Radiation Treatment Facilities Research Articles

Association of Radiation Facility Volume with Overall Survival in Patients with Very High-Risk Prostate Cancer Treated with Radiation and Androgen Deprivation Therapy.

Studies suggest an association of treatment at high volume facilities with improved survival in cancer patients receiving surgery or radiation therapy. This association has not been studied in patients with very high-risk prostate cancer, who are treated using a multimodality approach that often requires specialized care with advanced diagnostic imaging, complex radiotherapeutic planning, and multidrug antiandrogen regimens. We used the National Cancer Database (NCDB) to study the association of radiation treatment facility volume (FV) with overall survival (OS). We selected for patients with very high risk, localized prostate cancer by NCCN criteria (cT3b-T4, primary Gleason pattern 5, >4 cores with grade group 4-5, and/or 2-3 high risk features). We included patients who received hormone therapy with either external beam radiation to a dose of ≥60 Gy or external beam radiation to a dose of ≥45 Gy combined with brachytherapy. Association of FV with OS was evaluated through a bias-adjusted log-rank test to identify the optimal cut point of FV for dichotomization. Kaplan-Meier curves were used to study the association of binary FV with overall survival (OS) with and without IPTW (inverse probability treatment weighting) balancing the following confounders: age, race, median income, education, insurance, academic treatment facility, Charlson comorbidity score, T stage, PSA, Gleason score, total radiation dose, year of diagnosis, and patient distance from treatment facility. Cox proportional hazards model was built using backward variable selection strategy (α of 0.05 for removal). We identified 25,219 very high-risk prostate cancer patients by NCCN criteria (median follow up 57.36 months; 95% CI 56.67 - 58.09) diagnosed between 2004 and 2015. High FV (n = 6,438) was associated with better OS on univariable analysis (hazard ratio [HR] = 0.81; 95% confidence interval [CI] 0.77 - 0.86; p < 0.001) and multivariable analysis (HR = 0.89; 95% CI 0.84 - 0.95; p < 0.001). Other factors associated with improved OS on multivariable analysis included younger age, non-white/black race, higher income, private insurance, academic/research treatment facility, lower comorbidity, lower T-stage, lower PSA, and lower Gleason score. After IPTW adjustment, high FV remained associated with better OS (HR = 0.90; 95% CI 0.85 - 0.95; p < 0.001). Patients with NCCN very high-risk prostate cancer treated at a radiation facility with high case volume had better OS than patients treated at a facility with low volume, after adjustment for confounders. This may suggest that for very high-risk patients, outcomes may be improved by the expertise and optimal multidisciplinary care that typically accompany high facility treatment volume.

Comparison of twice weekly palliative RT versus continuous hypofractionated palliative RT for painful bone metastases.

Palliative hypofractionated radiotherapy (RT) is an effective mode of treating painful bone metastasis. While 8 Gy single fraction radiation is often effective for the same, for complicated bone metastases a protracted fractionated regimen is preferred, of which 30 Gy/10#/2weeks or 20 Gy/5#/1 week are the most common worldwide. However such schedules add to the burden of already overburdened radiation treatment facilities in a busy center, wherein alternative logistic favourable schedules with treatment on weekends are preferred. Here we compare the efficacy of a twice weekly schedule to that of standard continuous 20 Gy/5 #/1 week schedule in terms of pain relief, response and quality of life. A prospective non randomized study was undertaken from Jan 2018 to May 2019, wherein eligible patients of complicated bone metastases received palliative radiotherapy of 20 Gy/5#, either continuously for 5 fractions from Monday to Saturday or twice weekly, Saturday and Wednesday, starting on a Saturday over about 2 weeks. Pain relief was assessed by the Visual Analogue Scale (VAS) and FACES pain scale recorded prior to starting palliative RT and at 4 weeks, 3 months and 6 months. Thirteen patients received continuous Hypofractionated RT while 16 received it in a twice weekly schedule. Spine was the most common site receiving palliative Radiation (27/29), while breast cancer was the most common primary (16/29). The demographic and the baseline characteristics were comparable. The mean pain score decline at 4 weeks was 2.56 ± 1.1 and 2.71 ± 0.52 in the 5-day and the two-week schedule, respectively (p = 0.67). A twice weekly schedule over about two weeks was found to be equivalent in pain control and response to the standard fractionated palliative radiation and, thus, can be safely employed in resource constrained, busy radiotherapy centers.

Distance to radiation therapy facility influences surgery type among older women with early-stage breast cancer.

Breast-conserving surgery plus radiation (BCT) yields equivalent or better survival than mastectomy for early-stage breast cancer (ESBC) women. However, nationwide mastectomy trends increased in recent decades, attracting studies on underlying causes. Prior research identified that long distance to the radiation treatment facility (RTF) was associated with mastectomy. Still, it is unclear whether such association applies to young and old ESBC women comparably. We sought to delineate such impacts by age. Women diagnosed with stages 0-II breast cancer in 2013-2017 receiving either BCT or mastectomy were identified from the Louisiana Tumor Registry. We assessed the association of surgery (mastectomy vs. BCT) with the distance to the nearest or nearest accessible RTFs using multivariable logistic regression adjusting the socio-demographic and tumor characteristics. The nearest accessible RTF was determined based on patients' health insurance. For Medicaid, uninsured, and unknown insurance patients, the nearest accessible RTF is the nearest RTF owned by the government. The interaction effect of age and distance was evaluated as well. Of 11,604 patients, 46.7% received mastectomy. Compared with distance ≤5miles to the nearest RTF, those with distance ≥40 miles or 15-40 miles had higher odds of mastectomy (adjusted (adj) OR=1.39, 95% CI=1.07-1.82; adj OR=1.17, 95% CI=1.02-1.34). To the nearest accessible RTF, the adj ORs were 1.25 (95% CI=1.03-1.51) and 1.19 (95% CI=1.04-1.35), respectively. Age-stratified analysis showed the significant association (p < 0.05) only presented among women aged ≥65, but not those aged <65 years. Distance to the nearest or nearest accessible RTF influences the surgery choice, especially among women in Louisiana ≥65 years with ESBC. Further understanding of factors leading to the decision for mastectomy in this age group is needed.

Current status and future prospects of radiation oncology in Sri Lanka

Purpose: To investigate the current status of radiation treatment facilities in Sri Lanka and to explore future possibilities required to adequately address increasing cancer care.Methods: Hospitals with radiation therapy facilities from across the country were identified. Data pertaining to the types of radiotherapy equipment, radiation oncology staffing, and radiotherapy education were collected by onsite visit, conversation over the phone, and from other available cancer resources in Sri Lanka.Results: Seven government hospitals and two private sectors were identified with radiation therapy facilities over nine provinces in Sri Lanka for 21.4 million people. At present, there are twenty megavoltage machines (MVMs) operating. This is 0.93 MVMs per one million people. After completion of proposed radiotherapy facilities, it will be able to provide 1.21 MVMs per million people. In addition, multidisciplinary staffing has also been identified as inadequate.Conclusions: There is a significant shortfall in radiotherapy facilities and workforce in Sri Lanka. The current and future scope of radiation facilities is sub-optimal compared to internationally recognized guidelines.

Daily waiting time management for modern radiation oncology department in Indian perspective.

Radiation therapy is one of the most technically sophisticated branch of medical sciences which caters to very ill patients, some of whom may be terminally ill. Since patients are treated on an outpatient basis which requires daily visit to hospital for a number of days, it can make them sensitive toward any increase in waiting time for their radiation treatment. This could be a source of stress for them. However, given the technical sophistication involved and varied clinical profile of patients, some amount of delay is inevitable. To compile and suggest strategies to manage patient waiting time in Radiation oncology department to achieve optimum patient' satisfaction. The radiation oncologists in different institutes of the country were interviewed telephonically and were asked about the practices followed in their institutes/ departments in managing the patient waiting time during radiation treatment. The best practices being followed and the suggestions were compiled. Now it is being recognized that meticulous management of waiting time could go a long way in driving patient's satisfaction. Twoway communications are the best strategy. Apart from this many provisions could be made in waiting area as per institutional preferences and protocol to engage patient in waiting area of radiation treatment facility.

Association between travel distance and use of postoperative radiation therapy among men with organ-confined prostate cancer: Does geography influence treatment decisions?

24 Background: Following radical prostatectomy, men with adverse pathologic features or a persistent post-operative detectable PSA are candidates for postoperative radiation therapy (PORT). Previous data have suggested disparities in receipt of adjuvant radiation therapy for adverse pathologic features according to travel distance. Among patients without adverse pathologic features (pT2 disease and negative margins), the main indication for PORT is a persistent post-operative detectable PSA. However, it remains unknown whether the rate of receipt of PORT in this cohort of men with persistently detectable PSA is related to travel distance from the treating facility. Methods: Using the National Cancer Database, we identified 287,274 men with prostate cancer diagnosed in 2004-2015 managed with upfront surgery who were found to have pT2 disease with negative surgical margins. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% confidence intervals (95CI) of receiving PORT as the primary dependent variable and distance ( &lt; 5, 5-10, 10-20, &gt; 20 miles from the treatment facility) as the primary independent variable. Results: Within our cohort, progressively farther distance from the treatment facility was associated with lower rates of PORT. In patients living &lt; 5 miles, 5-10 miles, 10-20 miles, and &gt; 20 miles from the treating facility, rates of PORT were 1.52% (referent), 1.23% (AOR 0.86, 95CI 0.78-0.96), 1.11% (AOR 0.81, 95CI 0.73-0.90), and 0.65% (AOR 0.43, 95CI 0.38-0.47), respectively (p &lt; 0.005 in pairwise comparisons). Conclusions: For men with localized prostate cancer without adverse pathologic features managed with surgery, increasing distance from treatment facility was associated with lower receipt of PORT. Given that the rate of a persistent post-operative detectable PSA is unlikely to depend on the distance to the treatment facility, these findings raise the possibility that the geographic availability of radiation treatment facilities influences the decision to undergo PORT for patients with persistent post-operative detectable PSA.

Association Between Travel Distance and Use of Postoperative Radiation Therapy Among Men With Organ-Confined Prostate Cancer: Does Geography Influence Treatment Decisions?

PurposeAfter radical prostatectomy, men with adverse pathologic features or a persistent postoperative detectable prostate-specific antigen (PSA) are candidates for postoperative radiation therapy (PORT). Previous data have suggested disparities in receipt of adjuvant radiation therapy for adverse pathologic features according to travel distance. Among patients without adverse pathologic features (pT2 disease and negative margins), the main indication for PORT is a persistent postoperative detectable PSA. However, it remains unknown whether the rate of receipt of PORT in this cohort of men with persistently detectable PSA is related to travel distance from the treating facility. Methods and MaterialsUsing the National Cancer Database, we identified 170,379 men with prostate cancer diagnosed from 2004 to 2015 managed with upfront surgery who were found to have pT2 disease with negative surgical margins. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% confidence intervals (CIs) of receiving PORT as the primary dependent variable and distance (<5, 5-10, 10-20, ≥20 miles from the treatment facility) as the primary independent variable. ResultsWithin our cohort, progressively farther distance from the treatment facility was associated with lower rates of PORT. In patients living <5 miles, 5 to 10 miles, 10 to 20 miles, and >20 miles from the treating facility, rates of PORT of were 1.37% (referent), 1.16% (AOR, 0.90; 95% CI, 0.79-1.04; P = .158), 0.98% (AOR, 0.80; 95% CI, 0.70-0.93; P = .003), and 0.64% (AOR, 0.47; 95% CI, 0.41-0.54; P < .001), respectively. ConclusionsFor men with localized prostate cancer without adverse pathologic features managed with surgery, increasing distance from treatment facility was associated with lower receipt of PORT. Given that the rate of a persistent postoperative detectable PSA is unlikely to depend on the distance to the treatment facility, these findings raise the possibility that the geographic availability of radiation treatment facilities influences the decision to undergo PORT for patients with persistent postoperative detectable PSA.

10-Year Survival after Breast-Conserving Surgery Compared with Mastectomy in Louisiana Women with Early-Stage Breast Cancer: A Population-Based Study

Louisiana has the third highest breast cancer mortality in the US, despite ranking 30th in incidence. Whether surgical approach contributes to such a poor outcome is unknown. We compared outcomes of breast-conserving surgery plus radiation (BCT) vs mastectomy (MST) for Louisiana women with early-stage breast cancer. Data on women diagnosed with Stage I-II breast cancer from 2004 to 2016 were analyzed from the Louisiana Tumor Registry. Overall survival (OS) and breast cancer-specific survival (CSS) were compared between BCT and MST. Kaplan-Meier method and log-rank test were used to compare survival curves, and logistic regression was used to examine the association ofsociodemographic and clinical factors with the type of breast cancer surgery. Values of p<0.05 were considered significant. Of the 18,260 patients, 9,968 patients (54.6%) had BCT and 8,292 patients (45.4%) had MST. Compared with BCT, the MST group tended to be underinsured/Medicare/Medicaid, more impoverished, had higher stage 2 disease, were more likely to reside in rural regions, travel ≥25 miles to radiation treatment facility, be treated at low volume centers, and have T3, node positive, and poorly differentiated tumors. Ten-year OS and CSS were significantly better among those who had BCT (OS: 80.0%; 95% CI: 79.0%-81.1%; CSS: 92.7%; 95% CI: 92.1%-93.4%) than those having MST (OS: 69.3%; 95% CI: 68.0%-70.5%; CSS: 88.8%:95% CI: 87.9%-89.7%) (p < 0.05). Even after controlling for sociodemographic and clinical variables, MST was associated with a 28.6% increased risk of death from all causes (hazard ratio [HR]:1.286; 95% CI:1.197-1.380) and a 29.8% increased risk of breast-cancer specific death (HR:1.298; 95% CI: 1.150-1.465). Surgical approach, a factor that is within the control of the surgeon, has an impact on mortality for Louisiana women with early-stage breast cancer.

Association Between Travel Distance and Use of Post-Operative Radiation Therapy Among Men With Prostate Cancer: Does Geography Influence Treatment Decisions?

Following radical prostatectomy (RP), men with a persistent post-operative PSA and select men with adverse pathologic features are candidates for postoperative radiation therapy (PORT). However, travel distance to radiation therapy facilities may negatively affect patient access to PORT. In this study, we investigated disparities in rates of PORT in men with high risk prostate cancer according to their distance from the treatment facility. Using the National Cancer Database, we identified 510,665 men with prostate cancer diagnosed 2004-2015 who have received RP. Multivariable logistic regression defined adjusted odds ratios (AORs) with 95% confidence intervals (95CI) of receiving PORT as the primary dependent variable and distance from the treatment facility as the primary independent variable. Patients were defined as living “far” from the treatment facility if they lived beyond the median distances of 9.1 miles for metro counties, 38.1 miles for urban counties, and 52.9 miles for rural counties; all others were categorized as “near.” Analyses were stratified by the presence of adverse pathologic features (pT3 disease or positive surgical margins) and type of county (rural vs urban vs metro). Patients living far from the treatment facility received PORT less frequently than those living near a treatment facility (3.98% vs 6.33%, AOR 0.58, 95CI 0.56-0.60, P<0.001). These trends persisted in patients with adverse features (far vs near: 11.36% vs 17.94%, AOR 0.58, 95CI 0.56-0.60, P<0.001) and those with no adverse features (1.51% vs 2.62%, AOR 0.58, 95CI 0.55-0.60, P<0.001). When stratifying by county type, patients living far from a treatment facility had lower rates of PORT compared to those living near a treatment facility in metro (4.10% vs 6.16%, AOR 0.62, 95CI 0.61-0.64, P<0.001), urban (3.39% vs 7.42%, AOR 0.39, 95CI 0.36-0.42, P<0.001), and rural (3.26% vs 6.87%, AOR 0.41, 95CI 0.34-0.50, P<0.001) counties. For men with prostate cancer managed with surgery, patients living farther from their treatment facility were 38-61% less likely to receive PORT relative to those living near the treatment facility, regardless of the presence of adverse pathologic features and county type. While the decision to use PORT depends on many patient-specific factors, these findings raise the possibility that the geographic availability of radiation treatment facilities influences the treatment decision. As alternative payment models in radiation oncology are being explored, attention should be given to supporting community-based radiation treatment centers to ensure accessibility of care for patients with prostate cancer.Tabled 1Abstract 2941; TableOR95% CIP>|z|% PORTFarNearMetro0.620.610.640.0004.16.16Urban0.390.360.420.0003.397.42Rural0.410.340.500.0003.266.87 Open table in a new tab

Introduction of Quality Indicators into Radiotherapy Departments in Japan

This study investigates the quality indicators (QIs) of medical care that are expected to be introduced to radiotherapy departments in Japan and evaluates whether the QIs reflect the characteristics of the treatment facilities. For this purpose, a questionnaire survey was administered to radiotherapy treatment facilities in Japan. A consensus of early QI candidates was obtained from the panel members. The characteristics identified in the candidate QIs were subdivided into 140 items covering 27 domains of medical-care contents in radiotherapy departments. These 140 items were compiled into a questionnaire, which was administered to 15 treatment facilities in Japan. The primary results indicated that 36 items in five domains are useful QI contents. The secondary findings indicated that the provision of advanced radiotherapy to several patients, the waiting time, and the radiotherapy initiated depend on the manpower of the departmental staff.

Quantifying the under-estimation of cervical Cancer in remote regions of Tanzania

BackgroundCervical cancer is the most common cancer among women in Sub-Saharan countries, including Tanzania. While early detection and diagnosis are available in some parts of this large country, radiotherapy has been only available at the Ocean Road Cancer Institute (ORCI), in the capital city of Dar es Salaam and is just starting in a few regions.MethodsThe objective of this study was to compare the observed incidence of cervical cancer for the two remote regions of Mwanza in western Tanzania and Mbeya in southern Tanzania, based on their patients treated at the ORCI from 2011 to 2014. Results: The number patients referred and treated at ORCI were (120 from Mwanza, and 171 from Mbeya, representing 24.6 and 32.8% of the patients histopathologically confirmed in the two sites, respectively. The results showed significant underestimation of cervical cancer in the two regions. The vast majority of patients who were histopathologically-confirmed in their local regions (73.92% from Mwanza and 65.1% from Mbeya), but did not receive the needed radiotherapy treatment at the ORCI. The estimated incidence for the two regions based on the number of patients treated at the ORCI were underestimated by 53.9% for Mwanza and 68.9% for Mbeya.ConclusionsLocal establishment of radiotherapy treatment facilities in remote regions in Tanzania and similar other low-income countries is essential for providing effective treatment and improving survival of diagnosed cervical cancer patients. Linkage between the records of local remote hospitals and the main cancer treatment center in the capital city can also help support the emerging the population-based cancer registry at ORCI.

Outcomes of Observation vs Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer

Complete metastatic ablation of oligometastatic prostate cancer may provide an alternative to early initiation of androgen deprivation therapy (ADT). To determine if stereotactic ablative radiotherapy (SABR) improves oncologic outcomes in men with oligometastatic prostate cancer. The Observation vs Stereotactic Ablative Radiation for Oligometastatic Prostate Cancer (ORIOLE) phase 2 randomized study accrued participants from 3 US radiation treatment facilities affiliated with a university hospital from May 2016 to March 2018 with a data cutoff date of May 20, 2019, for analysis. Of 80 men screened, 54 men with recurrent hormone-sensitive prostate cancer and 1 to 3 metastases detectable by conventional imaging who had not received ADT within 6 months of enrollment or 3 or more years total were randomized. Patients were randomized in a 2:1 ratio to receive SABR or observation. The primary outcome was progression at 6 months by prostate-specific antigen level increase, progression detected by conventional imaging, symptomatic progression, ADT initiation for any reason, or death. Predefined secondary outcomes were toxic effects of SABR, local control at 6 months with SABR, progression-free survival, Brief Pain Inventory (Short Form)-measured quality of life, and concordance between conventional imaging and prostate-specific membrane antigen (PSMA)-targeted positron emission tomography in the identification of metastatic disease. In the 54 men randomized, the median (range) age was 68 (61-70) years for patients allocated to SABR and 68 (64-76) years for those allocated to observation. Progression at 6 months occurred in 7 of 36 patients (19%) receiving SABR and 11 of 18 patients (61%) undergoing observation (P = .005). Treatment with SABR improved median progression-free survival (not reached vs 5.8 months; hazard ratio, 0.30; 95% CI, 0.11-0.81; P = .002). Total consolidation of PSMA radiotracer-avid disease decreased the risk of new lesions at 6 months (16% vs 63%; P = .006). No toxic effects of grade 3 or greater were observed. T-cell receptor sequencing identified significant increased clonotypic expansion following SABR and correlation between baseline clonality and progression with SABR only (0.082085 vs 0.026051; P = .03). Treatment with SABR for oligometastatic prostate cancer improved outcomes and was enhanced by total consolidation of disease identified by PSMA-targeted positron emission tomography. SABR induced a systemic immune response, and baseline immune phenotype and tumor mutation status may predict the benefit from SABR. These results underline the importance of prospective randomized investigation of the oligometastatic state with integrated imaging and biological correlates. ClinicalTrials.gov Identifier: NCT02680587.

RTHP-10. PREDICTORS OF LINEAR ACCELERATOR VERSUS GAMMA KNIFE STEREOTACTIC RADIOSURGERY USE FOR BRAIN METASTASES IN THE UNITED STATES

Abstract INTRODUCTION Stereotactic radiosurgery (SRS) for brain metastases is predominantly delivered via single-fraction Gamma Knife SRS (GKRS) or linear accelerator (LINAC) in 1–5 fractions. Predictors of SRS modality have been sparsely examined on a nationwide level. METHODS The 2010–2016 National Cancer Database identified brain metastases patients from non-small cell lung cancer throughout the United States (US) having undergone SRS. A multivariable logistic regression model characterized SRS receipt, adjusting for patient age, dose, geographic location of treatment, facility type, and distance from treatment facility. RESULTS A total of 1,760 patients received GKRS, while 1,064 patients received LINAC SRS. Treatment at non-academic facilities was associated with increased LINAC SRS receipt, most prominently in the Midwestern (OR= 6.23; p&lt; 0.001), Northeastern (OR= 4.42; p&lt; 0.001), and Southern US (OR= 1.96;p&lt; 0.001). Administered doses of 18–19 Gy (OR= 1.42;p= 0.025), 20–21 Gy (OR= 1.82;p&lt; 0.001), and 22–24 Gy (OR= 3.11;p&lt; 0.001) were associated with increased LINAC SRS receipt, as was patient location within 20 miles of a radiation treatment facility (OR= 1.27;p= 0.007). CONCLUSIONS Despite Gamma Knife being more prominently used over LINAC for SRS, patients treated at non-academic facilities outside of the Western US were substantially more likely to receive LINAC over Gamma Knife. Patients located in the Midwest were 523% more likely, Northeast 342% more likely, and South 96% more likely to receive LINAC when treated at a non-academic facility. Increasing dose independently predicted LINAC over GKRS, indicating that smaller tumors – particularly those less than two centimeters (consistent with RTOG 90-05 recommendations) – are being treated with LINAC. Finally, patients residing in close proximity to a treatment center were 27% more likely to receive LINAC, likely indicative of the increased geographic accessibility of LINAC compared with GKRS. These findings should result in hypothesis-generating questions to further explore predictors of LINAC versus GKRS.

COMP report: CPQR technical quality control guidelines for Gamma Knife radiosurgery.

The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR), has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology (the most updated version of this guideline can be found on the CPQR website). This particular TQC details recommended quality control testing for Gamma Knife radiosurgery.

COMP Report: CPQR Technical Quality Control Guidelines for Data Management Systems.

The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR) has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology (the most updated version of this guideline can be found on the CPQR website). This particular TQC details recommended quality control testing of radiation data management systems.

Travel distance: Impact on stage of presentation and treatment choices in head and neck cancer

ObjectivesThe objective was to examine the impact of travel distance on stage of presentation and treatment choices in head and neck squamous cell carcinoma in the rural setting. Methods6029 cases diagnosed from 2002 to 2011 were obtained from the state cancer registry. Travel time was calculated to the nearest academic medical centers, otolaryngologist, and radiation treatment facilities. Multivariate logistic regression was used to examine the association of travel time with stage of presentation as well as the likelihood of appropriate therapy after adjustment for other demographic variables. ResultsPatients in the highest quartile for travel distance to academic centers were 33% more likely to present with early stage disease (p = 0.02), and 42% more likely to receive appropriate surgical therapy for oral cavity cancer. Patients were 70% more likely to receive appropriate surgery if they were farthest from the nearest radiation center (p = 0.03). Proximity to otolaryngology care was not significant. ConclusionIncreased travel distance to academic medical centers is associated with increased likelihood of proper therapy for surgically treated tumors of the head and neck. Impact on these findings on improvements in access to care is discussed.

COMP Report: CPQR technical quality control guidelines for conventional radiotherapy simulators.

The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR) has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology (the most updated version of this guideline can be found on the CPQR website). This particular TQC details recommended quality control testing of conventional radiotherapy simulators.

COMP report: CPQR technical quality control guidelines for major dosimetry equipment.

The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR) has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology (the most update version of this guideline can be found on the CPQR website). This article provides guidelines for quality control testing of major dosimetry equipment.

COMP report: CPQR technical quality control guidelines for low-dose-rate permanent seed brachytherapy.

The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR) has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology. This article contains detailed performance objectives and safety criteria for low‐dose‐rate (LDR) permanent seed brachytherapy.

COMP report: CPQR technical quality control guidelines for accelerator-integrated cone-beam systems for verification imaging.

The Canadian Organization of Medical Physicists, in close partnership with the Canadian Partnership for Quality Radiotherapy has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology. This article presents the quality control guideline accelerator‐integrated cone‐beam systems for verification imaging that has resulted from this process.