Prospective evaluation of patients for stereotactic radiosurgery/radiotherapy (SRS/SRT) by an experienced SRS/SRT radiation oncologist at a hospital-based cancer center lacking SRS/SRT capability.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14043-e14043
Author(s):  
Don Stacy ◽  
Christopher Rucker ◽  
Kimberly Cottongame ◽  
Lester Combs ◽  
Chad Jones ◽  
...  
Keyword(s):  
Practice Guidelines ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
Treatment Options ◽  
Specific Treatment ◽  
Treatment Recommendation ◽  
Cancer Center ◽  
Radiation Oncologist ◽  
Prospective Evaluation ◽  
Oncology Patient

e14043 Background: To prospectively determine the need for SRS/SRT at a hospital-based cancer center lacking SRS/SRT capability. Methods: An experienced SRS/SRT radiation oncologist prospectively evaluated new and established patients for radiation treatment at a hospital-based cancer center from July 30, 2018 through September 20, 2019. All radiation treatment options (per the NCCN Practice Guidelines in Oncology) were explained in detail to each patient. The radiation oncologist’s specific treatment recommendation to each patient was based on the radiation oncologist’s expertise. Cases for which the radiation oncologist recommended SRS/SRT were recorded. Results: From August 06, 2018 through September 25, 2019 an experienced SRS/SRT radiation oncologist evaluated 177 new or established patients for radiation treatment and recommended SRS/SRT for 23 patients (6 lung, 2 adrenal, 9 brain, 3 spine, 1 pituitary, 1 bone, and 1 prostate). Conclusions: To provide comprehensive radiation oncology patient services, SRS/SRT capability is required at a hospital-based cancer center evaluated by an experienced SRS/SRT radiation oncologist in this report, as SRS/SRT was recommended for twenty-three of one hundred seventy-seven (13%) patients evaluated for radiation treatment in a fourteen-month period.

scholarly journals Impact of COVID-19 on Radiation Oncology, an Austrian Experience

2021 ◽  
Vol 28 (6) ◽  
pp. 4776-4785
Author(s):  
Julian Mangesius ◽  
Christoph Reinhold Arnold ◽  
Thomas Seppi ◽  
Stephanie Mangesius ◽  
Mario Brüggl ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Prostate Cancer ◽  
Cancer Treatment ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
Treatment Options ◽  
Fractionation Schedules ◽  
Lower Count ◽  
Substantial Drop ◽  
Future Management

The COVID-19 pandemic has an unprecedented impact on cancer treatment worldwide. We aimed to evaluate the effects of the pandemic on the radiation treatment of patients in order to provide data for future management of such crises. We compared the number of performed radiotherapy sessions of the pandemic period from February 2020 until May 2021 with those of 2018 and 2019 for reference. At our department, no referred patients had to be rejected or postponed, nor any significant changes in fractionation schedules implemented. Nevertheless, there was a substantial drop in overall radiotherapy sessions in 2020 following the first incidence wave of up to −25% (in June) in comparison to previous years. For breast cancer, a maximum decline of sessions of −45% (July) was recorded. Only a short drop of prostate cancer sessions (max −35%, May) followed by a rebound (+42%, July) was observed. Over the investigated period, a loss of 4.4% of expected patients never recovered. The severe impact of COVID-19 on cancer treatment, likely caused by retarded diagnosis and delayed interdisciplinary co-treatment, is reflected in a lower count of radiotherapy sessions. Radiation oncology is a crucial cornerstone in upholding both curative treatment options and treatment capacity during a pandemic.

Does a community cancer center one-day prostate cancer multidisciplinary clinic result in a change in treatment recommendation?

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 82-82
Author(s):  
Taylor Reid Cushman ◽  
Joseph W Mashni ◽  
Rachit Kumar
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Treatment Recommendations ◽  
Treatment Recommendation ◽  
Cancer Center ◽  
Risk Category ◽  
Stereotactic Radiation ◽  
Cancer Multiple

82 Background: Multi-disciplinary clinics (MDCs) offer patients the opportunity to meet with multiple providers to discuss treatment options for recently diagnosed prostate cancer. Multiple academic centers have published their experience with these clinics. However, this approach has been sparsely reported in the community setting. Herein, we assess if an MDC results in more appropriate treatment recommendations for patients based on NCCN risk category compared to incoming (non-MDC) treatment recommendations. Methods: A retrospective chart review of patients evaluated in the institutional prostate cancer MDC clinic were reviewed over a 22 month period (January 2015 through October 2016). A single urologist and radiation oncologist served as clinic consultants for all patients. Patients were asked to report the recommendation for treatment prior to evaluation in the MDC clinic, and the patient selection for treatment after evaluation in the MDC clinic. Changes in treatment recommendation were recorded based on NCCN risk category (low [LR], intermediate [IR], and high [HR] risk groups). Results: Eighty patients were evaluated in the MDC. Of the 80 patients, 64 (80%) chose to continue care with the providers in the prostate MDC. Evaluable records (i.e. initial treatment recommendations) were available for 46 of the 64 patients (72%). Median age of the evaluable patients was 67 years (range 43-83). By risk category, 15 (33%) were LR, 21 (46%) were IR, and 10 (22%) were HR. Eleven patients in the LR group (73%) had altered treatment recommendations, 82% of whom were changed from any treatment (surgery or radiation) to active surveillance. Ten patients in the IR group (48%) and four patients in the HR group (40%) had altered treatment recommendations, mostly from surgery to radiation +/- ADT (50% in the IR, and 75% in the HR group). For all patients seen in the MDC, eight (10%) enrolled on a clinical trial (prostate stereotactic radiation). Conclusions: Implementation of a community-based, one-day prostate MDC resulted in significant changes in treatment recommendations, particularly in increasing active surveillance for LR patients and reducing surgical intervention in IR and HR patients.

Practice points for radiation oncology

2016 ◽  
pp. 173-185
Author(s):  
Annekatrin Seidlitz ◽  
Stephanie E. Combs ◽  
Jürgen Debus ◽  
Michael Baumann
Keyword(s):  
Radiation Oncology ◽  
Radiation Treatment ◽  
Wide Spectrum ◽  
Treatment Plan ◽  
Radiation Oncologist ◽  
Tumour Control ◽  
Dose Volume ◽  
The Individual ◽  
Tissue Reactions ◽  
Normal Tissue Reactions

Radiotherapy is an indispensable treatment modality in modern oncology with curative potential in applying ionizing radiation in a wide spectrum of malignancies. Radiotherapy is often combined in multidisciplinary concepts with surgery or cytostatic drugs, and increasingly also with molecular-targeted therapies. The aim of radiotherapy is to achieve uncomplicated local or locoregional tumour control, that is to permanently inactivate all cancer cells in the irradiated volume without inducing severe normal tissue reactions. This aim can be reached for a substantial proportion of patients with modern high-precision radiation treatment planning and application technologies. Clinical and radiobiological principles guide the radiation oncologist in time-dose volume prescription of radiotherapy and in selection of the optimal radiation treatment plan for the individual patient. The scope of this chapter is to summarize important basic biological, physical, and clinical principles and practice points of radiotherapy of relevance for the non-radiation oncologist.

scholarly journals Measures of infection prevention and incidence of SARS-CoV-2 infections in cancer patients undergoing radiotherapy in Germany, Austria and Switzerland

2020 ◽  
Vol 196 (12) ◽  
pp. 1068-1079 ◽  
Author(s):  
Christiane Matuschek ◽  
Johannes C. Fischer ◽  
Stephanie E. Combs ◽  
Rainer Fietkau ◽  
Stefanie Corradini ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
Screening Program ◽  
Disease Incidence ◽  
Treatment Options ◽  
Healthcare Providers ◽  
Office Work ◽  
Protective Measures ◽  
The Impact

Abstract Purpose COVID-19 infection has manifested as a major threat to both patients and healthcare providers around the world. Radiation oncology institutions (ROI) deliver a major component of cancer treatment, with protocols that might span over several weeks, with the result of increasing susceptibility to COVID-19 infection and presenting with a more severe clinical course when compared with the general population. The aim of this manuscript is to investigate the impact of ROI protocols and performance on daily practice in the high-risk cancer patients during this pandemic. Methods We addressed the incidence of positive COVID-19 cases in both patients and health care workers (HCW), in addition to the protective measures adopted in ROIs in Germany, Austria and Switzerland using a specific questionnaire. Results The results of the questionnaire showed that a noteworthy number of ROIs were able to complete treatment in SARS-CoV‑2 positive cancer patients, with only a short interruption. The ROIs reported a significant decrease in patient volume that was not impacted by the circumambient disease incidence, the type of ROI or the occurrence of positive cases. Of the ROIs 16.5% also reported infected HCWs. About half of the ROIs (50.5%) adopted a screening program for patients whereas only 23.3% also screened their HCWs. The range of protective measures included the creation of working groups, instituting home office work and protection with face masks. Regarding the therapeutic options offered, curative procedures were performed with either unchanged or moderately decreased schedules, whereas palliative or benign radiotherapy procedures were more often shortened. Most ROIs postponed or cancelled radiation treatment for benign indications (88.1%). The occurrence of SARS-CoV‑2 infections did not affect the treatment options for curative procedures. Non-university-based ROIs seemed to be more willing to change their treatment options for curative and palliative cases than university-based ROIs. Conclusion Most ROIs reported a deep impact of SARS-CoV‑2 infections on their work routine. Modification and prioritization of treatment regimens and the application of protective measures preserved a well-functioning radiation oncology service and patient care.

scholarly journals Tumor lysis syndrome following radiation therapy in metastatic pancreatic cancer: A case report

2017 ◽  
Vol 4 (4) ◽  
pp. 22
Author(s):  
Erin J. Song ◽  
Julian C. Hong ◽  
Brian G. Czito
Keyword(s):  
Pancreatic Cancer ◽  
Abdominal Pain ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
Treatment Options ◽  
Tumor Lysis Syndrome ◽  
Hematologic Malignancies ◽  
Metastatic Pancreatic Cancer ◽  
Potential Treatment ◽  
Tumor Lysis

A 65-year-old female presented to radiation oncology for potential treatment options due to metastatic pancreatic cancer and significant abdominal pain. Imaging demonstrated a large pancreatic mass with lymphadenopathy, vascular encasement, and liver metastases. She initiated palliative radiation treatment and developed persistent nausea and vomiting, as well as significant laboratory derangements. She was subsequently admitted and diagnosed with tumor lysis syndrome, though this diagnosis is usually an oncologic emergency seen with hematologic malignancies following chemotherapy. 

Practice points for radiation oncology

2016 ◽  
pp. 173-185
Author(s):  
Annekatrin Seidlitz ◽  
Stephanie E. Combs ◽  
Jürgen Debus ◽  
Michael Baumann
Keyword(s):  
Radiation Oncology ◽  
Radiation Treatment ◽  
Wide Spectrum ◽  
Treatment Plan ◽  
Radiation Oncologist ◽  
Tumour Control ◽  
Dose Volume ◽  
The Individual ◽  
Tissue Reactions ◽  
Normal Tissue Reactions

Radiotherapy is an indispensable treatment modality in modern oncology with curative potential in applying ionizing radiation in a wide spectrum of malignancies. Radiotherapy is often combined in multidisciplinary concepts with surgery or cytostatic drugs, and increasingly also with molecular-targeted therapies. The aim of radiotherapy is to achieve uncomplicated local or locoregional tumour control, that is to permanently inactivate all cancer cells in the irradiated volume without inducing severe normal tissue reactions. This aim can be reached for a substantial proportion of patients with modern high-precision radiation treatment planning and application technologies. Clinical and radiobiological principles guide the radiation oncologist in time-dose volume prescription of radiotherapy and in selection of the optimal radiation treatment plan for the individual patient. The scope of this chapter is to summarize important basic biological, physical, and clinical principles and practice points of radiotherapy of relevance for the non-radiation oncologist.

A radiation oncology peer review program for community hospitals.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 200-200
Author(s):  
Laurie Sturdevant ◽  
Wendi Martinez ◽  
Nikhil Thaker ◽  
Anuja Jhingran ◽  
Deborah A. Kuban
Keyword(s):  
Peer Review ◽  
Radiation Oncology ◽  
Radiation Treatment ◽  
Peer Review Process ◽  
Community Setting ◽  
High Volume ◽  
Integrated Approach ◽  
Cancer Center ◽  
National Guidelines ◽  
Md Anderson

200 Background: Certified Members within the MD Anderson Cancer Network must perform prospective internal review of radiation oncology cases treated at their institution. Since 2009, several Network sites have been systematically added to a quality oversight program. As part of this process, a sample of the internally peer reviewed cases are assessed by radiation oncology Faculty from MD Anderson Cancer Center (MDACC) who are considered disease site experts. Methods: An electronic tool was used by Network sites to enter clinical treatment information on patients undergoing peer review. This case log was used to select a sample size of not less than 10% of each physician’s case load for an in-depth quarterly evaluation by our Faculty. Quality and appropriateness metrics included review of the technical components of the radiation treatment (RT) plan and multidisciplinary management.. RT was scored as being concordant/non-concordant with MDACC or national guidelines. Non-concordant cases were further reviewed for appropriateness given the individualized case. Feedback was then provided by Faculty to the treating radiation oncologists quarterly, to discuss recommendations and practice pattern modifications. Results: To date, 6 of our 13 Network sites are participating in this peer review process with others being phased in. In 2013, we selected 104 of 719 cases entered into our database by the first four sites. 78% (81) of cases were concordant with guidelines, while 22% (23) were non-concordant. Of the non-concordant cases, 23% were deemed individually appropriate but the remainders (17 of 104) were not appropriate. Concordance in the most frequent disease sites ranged from 80 to 89%. In the less frequent disease sites concordance was lower, ranging from 50 to 73%. Conclusions: The highly technical aspects of radiation treatment, the frequent need to integrate a multidisciplinary approach, and the reality that low volume disease sites will need to be increasingly treated in the community accentuate the need for enhanced oversight and more effective consultation with high volume, expert providers. Our study suggests that an integrated approach to peer review can improve the quality and value of cancer therapy in the community setting.

Acute myeloid leukemia (AML) patients' understanding of prognosis and treatment goals: A mixed-methods study.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 221-221
Author(s):  
Thomas William LeBlanc ◽  
Catherine T Bloom ◽  
Debra M. Davis ◽  
Susan C. Locke ◽  
Karen E. Steinhauser ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Induction Chemotherapy ◽  
Treatment Options ◽  
Specific Treatment ◽  
Treatment Recommendation ◽  
Treatment Goals ◽  
Recommended Treatment ◽  
Complex Information ◽  
Relapsed Disease ◽  
Face Complex

221 Background: Patients with AML face complex information about the risks and rewards of pursuing treatments of varying intensity. Little is known about what patients understand or value in the decision-making process. Methods: AML inpatients receiving induction chemotherapy completed weekly electronic surveys about their prognosis and treatment goals, along with a baseline semi-structured, qualitative interview exploring their understanding of illness. Their oncologists (MDs) completed baseline surveys about prognosis and treatment goals. We followed a mixed-methods approach to analysis, applying standard statistical methods to survey data, and a constant-comparative qualitative approach to the interview data to enrich our understanding of survey results. Results: We enrolled 13 dyads (a patient and MD pair). Mean patient age was 65.5, and all had high-risk disease due to either age >60, complex cytogenetics, secondary AML, or relapsed disease. At baseline, mean MD-rated chance of cure was 27% (SD 17.6), while patients’ rating was 54% (SD 34.7; p=0.02). Only 2 patients’ estimates of cure matched their MD’s rating, yet MDs rated their patients’ prognostic understanding as high (mean 7.2 on an 11-point scale). MDs reported an average of 3.1 available treatment options, but patients recalled just 1.5. Most MDs gave a specific treatment recommendation (11 of 13), and most patients received the recommended treatment (10 of 11). Agreement about treatment goal was markedly worse than expected by chance (kappa -0.41; 95% CI -0.88-0.07). Qualitative analysis suggests that patients often viewed treatment decisions as binary “life-or-death” propositions, rather than choices between options with differing goals and intensities. Patients also significantly underestimated the risks of induction chemotherapy. Conclusions: AML patients receiving induction chemotherapy have a poor understanding of their prognosis, treatment goals, and risks of induction chemotherapy, but their oncologists are not aware of this. These findings suggest the need for an intervention to improve patient understanding of their illness and treatment options.

scholarly journals Molecular Subtypes and Precision Oncology in Intrahepatic Cholangiocarcinoma

2021 ◽  
Vol 10 (13) ◽  
pp. 2803
Author(s):  
Carolin Czauderna ◽  
Martha M. Kirstein ◽  
Hauke C. Tews ◽  
Arndt Vogel ◽  
Jens U. Marquardt
Keyword(s):  
Clinical Care ◽  
Treatment Options ◽  
Treatment Strategies ◽  
Specific Treatment ◽  
Growth Factor Receptor ◽  
Treatment Modalities ◽  
Precision Oncology ◽  
Recurrence Rates ◽  
Isocitrate Dehydrogenase 1 ◽  
Liver Cancers

Cholangiocarcinomas (CCAs) are the second-most common primary liver cancers. CCAs represent a group of highly heterogeneous tumors classified based on anatomical localization into intra- (iCCA) and extrahepatic CCA (eCCA). In contrast to eCCA, the incidence of iCCA is increasing worldwide. Curative treatment strategies for all CCAs involve oncological resection followed by adjuvant chemotherapy in early stages, whereas chemotherapy is administered at advanced stages of disease. Due to late diagnosis, high recurrence rates, and limited treatment options, the prognosis of patients remains poor. Comprehensive molecular characterization has further revealed considerable heterogeneity and distinct prognostic and therapeutic traits for iCCA and eCCA, indicating that specific treatment modalities are required for different subclasses. Several druggable alterations and oncogenic drivers such as fibroblast growth factor receptor 2 gene fusions and hotspot mutations in isocitrate dehydrogenase 1 and 2 mutations have been identified. Specific inhibitors have demonstrated striking antitumor activity in affected subgroups of patients in phase II and III clinical trials. Thus, improved understanding of the molecular complexity has paved the way for precision oncological approaches. Here, we outline current advances in targeted treatments and immunotherapeutic approaches. In addition, we delineate future perspectives for different molecular subclasses that will improve the clinical care of iCCA patients.

scholarly journals Patterns of care for prostate cancer radiotherapy—results from a survey among German-speaking radiation oncologists

2021 ◽  
Author(s):  
Marco M. E. Vogel ◽  
Sabrina Dewes ◽  
Eva K. Sage ◽  
Michal Devecka ◽  
Jürgen E. Gschwend ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Online Survey ◽  
Treatment Options ◽  
Equivalent Dose ◽  
Patterns Of Care ◽  
Treatment Recommendation ◽  
Published Data ◽  
Prostate Bed ◽  
Radiation Oncologists ◽  
German Speaking

Abstract Background Emerging moderately hypofractionated and ultra-hypofractionated schemes for radiotherapy (RT) of prostate cancer (PC) have resulted in various treatment options. The aim of this survey was to evaluate recent patterns of care of German-speaking radiation oncologists for RT of PC. Methods We developed an online survey which we distributed via e‑mail to all registered members of the German Society of Radiation Oncology (DEGRO). The survey was completed by 109 participants between March 3 and April 3, 2020. For evaluation of radiation dose, we used the equivalent dose at fractionation of 2 Gy with α/β = 1.5 Gy, equivalent dose (EQD2 [1.5 Gy]). Results Median EQD2(1.5 Gy) for definitive RT of the prostate is 77.60 Gy (range: 64.49–84.00) with median single doses (SD) of 2.00 Gy (range: 1.80–3.00), while for postoperative RT of the prostate bed, median EQD2(1.5 Gy) is 66.00 Gy (range: 60.00–74.00) with median SD of 2.00 Gy (range: 1.80–2.00). For definitive RT, the pelvic lymph nodes (LNs) are treated in case of suspect findings in imaging (82.6%) and/or according to risk formulas/tables (78.0%). In the postoperative setting, 78.9% use imaging and 78.0% use the postoperative tumor stage for LN irradiation. In the definitive and postoperative situation, LNs are irradiated with a median EQD2(1.5 Gy) of 47.52 Gy with a range of 42.43–66.00 and 41.76–62.79, respectively. Conclusion German-speaking radiation oncologists’ patterns of care for patients with PC are mainly in line with the published data and treatment recommendation guidelines. However, dose prescription is highly heterogenous for RT of the prostate/prostate bed, while the dose to the pelvic LNs is mainly consistent.

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