The Red Journal's Top 10 Most Downloaded Articles of 2011

Abstract

While an individual paper's total number of formal citations is recognized to be the “gold standard” for a paper's impact, citations may take years to accumulate. A more useful snapshot of a paper's immediate impact is to count the number of downloads, an easy statistic to obtain. A quick glance at the top 10 most downloaded articles in 2011 gives an extraordinary look at the papers that the radiation oncology community has found to be the most relevant to its work and practice. We do not, of course, know what proportion of these downloads are being made by practicing physicians as opposed to physicists, researchers, or by those in other specialties. A glance at the top 10 titles, however, suggests that it is the first category that dominates. The Red Journal, while having a strong research emphasis, is also at heart the journal that defines and shapes our practice.Guidelines are a critical component of contemporary practice. At a time when the specialty is “morphing” rapidly and struggling to incorporate multiple new technologies, guidelines developed by expert panels according to a strict methodology, help to keep us on track. All medical specialties have been guilty of the overexuberant use of therapy and payers are starting to question whether our practice is truly evidence-based. Their interpretation is becoming a way in which reimbursement can be restricted. It is, thus, incumbent upon the specialty societies such as our sponsor, the American Society for Radiation Oncology (ASTRO) and others like the American College of Radiology (ACR) to generate clear and credible guidelines that can be accepted by both physicians and payers.Among the “Top 10”, therefore, we see ASTRO's guideline on the palliation of bone metastases (1Lutz S. Berk L. Chang E. et al.Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline.Int J Radiat Oncol Biol Phys. 2011; 79: 965-976Abstract Full Text Full Text PDF PubMed Scopus (643) Google Scholar) and 2 guidelines on pelvic radiation therapy for cervix cancer (2Small Jr., W. Mell L.K. Anderson P. et al.Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer.Int J Radiat Oncol Biol Phys. 2008; 71: 428-434Abstract Full Text Full Text PDF PubMed Scopus (293) Google Scholar, 3Lim K. Small Jr., W. Portelance L. et al.Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive of treatment of cervix cancer.Int J Radiat Oncol Biol Phys. 2011; 79: 348-355Abstract Full Text Full Text PDF PubMed Scopus (290) Google Scholar). These represent contentious areas where physicians may need some reassurance and hand-holding.Also apparent glancing at the “Top 10” is a thirst among practitioners to become better radiographic anatomists (4Hall W.H. Guiou M. Lee N.Y. et al.Development and validation of a standardized method for contouring the brachial plexus: preliminary dosimetric analysis among patients treated with IMRT for head-and-neck cancer.Int J Radiat Oncol Biol Phys. 2008; 72: 1362-1367Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar, 5Kong F.M. Ritter T. Quint D.J. et al.Consideration of dose limits for organs at risk thoracic radiotherapy: atlas for lung, proximal bronchial tree, esophagus, spinal cords, ribs, and brachial plexus.Int J Radiat Oncol Biol Phys. 2011; 81: 1442-1457Abstract Full Text Full Text PDF PubMed Scopus (227) Google Scholar). This is essential if we are to take greatest advantage of the precision treatment technologies now available to us. One of the most popular sessions at the ASTRO annual meeting for several years has been the e-contouring course and the American Board of Radiology is now “enriching” both its written and oral exams with images to emphasize this great shift in our practice.Critical Reviews of the literature remain both popular and valuable particularly in controversial or rapidly evolving areas such as the role of radiation in the treatment of pelvic lymph nodes in advanced prostate cancer and the role of radiation in melanoma (6Khan N. Khan M.K. Almasan A. et al.The evolving role of radiation therapy in the management of malignant melanoma.Int J Radiat Oncol Biol Phys. 2011; 80: 645-654Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar, 7Morikawa L.K. Roach 3rd, M. Pelvic nodal radiotherapy in patients with unfavorable intermediate and high-risk prostate cancer: evidence, rationale, and future directions.Int J Radiat Oncol Biol Phys. 2011; 80: 6-16Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar). Translational research is now bearing fruit and entering the clinic and this is clearly reflected in the popularity of a comprehensive review of epidermal growth factor biology (8Herbst R.S. Review of epidermal growth factor receptor biology.Int J Radiat Oncol Biol Phys. 2004; 59: 21-26Abstract Full Text Full Text PDF PubMed Scopus (991) Google Scholar).The physics community has been superb at incorporating normal tissue risk into the models we now use daily in the clinic. The models are increasingly sophisticated and it is no surprise to find that the work of the QUANTEC group (9Marks L.B. Yorke E.D. Jackson A. et al.Use of normal tissue complication probability models in the clinic.Int J Radiat Oncol Biol Phys. 2010; 76: S10-S19Abstract Full Text Full Text PDF PubMed Scopus (1067) Google Scholar, 10Bentzen S.M. Constine L.S. Deasy J.O. et al.Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues.Int J Radiat Oncol Biol Phys. 2010; 76: S3-S9Abstract Full Text Full Text PDF PubMed Scopus (687) Google Scholar) is both relevant and popular. The advent of 3-dimensional (3D) treatment planning necessitated that physicians and planners make decisions based on 3D data. In 1991, investigators pooled their clinical experience, and available information, to produce the famous ‘‘Emami paper'’, that provided estimates for dose, volume, and outcome to help guide clinical practice. In subsequent years, numerous studies reported associations between dose-volume parameters and normal tissue. QUANTEC (quantitative analysis of normal tissue effects in the clinic) aimed to summarize the subsequently these data in a clinically-useful manner, to help facilitate safe clinical practice. The data are not perfect, and the reviews contain many caveats, but the QUANTEC papers provide a concise review of the available data for many organs, in a clear, logical and accessible manner.Tabled 1RankArticle title1Lutz et al. Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline 1Lutz S. Berk L. Chang E. et al.Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline.Int J Radiat Oncol Biol Phys. 2011; 79: 965-976Abstract Full Text Full Text PDF PubMed Scopus (643) Google Scholar 2011.2Lim et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive of treatment of cervix cancer 3Lim K. Small Jr., W. Portelance L. et al.Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive of treatment of cervix cancer.Int J Radiat Oncol Biol Phys. 2011; 79: 348-355Abstract Full Text Full Text PDF PubMed Scopus (290) Google Scholar 2011.3Marks et al. Use of normal tissue complication probability models in the clinic 9Marks L.B. Yorke E.D. Jackson A. et al.Use of normal tissue complication probability models in the clinic.Int J Radiat Oncol Biol Phys. 2010; 76: S10-S19Abstract Full Text Full Text PDF PubMed Scopus (1067) Google Scholar 2010.4Kong et al. Consideration of dose limits for organs at risk thoracic radiotherapy: atlas for lung, proximal bronchial tree, esophagus, spinal cords, ribs, and brachial plexus 5Kong F.M. Ritter T. Quint D.J. et al.Consideration of dose limits for organs at risk thoracic radiotherapy: atlas for lung, proximal bronchial tree, esophagus, spinal cords, ribs, and brachial plexus.Int J Radiat Oncol Biol Phys. 2011; 81: 1442-1457Abstract Full Text Full Text PDF PubMed Scopus (227) Google Scholar 2011.5Bentzen et al. Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues 10Bentzen S.M. Constine L.S. Deasy J.O. et al.Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues.Int J Radiat Oncol Biol Phys. 2010; 76: S3-S9Abstract Full Text Full Text PDF PubMed Scopus (687) Google Scholar 2010.6Hall et al. Development and validation of a standardized method for contouring the brachial plexus: preliminary dosimetric analysis among patients treated with IMRT for head-and-neck cancer 4Hall W.H. Guiou M. Lee N.Y. et al.Development and validation of a standardized method for contouring the brachial plexus: preliminary dosimetric analysis among patients treated with IMRT for head-and-neck cancer.Int J Radiat Oncol Biol Phys. 2008; 72: 1362-1367Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar 2008.7Herbst et al. Review of epidermal growth factor receptor biology 8Herbst R.S. Review of epidermal growth factor receptor biology.Int J Radiat Oncol Biol Phys. 2004; 59: 21-26Abstract Full Text Full Text PDF PubMed Scopus (991) Google Scholar 2004.8Morikawa et al. Pelvic nodal radiotherapy in patients with unfavorable intermediate and high-risk prostate cancer: evidence, rationale, and future directions 7Morikawa L.K. Roach 3rd, M. Pelvic nodal radiotherapy in patients with unfavorable intermediate and high-risk prostate cancer: evidence, rationale, and future directions.Int J Radiat Oncol Biol Phys. 2011; 80: 6-16Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar 2011.9Small et al. Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer 2Small Jr., W. Mell L.K. Anderson P. et al.Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer.Int J Radiat Oncol Biol Phys. 2008; 71: 428-434Abstract Full Text Full Text PDF PubMed Scopus (293) Google Scholar 2008.10Khan et al. The evolving role of radiation therapy in the management of malignant melanoma 6Khan N. Khan M.K. Almasan A. et al.The evolving role of radiation therapy in the management of malignant melanoma.Int J Radiat Oncol Biol Phys. 2011; 80: 645-654Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar 2011. Open table in a new tab While an individual paper's total number of formal citations is recognized to be the “gold standard” for a paper's impact, citations may take years to accumulate. A more useful snapshot of a paper's immediate impact is to count the number of downloads, an easy statistic to obtain. A quick glance at the top 10 most downloaded articles in 2011 gives an extraordinary look at the papers that the radiation oncology community has found to be the most relevant to its work and practice. We do not, of course, know what proportion of these downloads are being made by practicing physicians as opposed to physicists, researchers, or by those in other specialties. A glance at the top 10 titles, however, suggests that it is the first category that dominates. The Red Journal, while having a strong research emphasis, is also at heart the journal that defines and shapes our practice. Guidelines are a critical component of contemporary practice. At a time when the specialty is “morphing” rapidly and struggling to incorporate multiple new technologies, guidelines developed by expert panels according to a strict methodology, help to keep us on track. All medical specialties have been guilty of the overexuberant use of therapy and payers are starting to question whether our practice is truly evidence-based. Their interpretation is becoming a way in which reimbursement can be restricted. It is, thus, incumbent upon the specialty societies such as our sponsor, the American Society for Radiation Oncology (ASTRO) and others like the American College of Radiology (ACR) to generate clear and credible guidelines that can be accepted by both physicians and payers. Among the “Top 10”, therefore, we see ASTRO's guideline on the palliation of bone metastases (1Lutz S. Berk L. Chang E. et al.Palliative radiotherapy for bone metastases: an ASTRO evidence-based guideline.Int J Radiat Oncol Biol Phys. 2011; 79: 965-976Abstract Full Text Full Text PDF PubMed Scopus (643) Google Scholar) and 2 guidelines on pelvic radiation therapy for cervix cancer (2Small Jr., W. Mell L.K. Anderson P. et al.Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy in postoperative treatment of endometrial and cervical cancer.Int J Radiat Oncol Biol Phys. 2008; 71: 428-434Abstract Full Text Full Text PDF PubMed Scopus (293) Google Scholar, 3Lim K. Small Jr., W. Portelance L. et al.Consensus guidelines for delineation of clinical target volume for intensity-modulated pelvic radiotherapy for the definitive of treatment of cervix cancer.Int J Radiat Oncol Biol Phys. 2011; 79: 348-355Abstract Full Text Full Text PDF PubMed Scopus (290) Google Scholar). These represent contentious areas where physicians may need some reassurance and hand-holding. Also apparent glancing at the “Top 10” is a thirst among practitioners to become better radiographic anatomists (4Hall W.H. Guiou M. Lee N.Y. et al.Development and validation of a standardized method for contouring the brachial plexus: preliminary dosimetric analysis among patients treated with IMRT for head-and-neck cancer.Int J Radiat Oncol Biol Phys. 2008; 72: 1362-1367Abstract Full Text Full Text PDF PubMed Scopus (100) Google Scholar, 5Kong F.M. Ritter T. Quint D.J. et al.Consideration of dose limits for organs at risk thoracic radiotherapy: atlas for lung, proximal bronchial tree, esophagus, spinal cords, ribs, and brachial plexus.Int J Radiat Oncol Biol Phys. 2011; 81: 1442-1457Abstract Full Text Full Text PDF PubMed Scopus (227) Google Scholar). This is essential if we are to take greatest advantage of the precision treatment technologies now available to us. One of the most popular sessions at the ASTRO annual meeting for several years has been the e-contouring course and the American Board of Radiology is now “enriching” both its written and oral exams with images to emphasize this great shift in our practice. Critical Reviews of the literature remain both popular and valuable particularly in controversial or rapidly evolving areas such as the role of radiation in the treatment of pelvic lymph nodes in advanced prostate cancer and the role of radiation in melanoma (6Khan N. Khan M.K. Almasan A. et al.The evolving role of radiation therapy in the management of malignant melanoma.Int J Radiat Oncol Biol Phys. 2011; 80: 645-654Abstract Full Text Full Text PDF PubMed Scopus (54) Google Scholar, 7Morikawa L.K. Roach 3rd, M. Pelvic nodal radiotherapy in patients with unfavorable intermediate and high-risk prostate cancer: evidence, rationale, and future directions.Int J Radiat Oncol Biol Phys. 2011; 80: 6-16Abstract Full Text Full Text PDF PubMed Scopus (66) Google Scholar). Translational research is now bearing fruit and entering the clinic and this is clearly reflected in the popularity of a comprehensive review of epidermal growth factor biology (8Herbst R.S. Review of epidermal growth factor receptor biology.Int J Radiat Oncol Biol Phys. 2004; 59: 21-26Abstract Full Text Full Text PDF PubMed Scopus (991) Google Scholar). The physics community has been superb at incorporating normal tissue risk into the models we now use daily in the clinic. The models are increasingly sophisticated and it is no surprise to find that the work of the QUANTEC group (9Marks L.B. Yorke E.D. Jackson A. et al.Use of normal tissue complication probability models in the clinic.Int J Radiat Oncol Biol Phys. 2010; 76: S10-S19Abstract Full Text Full Text PDF PubMed Scopus (1067) Google Scholar, 10Bentzen S.M. Constine L.S. Deasy J.O. et al.Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): an introduction to the scientific issues.Int J Radiat Oncol Biol Phys. 2010; 76: S3-S9Abstract Full Text Full Text PDF PubMed Scopus (687) Google Scholar) is both relevant and popular. The advent of 3-dimensional (3D) treatment planning necessitated that physicians and planners make decisions based on 3D data. In 1991, investigators pooled their clinical experience, and available information, to produce the famous ‘‘Emami paper'’, that provided estimates for dose, volume, and outcome to help guide clinical practice. In subsequent years, numerous studies reported associations between dose-volume parameters and normal tissue. QUANTEC (quantitative analysis of normal tissue effects in the clinic) aimed to summarize the subsequently these data in a clinically-useful manner, to help facilitate safe clinical practice. The data are not perfect, and the reviews contain many caveats, but the QUANTEC papers provide a concise review of the available data for many organs, in a clear, logical and accessible manner.