Segmentation of organs at risk (OARs) and target volumes need time and precision but are highly repetitive tasks. Radiation oncology has known tremendous technological advances in recent years, the ...latest being brought by artificial intelligence (AI). Despite the advantages brought by AI for segmentation, some concerns were raised by academics regarding the impact on young radiation oncologists' training. A survey was thus conducted on young french radiation oncologists (ROs) by the SFjRO (Société Française des jeunes Radiothérapeutes Oncologues).
The SFjRO organizes regular webinars focusing on anatomical localization, discussing either segmentation or dosimetry. Completion of the survey was mandatory for registration to a dosimetry webinar dedicated to head and neck (H & N) cancers. The survey was generated in accordance with the CHERRIES guidelines. Quantitative data (e.g., time savings and correction needs) were not measured but determined among the propositions.
117 young ROs from 35 different and mostly academic centers participated. Most centers were either already equipped with such solutions or planning to be equipped in the next two years. AI segmentation software was mostly useful for H & N cases. While for the definition of OARs, participants experienced a significant time gain using AI-proposed delineations, with almost 35% of the participants saving between 50-100% of the segmentation time, time gained for target volumes was significantly lower, with only 8.6% experiencing a 50-100% gain. Contours still needed to be thoroughly checked, especially target volumes for some, and edited. The majority of participants suggested that these tools should be integrated into the training so that future radiation oncologists do not neglect the importance of radioanatomy. Fully aware of this risk, up to one-third of them even suggested that AI tools should be reserved for senior physicians only.
We believe this survey on automatic segmentation to be the first to focus on the perception of young radiation oncologists. Software developers should focus on enhancing the quality of proposed segmentations, while young radiation oncologists should become more acquainted with these tools.
In the case of synchronous metastatic disease, the local treatment of primary tumors by radiotherapy has long been reserved for palliative indications. The emergence of the concept of oligometastatic ...and oligopersistent diseases, the advent of new systemic therapies enabling longer overall survival with an enhanced quality of life, a better understanding of the biologic history of metastatic spread, and technical advances in radiation therapy are revolutionizing the management of patients with de novo metastatic cancer. The prognosis of these patients has been markedly improved and many studies have investigated the survival benefits from the local treatment of various primary tumors in cases of advanced disease at the time of diagnosis or in the case of oligopersistence. This article provides an update on the place of irradiation of the primary tumor in cancer with synchronous metastases, and discusses its interest through published or ongoing trials.
This article describes the methodology used and provides a characterization of the study population in CANTO-RT (CANcer TOxicities RadioTherapy). CANTO (NCT01993498) is a prospective clinical cohort ...study including patients with stage I-III BC from 26 French cancer centers. Patients matching all CANTO inclusion and exclusion criteria who received RT in one of the 10 top recruiting CANTO centers were selected. Individual full DICOM RT files were collected, pseudo-anonymized, structured and analyzed on the CANTO-RT/UNITRAD web platform. CANTO-RT included 3875 BC patients with a median follow-up of 64 months. Among the 3797 patients with unilateral RT, 3065 (80.4%) had breast-conserving surgery, and 2712 (71.5%) had sentinel node surgery. Tumor bed boost was delivered in 2658 patients (68.5%) and lymph node RT in 1356 patients (35%), including internal mammary chain in 844 patients (21.8%). Most patients (3691 (95.3%)) were treated with 3D conformal RT. Target volumes, organs at risk contours and dose/volume histograms were extracted after quality-control procedures. CANTO-RT is one of the largest early BC prospective cohorts with full individual clinical, biological, imaging and DICOM RT data available. It is a valuable resource for the identification and validation of clinical and dosimetric predictive factors of RT and multimodal treatment-related toxicities.
Giant hydronephrosis is rare to be seen in adults and is often the cause of misdiagnosis, It is usually caused by ureteropelvic junction syndrome. We here report the unusual case of a patient ...hospitalized with giant hydronephrosis secondary to ureteral calculi, associated with impaired general condition. Diagnosis was based on CT scan. The patient underwent deferred nephrectomy after percutaneous drainage.
Recently, ultrahigh-dose-rate radiation therapy (UHDR-RT) has emerged as a promising strategy to increase the benefit/risk ratio of external RT. Extensive work is on the way to characterize the ...physical and biological parameters that control the so-called “Flash” effect. However, this healthy/tumor differential effect is observable in in vivo models, which thereby drastically limits the amount of work that is achievable in a timely manner.
In this study, zebrafish embryos were used to compare the effect of UHDR irradiation (8-9 kGy/s) to conventional RT dose rate (0.2 Gy/s) with a 68 MeV proton beam. Viability, body length, spine curvature, and pericardial edema were measured 4 days postirradiation.
We show that body length is significantly greater after UHDR-RT compared with conventional RT by 180 µm at 30 Gy and 90 µm at 40 Gy, while pericardial edema is only reduced at 30 Gy. No differences were obtained in terms of survival or spine curvature.
Zebrafish embryo length appears as a robust endpoint, and we anticipate that this model will substantially fasten the study of UHDR proton-beam parameters necessary for “Flash.”
SPONTANEOUS RUPTURE OF DOUBLE J URETERAL STENT El Mostapha, Abdi; Youssef, Ghannam; Hagguir, Hissein ...
Journal of Surgical Sciences (Bucureşti),
12/2020, Letnik:
7, Številka:
3
Journal Article
Recenzirano
Odprti dostop
The double J stent is widely used in urological endoscopic surgery with different indications (ureteral stenosis, ureteropelvic junction obstruction, retroperitoneal tumor or fibrosis) and can be a ...subject to multiple complications including migration, encrustation, stone formation and fragmentation which is a rare complication. We are reporting a rare case of a 42-years-old, followed for cervical cancer since 2018 revealed by an acute obstructive renal failure drained by a left double J ureteral stent (of long duration) and right percutaneous nephrostomy. The patient maintained the double J stent for 2 years. On clinical examination there was a lumbar tenderness on the left side and a hardened vaginal cervix on bimanual vaginal examination. The patient underwent a renovesical ultrasound showing a minimal left ureterohydronephrosis. The uroscanner with reconstruction revealed a fragmented double J stent on the left side.
The reform of the third cycle of medical studies in France has introduced of the "Junior Doctor" status during the concluding year of residency. We wish to evaluate its implementation for the first ...promotion of medical oncology residents during 2021-2022 in correlation with the published guidelines.
AERIO conducted a cross-sectional study among French medical oncology residents. The survey was released via social networks and emails.
Twenty-eight of 47 residents responded. The typical week involved one to two half-days of consultation, one dedicated to clinical research, one multidisciplinary team meetings, with the rest of time being occupied by day care (mostly) and hospitalization. Teaching and quality management activities were infrequent (monthly or less). The Junior Doctors rated their overall satisfaction at 8/10. A large majority (92.5 %) felt equipped to handle most of the situations they encountered. Almost all residents (92.9 %) had negotiated with their placement supervisor prior to the selection procedure. In one third of the cases (35.7 %), the principle of mismatch between the number of residents and the number of training sites was not respected. Only 42.9 % received training in scientific writing and 82.2 % of the residents agreed on the relevance of the post-internship training modules developed in other specialties.
Junior doctors in medical oncology express overall satisfaction with this reform, which aligns with the recommendations. Nevertheless, certain concerns, such as selection procedure and inadequacy, along with areas requiring improvement, such as post-internship training and scientific writing, are clearly established.
•Irradiation of zebrafish embryos with helium ions at 18-24 Gy impairs development.•UHDR irradiation spares development compared to conv-dose RT.•First evidence of in vivo “FLASH” effect with helium ...ions.
The ability to reduce toxicity of ultra-high dose rate (UHDR) helium ion irradiation has not been reported in vivo. Here, we tested UHDR helium ion irradiation in an embryonic zebrafish model. Our results show that UHDR helium ions spare body development and reduce spine curvature, compared to conventional dose rate.
Skin reaction is a common toxicity during oncology management, especially followed during the radiotherapy. Its assessment and understanding of the factors influencing its occurrence, is a major ...issue in the management of patients treated for an early breast cancer (BC). We evaluated 8561 patients during their overall management for a BC. We focus on specific skin toxicities: erythema, fibrosis, telangiectasia and changes of skin colour. These toxicities were assessed at the baseline defined as 0-3-6 (M0), 12 (M12), 36 (M36) and 60 (M60) months. The prevalence of toxicities of interest varied over time, so at M0, 30.4% of patients had erythema while 17.7% of patients had fibrosis. At M60, the prevalence of erythema was 2%, while fibrosis remained stable at about 19%. After adjustments, at M0, there was a significant association between the onset of cutaneous erythema and obesity, the presence of axillary dissection, the type of surgery and the tumour phenotype RH+/HER2+. Concerning fibrosis, a significant association was found, at M12, with the age of the patient, obesity, Charlson score and type of surgery. Concerning the modification of skin colour at M12, we find a link between the age of the patient, obesity, tobacco consumption and alcohol consumption. The prevention of this toxicity is a major issue for the quality of life. Our results allow us to understand the risk of developing skin toxicity in a patient, depending on her intrinsic, tumour or therapeutic characteristics and to implement adapted means of prevention and monitoring.
Skin damage is the most common and most important toxicity during and after radiation therapy (RT). Its assessment and understanding of the factors influencing its occurrence, is a major issue in the ...management of patients irradiated for an early breast cancer. CANTO is a prospective clinical cohort study of 10 150 patients with stage I‐III BC treated from 2012 to 2017 in 26 cancer centres. In our study, we used CANTO‐RT, a subcohort of CANTO, including 3480 patients who received RT. We are focus on specific skin toxicities: erythema, fibrosis, telangiectasia and cutaneous pigmentation. The prevalence of toxicities of interest varied over time, so at baseline for early toxicity Month (M) 0‐3‐6, 41.1% of patients had erythema while 24.8% of patients had fibrosis. At M12 and M36, the prevalence of erythema decreased, respectively, while fibrosis remains stable. The prevalence of telangiectasia increases from 1% to 7.1% from M0‐3‐6 to M36. After adjustments, we showed an association between the occurrence of skin erythema and obesity; the type of surgery; the presence of axillary dissection; the use of taxane‐based CT and the 3D vs IMRT irradiation technique. Regarding fibrosis, an association is found, at M0‐3‐6, with age at diagnosis, obesity, tobacco and the use of boost. Only obesity and the type of surgery received by the patient remained statistically significant at M12 and M36. In our study we identified several risk factors for acute and late skin reactions. The use of a boost was mainly related to the occurrence of fibrosis while the use of IMRT‐type technique decreased the occurrence of skin erythema.
What's new?
Cutaneous toxicities are a significant concern in the treatment of early‐stage breast cancer. To minimise their occurrence, however, a greater understanding of factors influencing their development is needed. Here, using data from the prospective, multicentre CANTO study, occurrence of cutaneous toxicities was found to be influenced constantly over time by obesity and type of surgery received by patients, with both obesity and surgery acting as independent risk factors. Radiotherapy technique further impacted the occurrence of cutaneous toxicities. The results indicate that the modification of breast cancer treatment according to patient characteristics is a promising strategy for minimising cutaneous toxicities.
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