Radiation Oncology Department Research Articles

P-62 A CASE OF PAPILLARY THYROID CARCINOMA WITH ISOLATED BONE METASTASES

Abstract Introduction Thyroid carcinomas constitute less than 3% of all cancers (1). Papillary thyroid carcinoma (PTC) accounts for 80% of thyroid carcinomas and generally has a good prognosis(2). Lymph node metastases are frequently observed in thyroid cancers(30-40%). However, distant metastases are quite rare(1-4%)(2). Clinical Case A 52-year-old female patient presented to the neurosurgery department due to back pain of approximately 2 months. A mass lesion was observed in the T9 vertebral body on a thoracic CT scan, which was destroying the bone structure, causing a compression fracture in the vertebra, and extending into the spinal canal. A total laminectomy of T9 vertebra and partial laminectomies of T8 and T10 vertebrae were performed. Pathology revealed strongly positive for Vimentin, TTF-1, Thyroglobulin, and Pax 8, consistent with carcinoma metastasis. It was recommended to perform a whole-body scan, primarily focusing on the thyroid gland. PET-CT, thoracic and abdominal CT scans revealed a 62x48 mm metastatic lesion in the right iliac bone and metastatic involvement of the T9 vertebra, with no other pathological findings. The patient's history revealed that she had undergone a total thyroidectomy six years ago, and the result was reported as benign. She was on levothyroxine sodium replacement therapy. Blood tests revealed TSH: 0.288 (0.27-4.2 µIU/ml), T4: 18.7 (12-22 pmol/L), T3: 4.78 (3.1-6.8 pmol/L), Anti-Thyroglobulin Antibody: 60.8 (0-115 IU/ml), and Thyroglobulin: >500 (3.5-77 ng/ml). Neck ultrasonography did not reveal any residual thyroid tissue or pathological lymph nodes. Given the suspicion of thyroid carcinoma metastasis and high thyroglobulin levels, the pathology preparations of the total thyroidectomy were re-consulted by our hospital's pathology department. The pathology result was consistent with papillary thyroid carcinoma composed of 55% follicular subtype and 45% solid/trabecular subtype. As surgery for the iliac bone metastasis was not considered appropriate, the patient was referred to the nuclear medicine department for radioactive iodine therapy and to the radiation oncology department for radiotherapy. The nuclear medicine, radiation oncology, and our department continue to follow up and treat the patient. Conclusion PTC is generally a slowly progressing cancer with a good prognosis. The most common site of metastasis in all PTC cases is the cervical lymph node, and only 3.5-3.8% have distant metastases(3). Distant metastases are most commonly seen in the lungs (53.4%), followed by bones (28.1%), liver (8.3%), and brain (4.7%) (1,4). Distant metastases significantly increase mortality from PTC. Therefore, the importance of adjuvant therapy (endocrine therapy, radiotherapy, etc.) and regular follow-up after thyroid cancer surgery should be emphasized. It should be kept in mind that, as in our case, papillary thyroid carcinomas can also present with isolated bone metastases without cervical lymph node metastases.

Impact of microgeography on communication dynamics in a healthcare environment

BackgroundFor growing healthcare organisations, anchored resources—assets that are not easily movable—may complicate expansion and distort workflow patterns. We examine work patterns at a radiation oncology department of a major Canadian...

SEMI-AUTOMATED EXTRACTION OF RESEARCH TOPICS AND TRENDS FROM NCI FUNDING IN RADIOLOGICAL SCIENCES FROM 2000-2020.

Investigators and funding organizations desire knowledge on topics and trends in publicly funded research but current efforts for manual categorization have been limited in breadth and depth of understanding. We present a semi-automated analysis of 21 years of R-type National Cancer Institute (NCI) grants to departments of radiation oncology and radiology using natural language processing (NLP). We selected all non-education R-type NCI grants from 2000 to 2020 awarded to departments of radiation oncology/radiology with affiliated schools of medicine. We used pre-trained word embedding vectors to represent each grant abstract. A sequential clustering algorithm assigned each grant to one of 60 clusters representing research topics; we repeated the same workflow for 15 clusters for comparison. Each cluster was then manually named using the top words and closest documents to each cluster centroid. The interpretability of document embeddings was evaluated by projecting them onto 2 dimensions. Changes in clusters over time were used to examine temporal funding trends. We included 5,874 grants totaling 1.9 billion dollars of NCI funding over 21 years. The human-model agreement was similar to the human interrater agreement. Two-dimensional projections of grant clusters showed two dominant axes: physics-biology and therapeutic-diagnostic. Therapeutic and physics clusters have grown faster over time than diagnostic and biology clusters. The three topics with largest funding increase were Imaging biomarkers, Informatics, and Radiopharmaceuticals, which all had a mean annual growth of >$218,000. The three topics with largest funding decrease were Cellular stress response, Advanced imaging hardware technology, and Improving performance of breast cancer computer-aided detection (CAD), which all had a mean decrease of >$110,000. We developed a semi-automated NLP approach to analyze research topics and funding trends. We applied this approach to NCI funding in the radiological sciences to extract both domains of research being funded and temporal trends.

A Study On Clinical Response And Toxicity In Locally Advanced Head And Neck Cancers

Background: Treatment of locally advanced head and neck cancer is a clinical challenge and requires aggressive and concerted measures. Radiotherapy with concurrent chemotherapy is the standard curative treatment strategy for the locally advanced head and neck cancer. The ultimate aim of radiation therapy is the maximum local control of the tumour with minimal toxicity. Objectives: To assess the clinical response of treatment using Response Evaluation Criteria In Solid Tumors (RECIST) (version1.1) criteria. To assess the toxicities among the study population during chemo-radiation. Methodology: Hospital based observational prospective study was conducted at Department of Radiation oncology, in a Tertiary cancer care centre among Head and neck Cancer patients. Results: Most common site of head and neck cancer in the study was oral cavity followed by oropharynx and hypo pharynx. At the end of 4th week 58.33% had grade1 and 33.33% grade 2 mucositis. Response to treatment was found to be statistically significant. Conclusion: Mucositis was significant toxicities during treatment followed by dysphagia and radiation dermatitis. Complete response is seen in 50% of the patients clinically and radiologically. No patient died during treatment or at follow up.

Patient-Reported Distress in Individuals With Head and Neck Cancer

Distress is common among patients with cancer, and evidence of disparities associated with distress has been mixed. Head and neck cancer (HNC) is one of the most emotionally distressing cancers and is also a highly disparate disease. However, it is unknown whether there are disparities associated with patient-reported distress in HNC. To examine racial and sociodemographic factors associated with clinically meaningful distress in a cohort of patients with HNC. This retrospective cohort study analyzed data from a single tertiary institution at a National Cancer Institute-designated comprehensive cancer center in the Southeastern US. Participants included adult patients from January 2017 to December 2022 with confirmed diagnoses of head and neck squamous cell carcinoma who received radiation therapy up to 5 weeks from initial diagnosis. The outcome of interest was clinically meaningful distress (score of at least 4 on the distress thermometer). The distress thermometer is a single-item, self-reported tool used to measure a person's level of psychological distress over the past week, represented on a scale from 0 (no distress) to 10 (extreme distress). Patients were included in the study if they had visits with clinicians in the radiation oncology department within 5 weeks of diagnosis. Sociodemographic factors were race and ethnicity, age, sex, marital status, and health insurance status. Clinical variables (stage of presentation, anatomical subsites, smoking, and alcohol history) and problem list domain items were included in the adjusted model. Using multivariable logistic regression analysis, odds of meaningful distress by sociodemographic factors were estimated, adjusting for clinical factors and problem list domains. A total of 507 patients met the inclusion criteria. The study population included 389 male patients (76.7%). The median (IQR) age of participants was 63 (56-71) years, with a racial distribution of 89 Black patients (17.6%), 385 White patients (75.9%), and 33 patients of other categories (6.9%), including Asian, Native American, multiracial, declined to respond, and unknown. Overall, 232 patients (45.8%) had meaningful distress. The median (IQR) DT score for the entire cohort was 3 (0-6). Black patients had the highest rate of physical concerns (n = 31 [34.8%]) compared to the other racial groups (78 White patients [20.3%] and 7 persons of other race [21.2%]). However, in the final multivariable model, race was not significantly associated with clinically meaningful distress (Black compared with White: adjusted odds ratio [aOR], 0.76 [95% CI, 0.45-1.28]; other compared with White: aOR, 0.85 [95% CI, 0.37-1.94]). Compared to those married, unmarried patients were significantly more likely to report distress (aOR, 1.61 [95% CI, 1.05-2.50]). Also, patients with emotional problems had double the odds of reporting clinically meaningful distress (aOR, 2.03 [95% CI, 1.02-4.08]). Other factors associated with significant clinical distress included tobacco use (aOR, 2.14 [95% CI, 1.02-4.50]) and reported practical problems (aOR, 2.08 [95% CI, 1.17-3.69]). Independent of race or sociodemographic factors, the results of this retrospective cohort study underscore the need for social and emotional support in mitigating distress and optimizing mental health care in this patient population. Further studies should explore distress trajectories across the HNC continuum and their impact on HNC outcomes.

Comparative Study to Evaluate Irradiated Small Bowel Volume with or Without Using Belly Board During Treating Pelvic Malignancy in 3dcrt Technique

Gastrointestinal (GI) toxicity is the most frequently encountered complication of pelvic radiotherapy with clinically significant acute and late toxicity occurring in up to 60% and 20% of patients, respectively. The current study was conducted to assess and compare irradiated small bowel volume and dose between prone position using belly board and supine position without belly board in pelvic radiotherapy. Methods: It was a quasi-experimental study conducted at the department of Radiation Oncology of NICRH. Sixty patients of rectal and cervical malignancy were included in the study. They were enrolled in either arm A or arm B to receive radiotherapy to pelvis in supine position or prone position with belly board, respectively by 3DCRT technique. Results: There were no statistically significant differences in distributions of the patients across the two arms regarding age and other various demographic data, abdominal girth etc. Irradiated volume was significantly low in arm-B (5189cm3 vs. 3485cm3, <i>p-value</i><0.001). Small bowel volume which received 45Gy was also significantly low in arm-B (351cm3 vs. 191cm3, <i>p-value</i><0.001). Radiation dose to 195cm3 of small bowel volume was 53Gy vs. 36Gy in arm-A and arm-B respectively (<i>p-value</i><0.001). Conclusion: Using belly board in prone position is comfortable, inexpensive, highly reproducible, and permits maximal bowel displacement from standard pelvic radiotherapy fields.

Reirradiation Practice in Gynecological Cancer: Insights from a National Survey in Spain.

Given the lack of standardisation in gynecological cancer reirradiation, the Gyneacologial Radiation Oncology (GINECOR) working group on behalf of the Spanish Society of Radiation Oncology (SEOR), works towards to inquire the current state of reirradiation practices among the radiation oncology departments in Spain. An online 37-question survey was sent to all GINECOR members, representing most Spanish centers. The survey addressed general aspects of reirradiation, including experience, reirradiation sites, and techniques used. It included seven clinical case scenarios on reirradiation, and a final section on technical aspects of external beam radiotherapy (EBRT) and brachytherapy (BT) treatment. Descriptive statistics were used for data analysis. Out of 58 centers, 29 responded, with 51.7% performing ≥ 5 reirradiation cases annually. While most centers offer multiple techniques, only 16/29 have access to BT. For in-field local relapse with surgery contraindicated, 79.3% performed BT in endometrial cancer, but only 27.5% treated with BT in cervical cancer recurrence. In this case, 17.2% used SBRT. For endometrial and cervical cancer, 44.8% and 65.4% of centers prescribed doses based on organ-at-risk tolerance, respectively. For pelvic wall/parametrial in-field relapse, 46.4% of the centres reirradiated with stereotactic body radiotherapy (SBRT), and 32.1% with BT. In nodal reirradiation, SBRT was preferred by 90% of centers. Variability was observed in target volume definitions for EBRT and proton therapy. Reirradiation for gynecological cancer remains unstandardized, presenting significant challenges in clinical practice. To improve reirradiation protocols in gynecological cancer, the GINECOR working group is currently conducting a systematic review and formulating Delphi recommendations.

Short-term and long-term oncological outcomes of chemoradiotherapy for rectal cancer patients with or without oxaliplatin: a propensity score-matched retrospective analysis

Background/AimCurrent approaches for locally advanced rectal cancer (LARC) typically recommend neoadjuvant chemoradiotherapy (nCRT) with 5-fluorouracil (5FU) or its oral analogs followed by surgery as the standard of care. However, the question of whether intensifying concurrent chemotherapy by adding oxaliplatin to the 5FU-based backbone can yield better outcomes remains unresolved. This study aimed to investigate the benefits of incorporating oxaliplatin into fluoropyrimidine-based chemoradiotherapy (CRT) to increase locoregional control and survival.MethodsAmong 290 patients with LARC admitted to the Iran Cancer Institute’s radiation oncology department between January 2008 and December 2019, 29 received CAPEOX (capecitabine 625 mg/m²/bid on RT days and weekly oxaliplatin 50 mg/m²), whereas 293 received capecitabine (825 mg/m² twice daily or rarely 5FU in the first 4 days and last week of radiotherapy (RT)). Variables potentially affecting treatment outcomes were used for propensity score matching. Kaplan‒Meier and log-rank tests were employed for overall survival (OS) and disease-free survival (DFS) analyses and were adjusted with propensity score matching.ResultsData from 29 patients who received CAPEOX and 216 patients who received capecitabine were analyzed after propensity score matching without replacement. After propensity score matching, in the multivariate analysis, CAPEOX significantly increased the likelihood of achieving a pathologic complete response (pCR) by 4.38 times (CI: 1.90–10.08, p value < 0.001). However, CAPEOX did not demonstrate any statistically significant predictive value for DFS (P = 0.500) or OS (P = 0.449).ConclusionThe addition of oxaliplatin resulted in a significantly higher rate of pCR without any translation into long-term survival outcomes.

Comparison between The Efficacy of Concurrent Chemo-Radiation with Gemcitabine Followed by Intracavitary Radiotherapy in Patients with Locally Advanced Cervical Carcinoma

Introduction: Commonest threatening cancer in our Asian round is Cervical cancer. Currently, platinum-based concurrent chemo-radiation therapy is the standard of care for locally advanced cervical cancer but treatment results are disappointing, particularly for women with bulky tumors. To improve this result, several non-platinum-based agents with concurrent chemo-radiation have been evolved. Material and Methods: This was a quasi-experimental study, where 33 patients with untreated invasive squamous cell carcinoma of the cervix of stage IIB to stage IVA were enrolled in the study from the Radiation Oncology Department of Rajshahi Medical College Hospital from April 2019 to March 2020. Duration of the study was 2 years. All patients received 150 mg/m² of Gemcitabine weekly along with external beam radiation therapy (EBRT). EBRT dose was 50 Gy in 25 daily fractions followed by intracavitary radiotherapy (ICRT) of 21 Gy in 3 fractions. Results: The mean patient age was 45.4 years. Most patients were in stage IIB (59.1%) with moderately differentiated tumors (62.1%). After three months of treatment, 81.8% showed complete response, 12.1% partial response, and 6.1% disease progression. Grade 2 and 3 hematological toxicities were common, including anemia (60.6% grade 2; 24.2% grade 3) and neutropenia (24.2% grade 2; 6.1% grade 3). Other side effects included diarrhea (42.4%), proctitis (36.4%), skin toxicity (45.5%), mild renal toxicity (3%), and grade 2 cystitis (9.1%). Conclusion: Gemcitabine-based concurrent chemo-radiation is a potential alternative for patients contraindicated for Cisplatin. However, larger randomized studies are needed to confirm its safety and efficacy.

Characterizing Wellness Initiatives in Academic Radiation Oncology Departments

BackgroundBurnout is prevalent in radiation oncology (RO), and an increased focus on promoting physician wellness and formalizing wellness-directed efforts has transpired in recent years. We aim to characterize current wellness leadership positions and efforts within academic RO departments. MethodsAcademic RO department chairs were contacted with to inquire whether they had a departmental wellness leader with a request for leader contact information, if applicable. Wellness leaders were invited to complete an anonymous survey in January and February 2023 utilizing Qualtrics. Questions assessed leader demographics, role structure and resources, current initiatives, and impacts to date. Descriptive statistics and summaries of free text responses are reported. Results120 chairs were contacted. 71 (59%) responded with 43 (61%) having departmental wellness leaders, of which 17 (39.5%) responded to the survey. 70.6% were female and 76.5% were physician faculty. Most respondents were early-career. The most common previously implemented initiatives included offering programming and education (33.3%) and improved access to mental health services (25%). The most common active initiatives include conducting studies to address root causes of burnout (41.7%), develop specific wellness goals (25%), perform a review of policies that encourage prolonged work hours (25%), and offer programming and education (25%). Challenges included limited bandwidth (66.7%), lack of funding (41.7%), and lack of departmental interest in organizing or attending events (33.3%). Leaders highlight the importance of a dedicated individual to tangibly implement changes and the unique opportunity of someone within RO to understand the specific challenges faced by those in our field. DiscussionWellness leadership roles exist in many RO departments. Evidenced by a limited number of fully-implemented initiatives, these roles are new and evolving. A focus on wellness has the potential to bring positive change to departments, however the impact of newly established wellness roles on culture and balance requires longitudinal follow-up.

Comparison of Conventional Palliative Radiotherapy Fractionation Schedule with Quad Shot Regimen in Locally Advanced Head and Neck Cancer Patients: A Randomised Clinical Trial

Introduction: Head and Neck Cancer (HNC) accounts for 14.3% of all cancers in India and 4.8% of all cancers worldwide. In India, the most common sites are the lip and oral cavity (&gt;80%), which are more prevalent in men than in women. Histologically, most cases are Squamous Cell Carcinomas (SCC). The majority of patients present with locally advanced stages, where surgery and definitive chemoradiation therapy are not possible and palliative Radiotherapy (RT) is considered a treatment option for better symptomatic relief and improved Quality of Life (QoL). The Quad Shot (QS) palliative regimen has shortened treatment time, reduced toxicity and increased compliance. Aim: To compare the QS regimen administered over two consecutive days versus the Conventional Palliative Regimen in the treatment of locally advanced HNC, in terms of treatment response, acute toxicities and QoL. Materials and Methods: In this prospective randomised clinical trial conducted from May 2023 to July 2024 in the Department of Radiation Oncology at King George's Medical University (KGMU), Lucknow, Uttar Pradesh, India, patients with biopsyproven locally advanced carcinoma of the head and neck were recruited, with a sample size of 50 in each of the study Group B and control Group A arms. Patients in the control arm received 30 Gray (Gy) in 10 fractions, 5 fractions per week over two weeks (Conventional palliative arm). In the study arm, patients received 14 Gy in 4 fractions delivered in two daily sessions, six to eight hours apart, for two consecutive days over three cycles (QS arm). The Response Evaluation Criteria in Solid Tumours (RECIST) Criteria 1.1 was used to assess the tumour response objectively three months post-RT. Health-related QoL was assessed using questionnaires developed by the European Organisation for Research and Treatment of Cancer (EORTC), specifically the EORTC Quality of Life Questionnaire (QLQ). Continuous data were compared using the t-test for nominal data and the Mann-Whitney U test was used otherwise. Results: The mean age was 39.66±12.05 years in Group A and 42.76±11.65 years in Group B. The QS and conventional palliative arms each had 47 and 49 patients recruited, respectively. The QS arm exhibited fewer instances of skin toxicity, with 25 (53.2%) experiencing Grade I and 7 (14.9%) experiencing Grade II toxicity, compared to the conventional palliative arm, where 30 (61.2%) had Grade I and 12 (24.5%) had Grade II toxicity. Mucositis in the QS arm included 22 (46.9%) cases, with 14 (29.7%) classified as Grade I and Grade II, whereas the conventional arm had 12 (24.5%) Grade I cases, 29 (59.5%) Grade II cases and 3 (6.1%) Grade III cases. The treatment response, in terms of partial and stable disease combined, was observed in 61.2% of the conventional arm compared to 78.7% in the QS arm. QoL was reported to be better in the QS regimen post-treatment. Conclusion: Given the total number of patients recruited, the QS arm, with its shorter treatment time, demonstrated better benefits in terms of reduced toxicities and improved treatment response, as well as enhanced QoL compared to the conventional palliative arm.

Synaptive Magnetic Resonance Imaging for Stereotactic Radiosurgery.

Introduction The Synaptive magnetic resonance imaging (MRI) system (Synaptive Medical, Toronto, Canada) is a midfield 0.5 T head-only scanner for imaging the head and neck in adults and pediatrics. The system received US FDA and Health Canada clearance for clinical use in 2020. Initial installations occurred at sites throughout Canada with the first international installation occurring in the USA at Hackensack Meridian's Jersey Shore University Medical Center (JSUMC) in October 2023. The design of the Synaptive MRI allows the system to be installed and operated outside the context of standard Radiology facilities. In this study, we describe the implementation and adaptation of the Synaptive MRI into the cranial stereotactic radiosurgery (SRS) workflow, with the intention of reducing the time between consultation, MRI, and treatment. Methods The Synaptive MRI was installed next to the cranial SRS suite in the Radiation Oncology (RO) department, dedicated solely to SRS planning image acquisition.Geometric distortion was evaluated using the Magphan 128 Distortion Phantom (Phantom Laboratory, Greenwich, NY). The simplicity of the Synaptive interface allows Radiation Therapist operation, in the State of New Jersey, without the need for the physical presence of an MRI technologist.During imaging acquisition, the Physician verifies image quality and can rescan or make adjustments as needed, allowing for instantaneous confirmation of image quality. The Synaptive comes with a full set of neuro pulse sequences and protocols ranging from T1 3D spoiled gradient recalled echo to time-of-flight magnetic resonance angiography. Patient MRI comfort was evaluated after treatment by questionnaire for 51 patients using a Likert scale from 1 to 5 (1 = "very poor", 5 = "very good").The total Synaptive MRI time for 38 patients was tracked from arrival at the MRI suite to completion of imaging.Times from consult, imaging, and treatment for 58 ZAP-X(ZAP Surgical Systems, Inc., San Carlos, CA) SRS patients at JSUMC RO in 2024 who received Synaptive MRI were obtained from Aria (Varian Medical Systems, Palo Alto, CA) electronic medical records. JSUMC RO Departmental data was obtained on times from consult, imaging, and treatment for 58 randomly sampled patientsfrom 2018 to 2023whose treatment planning imaging was performed on out-of-department MRI units for comparison. Results The distortions on this system are less than 0.52 mm, for distances up to 90 mm from the isocenter.The average MRI comfort was4.7 ± 0.5. The average total MRI time for 38 patients was 36 ± 3 minutes.The median time for 58 ZAP-X SRS patients from MRI to treatment was seven days (interquartile range: p25 = six days, p75 = 10 days), consult to MRI 1.5 days (p25 = 0 days, p75 = nine days), and consult to treatment 12 days (p25 = seven days, p75 = 19 days). The median time for 34 malignant ZAP-X SRS patients from MRI to treatment was six days (p25 = five days, p75 = eight days) and from consult to treatment nine days (p25 = six days, p75 = 18 days). Significant decreases in MRI to treatment times (P < 0.001) and benign consult to MRI times (P = 0.0039) were demonstrated for 2024 Synaptive patients compared to 2018-2023 patients. Conclusion Dedicated Synaptive MRI installation for SRS in ROdepartments can improve the SRS workflow, potentially providing a more streamlined experience and reducing the time from diagnosis and imaging to treatment for cranial pathologies.

A Study on Breast Cancer Patient Care Using Chatbot and Video Education for Radiation Therapy: A Randomized Controlled Trial.

This study aimed to evaluate the use of chatbot and video education to reduce anxiety in patients with breast cancer undergoing radiation therapy (RT). This randomized controlled trial included patients with breast cancer scheduled for RT after surgery at an outpatient department of radiation oncology in a cancer center, randomly assigned to 4 groups: (1) video + chatbot, (2) video + paper, (3) paper + chatbot, and (4) paper + paper. In each group, patients received information regarding the treatment process and were frequently asked questions using the designated tool. Patient anxiety was evaluated using the Amsterdam preoperative anxiety and information scale (APAIS), state-trait anxiety inventory (STAI), and linear analog scale assessment (LASA) at 3 points: (1) initial outpatient visit (T0), (2) before the RT course (T1), and (3) after the RT course (T2). The primary endpoint was APAIS, and the secondaries were STAI and LASA. A mixed-model repeated-measures ANOVA was conducted with time as a within-group factor and treatment conditions as a between-group factor. The final analysis included 145 patients. No significant interaction was observed between groups and time for the APAIS, STAI, or LASA. Although unplanned, analyses were conducted using the age of 50 years as the cutoff, based on a previous systematic review of digital literacy in the medical field. A trend toward reduced APAIS was found among patients aged ≤50 years who used the chatbot (per-protocol subgroup). In the video + chatbot group, the APAIS score decreased from 3.06 (T0) to 1.88 (T2); in contrast, in the paper + paper group, it decreased from 2.42 (T0) to 2.06 (T2). In contrast, no significant interaction was observed in the APAIS of per-protocol patients aged ≥50 years. Overall, no significant differences were found in the effectiveness of different types of educational media in reducing patients' anxiety. However, for young patients who actively use video or chatbot resources, education through digital media may meaningfully reduce their anxiety during the RT process.

Enhancing safety: Multi-institutional FMEA and FTA on -based radio-pharmaceutical therapy.

This study investigates potential failure modes and conducts failure mode and effects analysis (FMEA) and fault tree analysis (FTA) on the administration of DOTATATE (LUTATHERA) and PSMA-617 (PLUVICTO). The quality management (QM) process in radiopharmaceutical therapies (RPTs) requires collaboration between nuclear medicine (NM) and radiation oncology (RO) departments. As part of a multi-institutional study, we surveyed various departments to identify and analyze failure modes, leading to a proposed comprehensive QM program. RPT teams in RO or NM clinics can benefit from this study by continually improving theirpractice. We reviewed the literature to investigate the administration of Pluvicto and Lutathera, focusing on prospective procedural failures and potential failure modes (PFMs) and their outcomes. We distributed an FMEA survey to multiple experienced centers in -based RPTs and calculated risk priority number (RPN) for various PFM. We conducted an FTA using this information to pinpoint the root causes of potentialfailures. The findings from the literature review and survey responses on the prospective study have identified several critical areas at risk of failure. These areas include non-optimized treatment delivery, inadequate patient monitoring, and lack of safety training, leading to radiation contamination from the dose excreted by the patients after treatment administration. A segmented FTA was created based on the FMEA results, focusing on radiation contamination with a high RPN value. By identifying the root causes of failures and proposing targeted improvements to the existing QM measures, this analysis enhances safety in treatment delivery of -based RPTs. Given the limited number of prospective risk analysis studies in RPTs, our research addresses the necessity for more such studies and recommends methods to apply this study to otherRPTs.

The assessment of psychosocial distress in hospitalized cancer patients during radio-oncological treatment: a monocentric experience study.

This study investigated the prevalence and determinants of psychosocial distress among hospitalized patients undergoing radiotherapy to identify opportunities for interventions to enhance patient well-being. Between January 2021 and May 2023, 137 hospitalized patients received radiotherapy treatment at the Department of Radiation Oncology of the Fondazione A. Gemelli IRCCS were recruited. Participants completed a questionnaire comprising the Distress Thermometer (DT) and the Hospital Anxiety and Depression Scale (HADS). The study revealed a significant correlation among anxiety, depression, total HADS scores, and Distress Thermometer scores (p < 0.001). Female patients exhibited higher total HADS scores and anxiety levels compared to males (p < 0.004, p < 0.010, respectively). Sleep disturbances were associated with increased anxiety, depression, and overall distress (p < 0.05). Younger patients (< 65years old) demonstrated elevated anxiety and depression levels, while no significant depressive tendency was observed among older participants (> 65years old). These findings underscore the intricate interplay between demographic variables, psychological distress, and treatment-related symptoms among patients during radiotherapy treatments. The study highlights the critical necessity of promptly identifying and addressing psychosocial distress in this population. It suggests that implementing a psychological therapeutic approach, particularly one focused on support, could effectively deter the onset of depression, especially among younger patients. Future research should focus on longitudinal studies to explore distress trajectories and interventions' effectiveness in mitigating distress, with collaborative efforts to translate research findings into evidence-based clinical practice for improved patient care.

Review of Quality Audit in a Radiation Oncology Department in a Tertiary Care Hospital- 2 Year-Results.

This study aimed to report the findings of comprehensive weekly quality audit of radiotherapy procedures conducted at our institute, assessing various domains including clinical notes, contour delineation, treatment planning, prescription accuracy, patient-specific quality assurance, and treatment set-up checks. The audit protocol, based on the Peer Review Audit Tool (PRAT) from the Royal Australian and New Zealand College of Radiologists, evaluated six critical parameters: clinical decisions, contours, treatment prescriptions, plan evaluation, plan quality assurance, and daily treatment set-ups. Patients were assessed for changes categorized as no change, minor change, or major change. The audit panel comprised radiation oncologists, medical physicists, and therapists. The audit is conducted on a weekly basis, including patients who initiated treatment within the preceding week. Between December 2020 to October 2023, 1831 cases were treated with radiotherapy in our institution and all of them were included in the quality audit. Overall, majority of patients exhibited no changes across various domains, with minor adjustments noted in a small percentage of cases. Notably, the clinical note check domain showed 99% adherence to standards, while contour delineation and treatment planning domains displayed minor adjustments in 2.7% and 1.7% of cases, respectively. Prescription accuracy and patient-specific quality assurance demonstrated high compliance, with minimal changes observed. Treatment set-up checks revealed minor variations in 0.3% and major changes in 0.2% of cases. This study underscores the importance of comprehensive quality audits in radiation oncology to ensure precision and consistency in treatment delivery. By identifying potential areas for improvement and maintaining high standards across all stages of the radiotherapy process, such audits play a crucial role in optimizing treatment outcomes and enhancing patient safety.

A Case Report and Literature Review of Metastatic Small Cell Carcinoma in Parotid Gland

Small cell lung cancer usually presents as a progressive disease in over 70% of patients. Common organs of metastasis include the liver, adrenal glands, bones, and brain. However, metastasis to the parotid gland is uncommon, as it has been discussed only in case reports. Among all parotid tumors, small cell cancer is rare, seen in only 1.7%.A 60-year-old man presented with a slow-growing, painless tumor of the left parotid gland and peripheral facial paralysis. Neck ultrasound identified a solid mass in the left parotid gland with enlarged lymph nodes in the parotid gland and ipsilateral neck lymphadenopathies with pathologic features in levels 2 and 3. Chest computed tomography (CT) demonstrated subsegmental collapse in the lingula with peribronchial cuffing in this lobe and mild cylindrical bronchiectatic changes in the left lower lobe. CT also showed multiple mediastinal lymphadenopa thies in prevascular, paraaortic, and paratracheal spaces. Core needle biopsy was done, and initial analysis revealed small cell carcinoma in the left parotid gland. Immunohistochemical analysis of the specimen demonstrated and confirmed the diagnosis. The patient was then referred to the radiation oncology unit for treatment. Chemotherapy was initiated with a combination of cisplatin and etoposide. No complications of the chemotherapy were observed after three cycles; treatment and follow-up are ongoing. No irradiation was performed after evaluation by the radiation oncology department. Due to the advanced stage of his disease, treatment is set for palliative purposes only. Small cell lung cancer diagnosed from solitary metastasis to the parotid gland is very rare. Physicians should keep pulmonary origin in mind when faced with a parotid tumor, as without careful examination, the primary focus may be overlooked, negatively impacting survival rates and the prognosis of the patient. Overall, this finding carries a poor prognosis, but the mainstay of treatment is palliation with systemic chemotherapy and possibly irradiation to control symptoms

Second Look Opportunity for Radiation Oncology Medical Residency During Virtual Interview Season

PurposeDespite easing of COVID-19 travel restrictions and social distancing, medical radiation oncology (RO) residency interviews for the 2023 Match remained exclusively virtual. Virtual interviews can be limited in providing program atmosphere, resident camaraderie, and city culture. Our institution offered a voluntary in-person second look (SL) to address these concerns and supplement the virtual interview. Methods and MaterialA voluntary in-person SL across 3 dates was offered to all applicants who successfully interviewed with the RO department for the 2023 Match (n=54). Attendees of the SLs (n=38) were invited to complete a voluntary 10-question anonymous survey after Match Day regarding their perspectives on this opportunity including motivations for attending, financial burden, and perceived benefits of SLs. Results38 individuals (70%) attended one of the departmental SLs with 19 participants (50%) completing the survey. 16 out of 19 (84%) participants traveled >200 miles to attend. All surveyed applicants were grateful for the in-person SL opportunity and agreed such opportunities should continually be offered with exclusively virtual residency interviews. All participants reported that their decision to attend the SL was affected by departmental financial support. Two applicants felt pressured to attend the SL to remain competitive to the program. Majority of applicants agreed that they achieved a better “feel” for the program culture and the larger institution, resident camaraderie, and the surrounding city from this in-person SL encounter, compared to virtual interview alone (18, 94%). ConclusionThese in-person second look opportunities were well-attended, well-received, and offered insights and experiences to RO resident applicants in the setting of exclusively virtual interviews. The cost of attendance may be a limiting factor when applicants are deciding to attend in-person SLs. Caution is needed to ensure applicants do not feel obligated to attend and SLs are not used as a platform for inappropriate post interview communication.

Assessing the practice of total neoadjuvant therapy for rectal cancer: an online survey among radiation oncology departments in Germany and German-speaking regions of Austria and Switzerland

Total neoadjuvant therapy (TNT) of rectal cancer improves rates of pathological complete remission and progression-free survival. With improved clinical response rates, interest grew in a non-operative approach/watch and wait (WaW) for this disease. In 2020, the working groups of ACO/AIO/ARO published a consensus statement on the use of TNT, including a non-operative approach. However, the best combination scheme remains unclear. Despite the increasing use of TNT, there is a lack of comprehensive data on its current implementation and practices. To address this knowledge gap, a multicenter survey was conducted to capture the use of TNT protocols in German-speaking radiotherapy departments. At the beginning of 2023, a GDPR-compliant online survey was conducted in Germany, Austria, and German-speaking Switzerland. The questionnaire comprised 43 questions covering various aspects of TNT, including chemotherapy and WaW concepts. Most respondents (98.4%) confirmed awareness of the consensus on TNT for rectal cancer. Institutions treated an average of 30.22 rectal cancer patients annually. Most respondents (76.2%) reported treating over 80% of patients neoadjuvantly. Regarding TNT, 33.3% treated 21–50% with such a protocol. No significant association was found between the institution type and TNT application. In 62/63 cases, tumor board discussion was standard before offering TNT. VMAT was the predominant technique (82.5%). For rectal cancer dosing, the 50/50.4Gy scheme was most common, followed by 45Gy with a boost and the 5 × 5Gy scheme. Dosing schemes for TNT varied slightly, with more participants reporting the use of 5 × 5Gy compared to radiation therapy for rectal cancer in general. CBCT was the primary IGRT method (88.9%). Larger hospitals typically administered chemotherapy themselves, while private practices collaborated with medical oncologists (p < 0.0001). The most common concurrent chemotherapy drugs were 5-fluorouracil/capecitabine (64.4%) and oxaliplatin (37.3%). A WaW strategy was reported to be institutional implemented by 63.8%. The timing of offering WaW was split, with 50% offering it after radiochemotherapy and 47% during the informed consent talk. For planned WaW, 62% prefer normofractionated TNT. TNT appears to be widely implemented in the German-speaking radio-oncological community, regardless of the type of institution. Image-guided therapy, multidisciplinary team decisions, and internal guidelines play an important role. TNT seems to have already altered treatment protocols for rectal cancer toward an organ-preserving approach in selected cases. In these WaW cases, normofractionation appears to be preferred over hypofractionation.

Socioeconomic and demographic factors predictive of same day access utilization in outpatient radiation oncology.

Access to medical care extends to not only the timely and appropriate receipt of services but also addresses inclusivity and underlying determinants of health. Given that patients from disadvantaged backgrounds have been shown to be more likely to experience delays in care, a same day access scheduling initiative was proposed to address this equity issue. Therefore, this study aims to evaluate our experience, focusing on identifying socioeconomic and demographic patterns of same day access utilization. From March 2021 to January 2023, all patients referred for new consultation to a tertiary care-based radiation oncology department were offered same day appointments as part of a prospective pilot initiative. Descriptive statistics were used to identify factors predictive of utilization. On multivariate analysis, patient characteristics independently associated with higher odds of same day access utilization included low-income status ([OR]=3.70, 95% CI (1.47-6.14)) and Black or Latino race ([OR]=4.05, 95% CI: 1.72-9.11). While we were unable to acquire data on actual clinical outcomes for patients opting for same day appointments, the enthusiasm for this program was obvious. Patients from disadvantaged backgrounds and vulnerable segments of the population were more likely to elect for same day appointments. Implications on health equity are discussed. Patient-centered approaches to overcome barriers of access can potentially help ensure that care is equitable. Our findings, representing the first published data analyzing a longitudinal experience with same day appointments in oncology, strongly suggest that certain disadvantaged populations may benefit more from access initiatives.