditional after-loading radiotherapy in aspects of efficacies and side effects. MATERIALS AND METHODS: MTT assay was adopted to detect the inhibitive effects of 5-ALA-PDT on Hela cells proliferation. Flow cytometry was used to analyze cell apoptosis. After establishment of human cervical cancer xenograft model, the comparisons between 5-ALA-PDT with radiotherapy were performed with respect to treatment efficacies (survival rate, body weight, and tumor volume) and side effects (appearance and behavior, ovarian endocrine functions, and skin lesion around the tumor). RESULTS: 5-Aminolevulinic acid photodynamic therapy exerted killing effects on cervical cancer cells. Morphological changes and flow cytometric analyses indicated apoptosis to be one of the mechanisms for tumor growth suppression. Both proliferation inhibition and cell apoptosis showed dependency on photosensitizer concentration and irradiation intensity. Repeated photodynamic therapy presented stronger inhibitive effects on tumor growth compared to after-loading radiotherapy, while producing milder impairment of ovarian endocrine functions and skin lesions around the tumors. CONCLUSIONS: 5-Aminolevulinic acid photodynamic therapy has great potential to be an alternative treatment modality for cervical cancer (AU)

Náuseas, vómitos, diarrea, estreñimiento e hiporexia en la alimentación del niño con cáncer / Nausea, vomiting, diarrhea, constipation and decreased appetite in feeding the child with cancer

Entre las manifestaciones digestivas que se presentan en el tratamiento del niño con cáncer, bien sea por la quimioterapia, la radioterapia, los medicamentos subyacentes a estas terapias o a la misma enfermedad per sé, se encuentran las náuseas, los vómitos, la diarrea, el estreñimiento y la disminución del apetito. Todos ellos, junto con la pérdida de la actividad física y los cambios en los hábitos alimentarios, pueden conllevar a malnutrición. Es necesario así entonces realizar algunas sugerencias preventivas nutricionales y de puericultura, para evitar la morbilidad secundaria a ello.

Among the digestive symptoms that occur in the treatment of children with cancer, either gy chemotherapy, radiotherapy, drug therapy or underlying these the same disease per se, include nausea, vomiting, diarrea, constipation and the decline and loss of appetite. They, along with the loss of physycal activit and changes in eating habits, can lead to malnutrition. Need and then make some suggestions preventive nutrition and childcare, to avoid the morbidity secondary to it.

[Side effects evaluation of ionizing radiation]. / Evaluation des effets secondaires des radiations ionisantes.

Ionizing radiation is frequently used for cancers with a curative intent for many patients. The total dose delivered on the tumour plays a major factor for locoregional control. Increasing the dose to the tumour volume is generally correlated with an increased dose to normal tissue. Dose constraints to organs at risk must be taken into account for the planning of external beam radiation. A high dose will generate more acute and late side effects. Medical doctors should record these toxicities prospectively. Registration and grading should be simple, reproducible and sensitive in order to obtain an accurate and appropriate evaluation for each organ. Several scales have been published in the literature (WHO, EORTC/RTOG, LENT-SOMA, NCI CTCAE) but none have a satisfactory level. The National Cancer Institute has proposed several version of the CTCAE and its latest version 4.0, currently appears to be the most adapted. The advantage of using only this common and universal classification will be to harmonize practices and have a common language.

Comparison of electron IMRT to helical photon IMRT and conventional photon irradiation for treatment of breast and chest wall tumours.

BACKGROUND AND PURPOSE: Conventional irradiation of breast and chest wall tumours may cause high doses in underlying organs. Intensity-modulated radiation therapy (IMRT) with photons achieves high conformity between treated and tumour volume but is associated with considerable low-dose effects which may induce secondary malignancies. We compare treatment plans of electron IMRT to helical photon IMRT and conventional irradiation. MATERIAL AND METHODS: Treatment planning for three patients (breast, chest wall plus lymph nodes, sarcoma of medial chest wall/sternum) was performed using XiO 4.3.3 (CMS) for conventional photon irradiation, Hi-Art 2.2.2.05 (TomoTherapy) for helical photon IMRT, and a self-designed programme for electron IMRT. RESULTS: The techniques resulted in similar mean and maximum target doses. Target coverage by the 95%-isodose was best with tomotherapy. Mean ipsilateral lung doses were similar with all techniques. Electron IMRT achieved best sparing of heart, and contralateral breast. Compared with photon IMRT, electron IMRT allowed better sparing of contralateral lung and total healthy tissue. CONCLUSIONS: Electron IMRT is superior to conventional irradiation, as it allows satisfying target coverage and avoids high doses in underlying organs. Its advantage over photon IMRT is better sparing of most organs at risk (low-dose effects) which reduces the risk of radiation-induced malignancies.

Quality of radiosurgery for single brain metastases with respect to treatment technology: a matched-pair analysis.

OBJECTIVE: A comparison of treatment parameters and quality of clinical outcome in patients with single brain metastases treated with two different technologies for radiosurgery (Gamma Knife and CyberKnife). METHODS: Treatment parameters were statistically analyzed. Clinical outcome was assessed by matched-pair analysis based on the treatment device, differences in dose prescription, and the date of the treatment. Patients were matched according to their tumor size, age, gender, primary cancer, and Radiation Therapy Oncology Group score. Survival post-radiosurgery, local and distant tumor control, and complications were analyzed. Predictive factors were investigated. RESULTS: 423 single brain metastases were treated with Gamma Knife and 73 with CyberKnife. Tumor volumes were similar. The parameters minimum tumor dose, maximum tumor dose, prescription isodose volume, conformality index, homogeneity index, volume of tissue receiving a dose of 10 Gy or more were significantly larger in Gamma Knife group. Sixty-three patients were good matches. These showed the same pattern in parameters. Concerning the outcome analysis, only overall survival differed significantly between groups, twice as long with CyberKnife (P < 0.03). According to pooled data, dose was predictive of local failure, whole brain radiation therapy and chemotherapy were predictive of toxicity, the Radiation Therapy Oncology Group score was predictive of survival after radiosurgery, and date of treatment was predictive of overall survival. No factor predicted new brain metastases, including whole brain radiation therapy. CONCLUSIONS: The most important result of this study was the finding that the obvious differences in treatment-related parameters between Gamma Knife and CyberKnife had no impact on the quality of the clinical outcome after radiosurgery. Survival time increased chronologically, presumably due to an intensified anti-cancer therapy in the more recent era of the CyberKnife treatments.

Postal dose audits for radiotherapy centers in Latin America and the Caribbean: trends in 1969-2003

Since 1969 the International Atomic Energy Agency and the World Health Organisation (along with the Pan American Health Organization, working with countries in Latin America and the Caribbean) have operated postal dosimetry audits based on thermoluminescent dosimetry (TLD) for radiotherapy centres. The purpose of these audits is to provide and independent dosimetry check of radiation beams used to treat cancer patients. The success of radiotherapy treatment depends on accurate dosimetry. Over the period of 1969 through 2003 the calibration of approximately 5200 photon beams in over 1300 radiotherapy centres in 115 countries worldwide was checked. Of these audits, 36 percent were performed in Latin America and the Caribbean, with results improving grealtly over the years. Unfortunately, in several instances large TLD deviations have confirmed clinical observations of inadequate dosimetry practices in hospitals in various parts of the world or even accidents in radiotherapy, such as the one that occurred in Costa Rica in 1996. Hospitals or centres that operate radiotherapy services without qualified medical physicists or without dosimetry equipment have poorer results than do hospitals or centres that are properly staffed and equipped. When centres have poor TLD results, a follow-up program can help them improve their dosimetry status. However, to achieve audit results that are comparable to those for centers in industrialized countries, additional strengthening of the radiotherapy infrastructure in Latin America and the Caribbean is needed (AU)

Role of radiotherapy in the treatment of gliomas.

Malignant gliomas are challenging tumors that are often treated with a multimodality approach. This article focuses on the role of radiotherapy in the management of these tumors. The role of radiotherapy in low-grade gliomas remains controversial and this review focuses on the importance of prognostic factors, recent randomized trials involving radiotherapy, and toxicity from radiotherapy. In terms of high-grade gliomas, radiotherapy has a more established role and this review will address methods that have been evaluated in order to improve radiotherapy outcome. Improvements in radiotherapy delivery, tumor imaging and biologic modifiers may ultimately lead to improved outcome in the treatment of these difficult tumors.

Planning for a dedicated coder.

Although there are a number of complaints about the complexity of coding rules and regulations, physicians and facilities are still responsible for knowing the guide- lines-or employing someone who does. Also, the practice needs to establish processes to monitor compliance with payor guidelines. The good news is that physicians have an opportunity to improve their income through appropriate coding. According to MD Compliance Alert, April 15, 2002: "In fact, improper coding is the number one most visible and correctable problem in any given practice. Corrected, it can have the simplest, biggest, and quickest impact on most doctors' income".

IMRT bundling myths.

Payment for IMRT planning bundles, or includes, many services represented by other procedure codes when performed on the same date. As a result, radiation therapy providers must maintain an awareness of bundling edits and coding guidelines to ensure complete and accurate reimbursement for this advanced technology.

[Classification of early and late radiation reactions and injuries]. / Klasyfikatsiia rannikh i piznikh promenevnykh reaktsii ta uskladnen'.

Radiation tolerance of normal tissues remains the limiting factor for delivering crucial tumoridical dose. The late toxicity of normal tissues is the most element of an irradiation: somatic, functional and structural alterations occur during the actual treatment itself, but late effects manifest months to years after acute effects heal, and may progress with time. The optimal therapeutic ratio ultimately requires not only complete tumor clearance, but also minimal residual injury to surrounding vital normal tissues. The disparity between the intensity of acute and late effects and the inability to predict the eventual manifestations of late normal tissue injury has made radiation oncologists recognize the importance of careful patient follow-up. There is so far no uniform toxicity scoring system to compare several clinical studies in the absence of a "common toxicity language". This justifies the need to establish a precise evaluation system for the analysis of late effects of radiation on normal tissues. The current proposed scales are not yet validated, and should be used cautiously. The present toxicity scale for acute and late radiation complications is not complete. It bases on analyses and additions of existent system as CTC (Common Toxicity Criteria) and SOMALENT by EORTC/RTOG. Current classification can be used for quantitative definition of complications' grade and for treatment planning.