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ESTRO ACROP guideline on prostate bed delineation for postoperative radiotherapy in prostate cancer.Clinical and Translational Radiation... Jul 2023Radiotherapy to the prostate bed is a potentially curative salvage option after radical prostatectomy. Although prostate bed contouring guidelines are available in the... (Review)
Review
PURPOSE/OBJECTIVE
Radiotherapy to the prostate bed is a potentially curative salvage option after radical prostatectomy. Although prostate bed contouring guidelines are available in the literature, important variabilities exist. The objective of this work is to provide a contemporary consensus guideline for prostate bed delineation for postoperative radiotherapy.
METHODS
An ESTRO-ACROP contouring consensus panel consisting of 11 radiation oncologists and one radiologist, all with known subspecialty expertise in prostate cancer, was established. Participants were asked to delineate the prostate bed clinical target volumes (CTVs) in 3 separate clinically relevant scenarios: adjuvant radiation, salvage radiation with PSA progression, and salvage radiation with persistently elevated PSA. These cases focused on the presence of positive surgical margin, extracapsular extension, and seminal vesicles involvement. None of the cases had radiographic evidence of local recurrence on imaging. A single computed tomography (CT) dataset was shared via FALCON platform and contours were performed using EduCaseTM software. Contours were analyzed qualitatively using heatmaps which provided a visual assessment of controversial regions and quantitatively analyzed using Sorensen-Dice similarity coefficients. Participants also answered case-specific questionnaires addressing detailed recommendations on target delineation. Discussions via electronic mails and videoconferences for final editing and consensus were performed.
RESULTS
The mean CTV for the adjuvant case was 76 cc (SD = 26.6), salvage radiation with PSA progression was 51.80 cc (SD = 22.7), and salvage radiation with persistently elevated PSA 57.63 cc (SD = 25.2). Compared to the median, the mean Sorensen-Dice similarity coefficient for the adjuvant case was 0.60 (SD 0.10), salvage radiation with PSA progression was 0.58 (SD = 0.12), and salvage radiation with persistently elevated PSA 0.60 (SD = 0.11). A heatmap for each clinical scenario was generated. The group agreed to proceed with a uniform recommendation for all cases, independent of the radiotherapy timing. Several controversial areas of the prostate bed CTV were identified based on both heatmaps and questionnaires. This formed the basis for discussions via videoconferences where the panel achieved consensus on the prostate bed CTV to be used as a novel guideline for postoperative prostate cancer radiotherapy.
CONCLUSION
Variability was observed in a group formed by experienced genitourinary radiation oncologists and a radiologist. A single contemporary ESTRO-ACROP consensus guideline was developed to address areas of dissonance and improve consistency in prostate bed delineation, independent of the indication.There is important variability in existing contouring guidelines for postoperative prostate bed (PB) radiotherapy (RT) after radical prostatectomy. This work aimed at providing a contemporary consensus guideline for PB delineation. An ESTRO ACROP consensus panel including radiation oncologists and a radiologist, all with known subspecialty expertise in prostate cancer, delineated the PB CTV in 3 scenarios: adjuvant RT, salvage RT with PSA progression, and salvage RT with persistently elevated PSA. None of the cases had evidence of local recurrence. Contours were analysed qualitatively using heatmaps for visual assessment of controversial regions and quantitatively using Sorensen-Dice coefficient. Case-specific questionnaires were also discussed via e-mails and videoconferences for consensus. Several controversial areas of the PB CTV were identified based on both heatmaps and questionnaires. This formed the basis for discussions via videoconferences. Finally, a contemporary ESTRO-ACROP consensus guideline was developed to address areas of dissonance and improve consistency in PB delineation, independent of the indication.
PubMed: 37251620
DOI: 10.1016/j.ctro.2023.100638 -
Cell Mar 2024The integration of cancer biomarkers into oncology has revolutionized cancer treatment, yielding remarkable advancements in cancer therapeutics and the prognosis of... (Review)
Review
The integration of cancer biomarkers into oncology has revolutionized cancer treatment, yielding remarkable advancements in cancer therapeutics and the prognosis of cancer patients. The development of personalized medicine represents a turning point and a new paradigm in cancer management, as biomarkers enable oncologists to tailor treatments based on the unique molecular profile of each patient's tumor. In this review, we discuss the scientific milestones of cancer biomarkers and explore future possibilities to improve the management of patients with solid tumors. This progress is primarily attributed to the biological characterization of cancers, advancements in testing methodologies, elucidation of the immune microenvironment, and the ability to profile circulating tumor fractions. Integrating these insights promises to continually advance the precision oncology field, fostering better patient outcomes.
Topics: Humans; Biomarkers, Tumor; Medical Oncology; Neoplasms; Precision Medicine; Tumor Microenvironment
PubMed: 38552610
DOI: 10.1016/j.cell.2024.02.041 -
Cureus Sep 2023As artificial intelligence (AI) models improve and become widely integrated into healthcare systems, healthcare providers must understand the strengths and limitations...
As artificial intelligence (AI) models improve and become widely integrated into healthcare systems, healthcare providers must understand the strengths and limitations of AI tools to realize the full spectrum of potential patient-care benefits. However, most providers have a poor understanding of AI, leading to distrust and poor adoption of this emerging technology. To bridge this divide, this editorial presents a novel view of ChatGPT's current capabilities in the medical field of radiation oncology. By replicating the format of the oral qualification exam required for radiation oncology board certification, we demonstrate ChatGPT's ability to analyze a commonly encountered patient case, make diagnostic decisions, and integrate information to generate treatment recommendations. Through this simulation, we highlight ChatGPT's strengths and limitations in replicating human decision-making in clinical radiation oncology, while providing an accessible resource to educate radiation oncologists on the capabilities of AI chatbots.
PubMed: 37790062
DOI: 10.7759/cureus.44541 -
ESMO Open Oct 2023
Topics: Humans; Medical Oncology; Oncologists
PubMed: 37659290
DOI: 10.1016/j.esmoop.2023.101625 -
Current Opinion in Urology May 2024To summarize the recent findings on the subject of metastasis-directed therapy (MDT) in the treatment of oligometastatic prostate cancer (omPCa). (Review)
Review Meta-Analysis
PURPOSE OF REVIEW
To summarize the recent findings on the subject of metastasis-directed therapy (MDT) in the treatment of oligometastatic prostate cancer (omPCa).
RECENT FINDINGS
Evidence from two randomized clinical trials (RCTs) and a meta-analysis show favorable toxicity profiles, and the potential to delay androgen-deprivation therapy (ADT) for up to two years in nearly half of patients with metachronous hormone-sensitive omPCa. Another RCT showed promising results of MDT as treatment-escalation method combined with androgen receptor signaling inhibitors (ARSI) in first-line treatment for castration-resistant omPCa.Surveys by radiation oncologists and consensus guidelines advocate for MDT across various omPCa scenarios. Multiple single-arm trials present encouraging results; however, the evidence for the benefit of MDT is still weak requiring further investigation to assess its impact on pivotal endpoints, such as survival and quality of life.
SUMMARY
MDT is a promising approach in omPCa, and can be used to defer ADT in newly diagnosed metachronous omPCa patients, or to add to ARSI treatment at first diagnosis of castration-resistance. Ongoing prospective trials are needed to guide its optimal utilization in other settings, and patients should be informed about the evolving landscape of systemic therapies with proven survival benefits alongside MDT options.
Topics: Male; Humans; Prostatic Neoplasms; Antineoplastic Agents, Hormonal; Androgen Antagonists
PubMed: 38426229
DOI: 10.1097/MOU.0000000000001169 -
La Tunisie Medicale Nov 2023Pediatric radiotherapy (PR) faces several issues in middle- and low-income countries.
INTRODUCTION
Pediatric radiotherapy (PR) faces several issues in middle- and low-income countries.
AIM
Our study is a cross-sectional observation which aimed to describe the current situation of PR in Morocco in order to identify the needs and to propose an organizational shema for this discipline.
METHODS
The collection of data used two surveys, one of which was intended to the heads of the radiotherapy department of all university hospital centers (UHC) in Morocco concerning the hospital's infrastructure, human resources, technical and the course of radiotherapy. A second survey was intended for all radiation oncologists trained and working in Morocco with data related to the practice of PR.
RESULTS
In 2021, 295 children were treated in the radiotherapy departments of the seven university hospitals in Morocco. One hundred and two radiation oncologists responded to our survey. The multidisciplinary consultation board is held in five university hospitals, four of which have a complete multidisciplinary team. The children are sent to another structure by default of anesthesia according to 21% of the radiotherapists questioned. The three-dimensional technique is available in all university hospitals. Intensity modulated radiotherapy is available in 5 UHC. Additional training in radiotherapy after residency was necessary according to 60% of the radiotherapists questioned.
CONCLUSION
Despite the progress that Morocco has made in terms of infrastructure and radiotherapy equipment, this first national survey has identified some weaknesses and developed some recommendations for the organization of PR.
Topics: Humans; Child; Morocco; Cross-Sectional Studies; Radiation Oncology; Surveys and Questionnaires; Hospitals, University
PubMed: 38468582
DOI: No ID Found -
Frontiers in Oncology 2023The skull base is an anatomically and functionally critical area surrounded by vital structures such as the brainstem, the spinal cord, blood vessels, and cranial... (Review)
Review
The skull base is an anatomically and functionally critical area surrounded by vital structures such as the brainstem, the spinal cord, blood vessels, and cranial nerves. Due to this complexity, management of skull base tumors requires a multidisciplinary approach involving a team of specialists such as neurosurgeons, otorhinolaryngologists, radiation oncologists, endocrinologists, and medical oncologists. In the case of pediatric patients, cancer management should be performed by a team of pediatric-trained specialists. Radiation therapy may be used alone or in combination with surgery to treat skull base tumors. There are two main types of radiation therapy: photon therapy and particle therapy. Particle radiotherapy uses charged particles (protons or carbon ions) that, due to their peculiar physical properties, permit precise targeting of the tumor with minimal healthy tissue exposure. These characteristics allow for minimizing the potential long-term effects of radiation exposure in terms of neurocognitive impairments, preserving quality of life, and reducing the risk of radio-induced cancer. For these reasons, in children, adolescents, and young adults, proton therapy should be an elective option when available. In radioresistant tumors such as chordomas and sarcomas and previously irradiated recurrent tumors, particle therapy permits the delivery of high biologically effective doses with low, or however acceptable, toxicity. Carbon ion therapy has peculiar and favorable radiobiological characteristics to overcome radioresistance features. In low-grade tumors, proton therapy should be considered in challenging cases due to tumor volume and involvement of critical neural structures. However, particle radiotherapy is still relatively new, and more research is needed to fully understand its effects. Additionally, the availability of particle therapy is limited as it requires specialized equipment and expertise. The purpose of this manuscript is to review the available literature regarding the role of particle radiotherapy in the treatment of skull base tumors.
PubMed: 37350949
DOI: 10.3389/fonc.2023.1161752