Abstract Lung stereotactic ablative radiotherapy (SABR) is a method of delivering high ‘ablative’ doses of radiotherapy to tumours in the lung. It was developed at the Karolinska Institute in the ...early 1990s using the methods established in cranial radiosurgery with multiple beams prescribed to an isodose and using a custom designed stereotactic body frame for immobilisation. Since then, aligned with the advances in radiotherapy technology and techniques (e.g. four-dimensional computed tomography simulation and image-guided radiotherapy), there has been a rapid increase in the use of lung SABR for both early stage lung cancer and lung metastases. For peripheral primary lung cancers less than 5 cm in diameter, high rates of local control and low levels of acute and late toxicity are consistently reported in the published literature. Compared with historical control rates of stage I lung cancers treated with conventionally fractionated radiotherapy, SABR seems to offer higher rates of local control, lower levels of acute toxicity and a better quality of life after treatment. However, the full results of randomised controlled trials of SABR versus conventionally fractionated are awaited and will provide higher-level evidence. For central lung tumours, very high SABR doses can be associated with significant toxicity. Dose-adapted fractionation schedules seem to have much lower rates of toxicity and prospective trials, including the completed RTOG 0813 study and the on-going EORTC LUNGTEC study, should provide further evidence of safety and establish organ at risk tolerances. SABR can also be used for tumours metastatic to the lung with high rates of local control and is a reasonable alternative to surgery in selected patients. Going forward, prospective trials are underway to establish the safety and efficacy of SABR in oligometastatic disease. Population-based outcomes will be crucial in supporting/establishing SABR as the treatment of choice in medically inoperable patients with peripheral stage I lung cancers. Randomised phase III trials will hopefully extend the evidence base and show the safety and the utility of SABR in early central tumours and oligometastatic disease.
A systematic review of the literature evaluating the clinical use of respiratory-gated (four-dimensional; 4D) fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) ...compared with non-gated (three-dimensional; 3D) PET/CT for radiotherapy planning in lung cancer.
A search of MEDLINE, Cochrane, Web of Science, SCOPUS and clinicaltrials.gov databases was undertaken for articles comparing 3D and 4D PET/CT tumour volume or 4D PET/CT for radiotherapy planning. PRISMA guidelines were followed.
Thirteen studies compared tumour volumes at 3D and 4D PET/CT; eight reported significantly smaller volumes (6.9–44.5%), three reported significantly larger volumes at 4D PET/CT (16–50%), one reported no significant difference and one reported mixed findings. Six studies, including two that reported differences in tumour volumes, compared target volumes or studied geographic misses. 4D PET/CT target volumes were significantly larger (19–40%) when compared with 3D PET/CT in all but one study, where they were smaller (3.8%). One study reported no significance in 4D PET/CT target volumes when compared with 4D CT, whereas another study reported significantly larger volumes (38.7%).
The use of 4D PET/CT leads to differences in target volume delineation compared with 3D PET/CT. These differences vary depending upon technique and the clinical impact currently remains uncertain. Correlation of pretreatment target volumes generated at 3D and 4D PET/CT with postsurgical histology would be ideal but technically challenging. Evaluation of patient outcomes based on 3D versus 4D PET/CT derived treatment volumes warrants further investigation.
Engaging with patients when designing a clinical or research project is beneficial; feedback from the intended audience provides invaluable insight form the patients’ perspective. Working with ...patients can result in developing successful research grants and interventions. The benefit of including the voice of the patient in the Yorkshire Cancer Research funded PREHABS study is described in this article.
Patients were included in the PREHABS study from inception to completion. The Theory of Change methodology was used to provide a framework to implement patient feedback to refine the study intervention.
In total, 69 patients engaged with the PREHABS project. Two patients were recruited as co-applicants on the grant and were members on the Trial Management Group. Six patients attended the pre application workshop and provided feedback on their lived experiences of being a lung cancer patient. Commentary from the patients influenced the interventions selected and the design of the prehabs study.
Following ethical approval (21/EE/0048) and informed written consent, 61 patients were recruited into the PREHABS study between October 2021 and November 2022. The breakdown of recruited patients was 19 males: mean age 69.1 years (SD 8.91) and 41 females; mean age 74.9 years (SD 8.9).
It is practicable and beneficial to include patients at all stages of designing and delivering a research study. Patient feedback can help refine the study interventions to allow for maximum acceptance, recruitment and retention.
Including patients in the design of radiotherapy research studies can provide invaluable insight that can support the selection and delivery of interventions that are acceptable to the patient cohort.
Therapy dogs have commonly been used to relieve a number of different types of stress in people ranging from PTSD to the more simple stresses of daily life. On a university campus, two of the most ...stressful times for a student are during midterm and final examinations. Here, an abstract of an article by Anderson et al on quantifying the effectiveness of therapy dogs to relieve stress and/or anxiety during major exam time periods is presented.
So far, the impact of intra-thoracic anatomical changes (ITACs) on patients treated with stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer is unknown. Studying ...these is important, as ITACs have the potential to impact the workflow and reduce treatment quality. The aim of this study was to assess and categorise ITACs, as detected on cone beam computed tomography scans (CBCT), and their subsequent impact upon treatment in lung cancer patients treated with SABR.
CBCTs from 100 patients treated with SABR for early non-small cell lung cancer were retrospectively reviewed. The presence of the following ITACs was assessed: atelectasis, infiltrative change, pleural effusion, baseline shift and gross tumour volume (GTV) increase and decrease. ITACs were graded using a traffic light protocol. This was adapted from a tool previously developed to assesses potential target undercoverage or organ at risk overdose. The frequency of physics or clinician review was noted. A linear mixed effects model was used to assess the relationship between ITAC grade and set-up time (time from first CBCT to beam delivery).
ITACs were observed in 22% of patients. Twenty-one per cent of these were categorised as ‘red’, implying a risk of underdosage to the GTV. Most were ‘yellow’ (51%), indicating little impact upon planning target volume coverage of the GTV. Physics or clinician review was required in 10% of all treatment fractions overall. Three patients needed their treatment replanned. The mixed effect model analysis showed that ITACs cause a significant prolongation of set-up time (Χ2(3) = 9.22, P = 0.02).
Most ITACs were minor, but associated with unplanned physics or clinician review, representing a potentially significant resource burden. ITACs also had a significant impact upon set-up time, with consequences for the wider workflow and intra-fraction motion. Detailed guidance on the management of ITACs is needed to provide support for therapeutic radiographers delivering lung SABR.
•ITACs occur not infrequently during the delivery of stereotactic ablative radiotherapy for lung cancer.•The development of ITACs represents a resource burden due to the unscheduled clinician and physics involvement.•Intra-thoracic anatomical changes have the potential to prolong treatment set-up time.
The purpose of this qualitative study is to explore the experiences of college dance majors in Texas who have a background in studio dance, competitive dance, or drill team as they navigate the ...culture of dance in postsecondary education. At this stage in the research, the experience of college dance majors will be generally defined as the benefits and challenges they face, the positive and negative impacts of these challenges and benefits, and the interpretations they have of their existence within the culture of dance in postsecondary education, as well as how they define that culture of dance. Findings from this study show dance majors from this participant pool who had consistently challenging experiences regarding their own integration into postsecondary programs. The conclusion of this study provides a recommendation for postsecondary dance programs to consider curriculum revision to better suit the needs of a significant demographic within their student populations.
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