Authors: William A Hall, Eric Paulson, Brian J Davis...

PURPOSE

In 2009, the Radiation Therapy Oncology Group (RTOG) genitourinary members published a consensus atlas for contouring prostate pelvic nodal clinical target volumes (CTVs). Data have emerged further informing nodal recurrence patterns. The objective of this study is to provide an updated prostate pelvic nodal consensus atlas.

METHODS AND MATERIALS

A literature review was performed abstracting data on nodal recurrence patterns. Data were presented to a panel of international experts, including radiation oncologists, radiologists, and urologists. After data review, participants contoured nodal CTVs on 3 cases: postoperative, intact node positive, and intact node negative. Radiation oncologist contours were analyzed qualitatively using count maps, which provided a visual assessment of controversial regions, and quantitatively analyzed using Sorensen-Dice similarity coefficients and Hausdorff distances compared with the 2009 RTOG atlas. Diagnostic radiologists generated a reference table outlining considerations for determining clinical node positivity.

RESULTS

Eighteen radiation oncologists' contours (54 CTVs) were included. Two urologists' volumes were examined in a separate analysis. The mean CTV for the postoperative case was 302 cm, intact node positive case was 409 cm, and intact node negative case was 342 cm. Compared with the original RTOG consensus, the mean Sorensen-Dice similarity coefficient for the postoperative case was 0.63 (standard deviation [SD] 0.13), the intact node positive case was 0.68 (SD 0.13), and the intact node negative case was 0.66 (SD 0.18). The mean Hausdorff distance (in cm) for the postoperative case was 0.24 (SD 0.13), the intact node positive case was 0.23 (SD 0.09), and intact node negative case was 0.33 (SD 0.24). Four regions of CTV controversy were identified, and consensus for each of these areas was reached.

CONCLUSIONS

Discordance with the 2009 RTOG consensus atlas was seen in a group of experienced NRG Oncology and international genitourinary radiation oncologists. To address areas of variability and account for new data, an updated NRG Oncology consensus contour atlas was developed.

Topics: Consensus; Humans; Internationality; Lymph Nodes; Male; Oncologists; Organ Size; Pelvis; Prostatic Neoplasms

PubMed: 32861817
DOI: 10.1016/j.ijrobp.2020.08.034

Review

Authors: Alan Dal Pra, Piet Dirix, Vincent Khoo...

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

Review

Authors: Toshifumi Ozaki

Ewing sarcoma (ES) is rare in Japanese people, and only 30-40 patients develop the disease annually. To diagnose ES, molecular techniques that aim to detect characteristic fusion genes are commonly used in combination with conventional histological and immunohistochemical examinations. The treatment strategy for ES is characterized by multi-disciplinary collaboration between pediatric oncologists, medical oncologists, radiation oncologists, and orthopedic surgeons. In recent years, numerous large-scale national or international multi-institutional studies of ES have been performed. Pre- and postoperative intensive systemic chemotherapy with multiple anticancer drugs is the standard treatment method for ES. Depending on the obtained surgical margin, postoperative radiation might also be performed. If preoperative radiological examinations indicate that surgical excision would be difficult, preoperative radiation can be administered. As the treatment outcomes of ES have improved, late complications and secondary malignancies have become a problem. After treatment, patients with ES require very long-term follow-up in order to detect secondary malignancies and growth-related musculoskeletal complications.

Topics: Bone Neoplasms; Combined Modality Therapy; Humans; Neoplasms, Second Primary; Sarcoma, Ewing

PubMed: 25691401
DOI: 10.1007/s00776-014-0687-z

Authors: Tiffany Sandell, Andrew Miller, Heike Schütze...

(1) Background: Patients treated with radiotherapy require follow-up care to detect and treat acute and late side effects, and to monitor for recurrence. The increasing demand for follow-up care poses a challenge for specialists and general practitioners. There is a perception that general practitioners do not have the specialised knowledge of treatment side effects and how to manage these. Knowing the concordance between general practitioner and oncologist clinical assessments can improve confidence in healthcare professionals. This study aimed to measure the level of agreement between general practitioners and radiation oncologists using a standardised clinical assessment; (2) Methods: a cross-sectional clinical practice study; sample aim of 20 breast, prostate or colorectal patients, three years post-radiotherapy treatment; their general practitioner and radiation oncologist; (3) Results: There was acceptable percent agreement (>75%) and a moderate to almost perfect agreement (Fleiss kappa) for all variables between the 15 general practitioner-radiation oncologist dyads; (4) Conclusions: The general practitioner and radiation oncologist concordance of a clinical follow-up assessment for radiation oncology patients is an important finding. These results can reassure both general practitioners and oncologists that general practitioners can provide cancer follow-up care. However, further studies are warranted to confirm the findings and improve reassurance for health professionals.

Topics: Male; Humans; General Practitioners; Radiation Oncologists; Aftercare; Cross-Sectional Studies; Neoplasms

PubMed: 36612430
DOI: 10.3390/ijerph20010108

Authors: Nabila Sellal, Souha Sahraoui, Mohamed El Hfid...

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

Review

Authors: Alicia C Smart, Kevin X Liu, Jason D Domogauer...

Access to gender-affirming surgery is increasing for many transgender and nonbinary people in the United States, and radiation oncologists must be equipped to care for patients who have undergone such surgery in the region of their planned radiation treatment field. There are no guidelines for radiation treatment planning after gender-affirming surgery, and most oncologists do not receive training in the unique needs of transgender people with cancer. We review common gender-affirming genitopelvic surgeries for transfeminine people, including vaginoplasty, labiaplasty, and orchiectomy, and summarize the existing literature on the treatment of cancers of the neovagina, anus, rectum, prostate, and bladder in these patients. We also describe our systematic treatment approach and rationale for pelvic radiation treatment planning.

Topics: Male; Female; Humans; Gender-Affirming Surgery; Radiation Oncologists; Transgender Persons; Vagina; Anal Canal; Neoplasms

PubMed: 37230432
DOI: 10.1016/j.ijrobp.2023.05.028

Review

Authors: Elizabeth A Barnes, Edward Chow, Cyril Danjoux...

Communication between physicians is required to ensure important patient information is relayed during the workup, treatment, follow-up and subsequent transition of care back to the primary care physician (PCP). In this review we discuss how survivorship care is being increasingly recognized as an important component of the patient's cancer journey, and one often provided by the PCP. Palliative care and symptom control for patients with non-curable malignancy is often provided by the PCP during and after cancer treatment. Physician communication is paramount to ensure optimal patient care.

Topics: Aftercare; Cooperative Behavior; Humans; Interdisciplinary Communication; Palliative Care; Physicians, Primary Care; Radiation Oncologists; Survivors

PubMed: 28209071
DOI: 10.21037/apm.2016.11.03

Authors: Ann Raldow, Bethel Adefres, Michael Warso...

BACKGROUND

Unsolicited patient complaints (UPCs) about physician practices are nonrandomly associated with malpractice claims and clinical quality. The authors evaluated the distributions and types of UPCs associated with oncologists by specialty and assessed oncologist characteristics associated with UPCs.

METHODS

This retrospective study reviewed UPCs associated with US radiation oncologists (ROs), medical oncologists (MOs), and surgical oncologists (SOs) from 35 health care systems from 2015 to 2018. Average total UPCs were compared by specialty in addition to sex, medical school graduation year, degree, medical school location, residency location, practice setting, and practice region. For continuous variables, linear regression was used to test for an association with total complaints.

RESULTS

The study included 1576 physicians: 318 ROs, 1020 MOs, and 238 SOs. The average number of UPCs per physician was different and depended on the oncologic specialty: ROs had significantly fewer complaints (1.28; 95% confidence interval [CI], 1.02-1.54) than MOs (3.81; 95% CI, 3.52-4.10) and SOs (6.89; 95% CI, 5.99-7.79; P < .0001). In a multivariable analysis, oncologic specialty, recency of graduation, and academic practice were predictive of higher total UPCs (P < .05). UPCs described concerns with care and treatment (42.8%), communication (26.4%), accessibility (17.5%), concern for patient (10.3%), and billing (2.9%).

CONCLUSIONS

ROs had significantly fewer complaints than MOs and SOs and may have a lower risk of malpractice claims as a group. In addition to oncologic specialty, a more recent year of medical school graduation and working at an academic center were independent risk factors for UPCs. Further research is needed to clarify the reasons underlying these associations and to identify interventions that decrease UPCs and associated risks.

LAY SUMMARY

This study of 1576 oncologists found that radiation oncologists had significantly fewer complaints than medical oncologists, who in turn had significantly fewer complaints than surgical oncologists. Other characteristics associated with more patient complaints included recency of medical school graduation and practice in an academic setting. Oncologists' patient complaints provide information that may have practical applications for patient safety and risk management. Understanding and addressing the characteristics that increase the risk for complaints could improve patients' experiences and outcomes.

Topics: Communication; Humans; Malpractice; Oncologists; Radiation Oncologists; Retrospective Studies; Risk Factors

PubMed: 33724453
DOI: 10.1002/cncr.33513

Authors: Vincent Bourbonne, Adrien Laville, Nicolas Wagneur...

INTRODUCTION

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).

METHODOLOGY

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.

RESULTS

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.

CONCLUSIONS

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.

PubMed: 37046704
DOI: 10.3390/cancers15072040