Presently, educational programming is not standardized across radiation oncology (RO) training programs. Specifically, there are limited materials through national organizations or structured ...practice exams for residents preparing for the American Board of Radiology (ABR) oral board examination. We present our 2019 experience implementing a formalized program of early mock oral board examinations (MOBE) for residents in post-graduate years (PGY) 3-5.
A mixed-methods survey regarding MOBE perception and self-reported comfort across five clinical domains were administered to PGY2-5 residents. MOBEs and a post-intervention survey were implemented for the PGY3-5. The pre and post-intervention score across clinical domains were compared using t-tests. Faculty and residents were asked for post-intervention comments.
A total of 14 PGY2-5 residents completed the pre-intervention survey; 9 residents participated in the MOBE (5/14 residents were PGY2s) and post-intervention survey. This was the first mock oral radiation oncology examination experience for 65% of residents. 100% of residents felt the MOBE increased their clinical knowledge and comfort with clinical reasoning. Overall, there was a trend towards improved resident confidence giving planning dose parameters and (p = 0.08). There was also unanimous request for more MOBE experiences from residents and faculty, but time was identified as a significant barrier.
Future directions for this MOBE program are inclusion of more disease sites, better emulation of the exam, the creation of a more rigorous consolidated format testing all sites at once, and consideration for grading of these sessions for future correlation with certifying oral board examination (OBE) performance.
An original work in this month’s issue of Clinical Lung Cancer highlights the role of physician bias in the decision to recommend prophylactic cranial irradiation (PCI) to patients with small-cell ...lung cancer, and presents a patient decision aid to facilitate discussion. After decades of clinical trials, we’ve learned that PCI can significantly decrease the risk of brain metastases and possibly improve survival. However, PCI is also associated with negative impacts on cognition and quality of life. At present, there is no consensus on how to balance these risks and benefits. Understanding and exploring these issues in a structured fashion offers an opportunity to return decision-making to patients, incorporating their values and priorities.
Taking "the Game" Out of The Match: A Simple Proposal Wu, Abraham J; Vapiwala, Neha; Chmura, Steven J ...
International journal of radiation oncology, biology, physics,
12/2015, Letnik:
93, Številka:
5
Journal Article
To determine the effect of biologically effective dose (BED
) and radiation treatment schedule on overall survival (OS) in patients with early-stage non-small cell lung cancer (NSCLC) undergoing ...stereotactic body radiation therapy (SBRT).
Using data from 65 treatment centers in the United States, we retrospectively reviewed the records of T1-2 N0 NSCLC patients undergoing SBRT alone from 2006 to 2014. Biologically relevant covariates, including dose per fraction, number of fractions, and time between fractions, were used to quantify BED
and radiation treatment schedule. The linear-quadratic equation was used to calculate BED
and to generate a dichotomous dose variable of <105 Gy versus ≥105 Gy BED
. The primary outcome was OS. We used the Kaplan-Meier method, the log-rank test, and Cox proportional hazards regression with propensity score matching to determine whether prescription BED
was associated with OS.
We identified 747 patients who met inclusion criteria. The median BED
was 132 Gy, and 59 (7.7%) had consecutive-day fractions. Median follow-up was 41 months, and 452 patients (60.5%) had died by the conclusion of the study. The 581 patients receiving ≥105 Gy BED
had a median survival of 28 months, whereas the 166 patients receiving <105 Gy BED
had a median survival of 22 months (log-rank, P=.01). Radiation treatment schedule was not a significant predictor of OS on univariable analysis. After adjusting for T stage, sex, tumor histology, and Eastern Cooperative Oncology Group performance status, BED
≥105 Gy versus <105 Gy remained significantly associated with improved OS (hazard ratio 0.78, 95% confidence interval 0.62-0.98, P=.03). Propensity score matching on imbalanced variables within high- and low-dose cohorts confirmed a survival benefit with higher prescription dose.
We found that dose escalation to 105 Gy BED
and beyond may improve survival in NSCLC patients treated with SBRT.
Stereotactic body radiation therapy (SBRT) has increasingly been used to treat early-stage primary lung cancers, but its effectiveness and safety in patients with multiple synchronous primary lung ...tumors is not as well established. Our aim was to evaluate clinical outcomes, patterns of recurrence, and toxicities for these patients.
We queried an institutional database of patients treated with SBRT for primary lung tumors from 2007 to 2019. Patients with known metastatic disease were excluded. Recurrences were described as new primaries (NP) if they occurred as an isolated pulmonary mass outside the previous planning target volume.
We analyzed 126 lesions from 60 consecutive patients who received SBRT synchronously to ≥2 lesions for nonmetastatic lung cancers. Median total dose per lesion was 50 Gy (range, 30-60 Gy) delivered over 3 to 5 fractions. All but 4 lesions were treated to a biologically effective dose ≥100 Gy. The median follow-up time was 47.3 months (interquartile range, 34.1-65.6). Median overall survival was 46.2 months. Two and 5-year overall survival for all patients was 70% and 48%, respectively. Median progression-free survival was 26 months (interquartile range, 7.6-32.6), and at the time of data collection 25 patients (42%) had experienced any disease progression. Median time to progression was 36 months: 9 (15%) patients experienced local failure, with 1- and 2-year local failure rates of 8% and 13%, respectively. Four patients (7%) experienced regional failure, at 3, 10, 30, and 50 months. Eleven patients (18%) experienced distant failure, with 2-year distant failure rate of 13%. Thirteen patients (21%) developed NPs, with 2-year NP rate of 15.1%. Fourteen patients (23%) experienced Common Terminology Criteria for Adverse Events grade ≥2 toxicity, and 2 patients (3%) experienced Common Terminology Criteria for Adverse Events grade ≥3 toxicity (pneumonitis and hemoptysis).
Synchronous SBRT to biologically effective dose ≥100 Gy appears safe and effective for selected patients with synchronous primary lung tumors.
Clinical decision-making for patients with stage I lung cancer is complex. It involves multiple options lobectomy, segmentectomy, wedge, stereotactic body radiotherapy (SBRT), thermal ablation, ...weighing multiple outcomes (e.g., short-, intermediate-, long-term) and multiple aspects of each (e.g., magnitude of a difference, the degree of confidence in the evidence, and the applicability to the patient and setting at hand). A structure is needed to summarize the relevant evidence for an individual patient and to identify which outcomes have the greatest impact on the decision-making.
A PubMed systematic review from 2000-2021 of outcomes after SBRT or thermal ablation
resection is the focus of this paper. Evidence was abstracted from randomized trials and non-randomized comparisons with at least some adjustment for confounders. The analysis involved careful assessment, including characteristics of patients, settings, residual confounding etc. to expose degrees of uncertainty and applicability to individual patients. Evidence is summarized that provides an at-a-glance overall impression as well as the ability to delve into layers of details of the patients, settings and treatments involved.
Short-term outcomes are meaningfully better after SBRT than resection. SBRT doesn't affect quality-of-life (QOL), on average pulmonary function is not altered, but a minority of patients may experience gradual late toxicity. Adjusted non-randomized comparisons demonstrate a clinically relevant detriment in long-term outcomes after SBRT
surgery. The short-term benefits of SBRT over surgery are accentuated with increasing age and compromised patients, but the long-term detriment remains. Ablation is associated with a higher rate of complications than SBRT, but there is little intermediate-term impact on quality-of-life or pulmonary function tests. Adjusted comparisons show a meaningful detriment in long-term outcomes after ablation
surgery; there is less difference between ablation and SBRT.
A systematic, comprehensive summary of evidence regarding Stereotactic Body Radiotherapy or thermal ablation
resection with attention to aspects of applicability, uncertainty and effect modifiers provides a foundation for a framework for individualized decision-making.
Radiation pneumonitis (RP) may be severe after stereotactic body radiation therapy. Our purpose was to identify pulmonary and cardiac dosimetric parameters that predicted for post-stereotactic body ...radiation therapy grade ≥2 RP.
A total of 335 patients with ≥3 months' follow-up were included. Normal pulmonary volume was total lungs minus gross tumor volume. Pulmonary maximum dose, mean lung dose (MLD), and the percent of lung receiving ≥x Gy for 5 to 50 Gy in 5-Gy increments were collected. Cardiac maximum dose, mean dose, volume of lung receiving ≥0.1 Gy (V0.1), V0.25 to V1, and V2.5 to V12.5 were recorded. Multivariable logistic regression with manual backward stepwise elimination was used to identify the best dosimetric predictors of toxicity. Optimal dose-volume cutoffs were isolated with recursive partitioning analysis (RPA).
The grade ≥2 RP rate was 18.8%. Pulmonary V5 to V50, MLD, and cardiac V0.1 to V2.5 were significantly associated with toxicity on univariate analysis. On multivariable logistic regression, V10 was the strongest dosimetric predictor of grade ≥2 RP (odds ratio, 1.052; 95% confidence interval, 1.014-1.092; P = .007). RPA identified a 21.6% risk of grade ≥2 RP with V10 ≥6.14% (vs 3.8% with <6.14). MLD was the most significant predictor of grade ≥3 RP (odds ratio, 1.002; 95% confidence interval, 1.000-1.003; P = .031). RPA identified a 25.0% risk of grade ≥3 RP with MLD ≥7.84 Gy (vs 8.0% when <7.84 Gy).
With a grade ≥2 RP rate of 18.8%, lung V10 was the best predictor of grade ≥2 toxicity. MLD was the best predictor of grade ≥3 RP.
Highlights • We compare racial differences in the treatment of early stage lung cancer patients. • Black patients were less likely to receive SBRT than white patients. • Black patients were also less ...likely to receive surgery than white patients. • Black patients were more likely to receive standard fractionated RT or no treatment. • This suggests black patients are being treated with less aggressive therapy.
Abstract Objective Adjuvant therapy for advanced endometrial cancer (AEC) is not standardized. We investigated whether regional radiotherapy with chemotherapy (CRT) compared to chemotherapy alone ...(CT) was associated with improved overall survival (OS) in an AEC cohort and among subgroups by stage and histologic grade. Methods Women who received CT or CRT after hysterectomy and bilateral salpingo-oophorectomy for FIGO stage III–IVA AEC diagnosed in 2004–2012 were identified in the National Cancer Data Base. Multilevel modeling was used to identify covariates associated with treatment selection. OS was compared using Kaplan-Meier estimates, the log-rank test, Cox proportional hazards regression, and propensity score matching. Results We identified 9837 patients, of whom 6358 (65%) received CT and 3479 (35%) received CRT. Median follow-up was 59.6 months. OS was higher in patients receiving CRT compared to CT (70% v 55% at 5 years, log-rank P < 0.001). Controlling for stage, histologic grade, tumor size, age, comorbidity and race, CRT remained independently associated with improved OS (HR 0.63, 95% CI 0.57–0.70, P < 0.001). When stratified by stage and histologic grade, there was a significant OS benefit for stage IIIA, IIIB, IIIC, grade 2, and grade 3 (all P < 0.001), a trend for stage IVA (P = 0.06), but no benefit for grade 1 (P = 0.91). On multivariable subgroup analyses, these findings persisted, including lack of benefit in grade 1 patients (HR 0.72, P = 0.14). These results were further confirmed after propensity score matching. Conclusions Adjuvant CRT for AEC was associated with improved OS, except for patients with well-differentiated disease, who fared equally well with CT alone.
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