Vulvar cancer is a rare malignancy, with an estimated 6.900 cases diagnosed in 2024, though incidence has been rising in recent years. Radiation plays a critical role in definitive and adjuvant management, however late t...Vulvar cancer is a rare malignancy, with an estimated 6.900 cases diagnosed in 2024, though incidence has been rising in recent years. Radiation plays a critical role in definitive and adjuvant management, however late toxicities including pelvic insufficiency fractures (PIFs), anal/fecal incontinence, sexual dysfunction, cutaneous and sub-cutaneous fibrosis, and lymphedema may significantly impact quality of life in long-term survivors. This article will describe the most commonly encountered late radiation-induced toxicities seen in the management of vulvar cancers and provide practical guidance regarding work-up, and evidence-based management.
PURPOSE: This study aims to evaluate the primary endpoint of a phase 2 prospective trial, which included a patient cohort staged with 18F-prostate-specific membrane antigen positron emission tomography/computed tomograph...PURPOSE: This study aims to evaluate the primary endpoint of a phase 2 prospective trial, which included a patient cohort staged with 18F-prostate-specific membrane antigen positron emission tomography/computed tomography (CT), treated with a combination of prostate high dose-rate brachytherapy and prostate/seminal vesicles external beam radiation therapy for intermediate and high-risk prostate cancer. METHODS AND MATERIALS: Forty-one patients with unfavorable intermediate, high risk (HR), and very HR prostate cancer were recruited to receive a combination of hypofractionated external beam radiation therapy to the prostate ± seminal vesicles of 36 Gy (12 fractions of 3 Gy each) delivered in consecutive days, followed by single-fraction real-time high-dose-rate brachytherapy of 14 Gy. Patients also received risk-adjusted androgen deprivation therapy (ADT). All patients were primarily conventionally staged with prostate multiparametric magnetic resonance imaging, abdomen/pelvis CT, and bone scintigraphy, receiving an additional prostate-specific membrane antigen positron emission tomography/CT before their study inclusion. Urinary, gastrointestinal symptomatology, sexual potency and acute, as well as early late toxicity, were assessed using various questionnaires (International Prostate Symptom Score, International Index for Erectile Function, Extended Prostate cancer Index Composite for Clinical Practice, Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer). RESULTS: Forty-one patients (based on National Comprehensive Cancer Network stratification system 48.8% unfavorable intermediate, 43.9% HR, and 7.3% very HR) completed treatment and reached at least 12 months of follow-up at the time of the current analysis. Median follow-up was 20 months (IQR, 13-28). Median age was 71.7 years, median prostate specific antigen before treatment was 8.4 ng/mL (5.0-28.3), and median volume of the prostate was 36.6 cc (14.9-68.2). Short-term ADT was administered to 43.9% of patients, whereas 48.8% received long-term ADT; the rest of the patients did not receive hormonal therapy. No severe (grade ≥3) acute events were recorded. An increase was observed in the prevalence of grade 2 genitourinary toxicity, owed mainly to nocturia (2.4% at 3 months, 4.9% at 6 months, and 26.8% at 12 months), with grade 1 remaining stable over this period. Regarding gastrointestinal toxicity, grade 1 and 2 incidences remained low and almost unchanged over this time interval. A significant decline from baseline compared to 3 months post treatment was observed both in hormonal and sexual domains, with high severity exhibited as a worsening from 12% to 38% and from 0% to 5%, respectively. No other domains exhibited any significant decline (urinary incontinence, irritation/bother, and bowel). CONCLUSIONS: The evaluation of the primary results of the presented prospective phase 2 trial suggests that this hypofractionated combined radiotherapeutic scheme is well tolerated, presenting no early severe adverse events. Moreover, patient-reported outcomes confirm these results because no significant decline in any domain from baseline values was recorded.
Accurate tumor and organ-at-risk contouring is a critical step in radiation therapy. Contouring procedures, both manual and automated, are prone to errors and to a large degree of interobserver and intraobserver variabil...Accurate tumor and organ-at-risk contouring is a critical step in radiation therapy. Contouring procedures, both manual and automated, are prone to errors and to a large degree of interobserver and intraobserver variability. Radiation oncologists and/or medical physicists have to perform independent reviews of all contours for each patient before using them for treatment planning, which is a time-consuming, labor-intensive, and still not error-free process. We presented the tracing of a subtle near-miss event because of the presence of a random outlier in the contours of a lung tumor, very far from the actual gross tumor volume. The treatment plan was performed with an automated treatment engine using the volumetric-modulated arc therapy technique. Despite the implementation and adoption of systematic procedures of quality assurance in our clinical routine, the error crossed the barriers of peer review and was identified subsequently only in the step of pretreatment dosimetric verification. The error was corrected, and the patient was replanned before treatment initiation. In this case study, we showed that the random creation of false-positive target outliers may have a detrimental impact on patient dose when automated planning is performed. This risk is not negligible, and all strategies for improving the robustness of target segmentation should be pursued.
Pract Radiat Oncol
· 2026 · PMID 40499814
·
Full text
PURPOSE: Radiation and medical oncology face pressure from payment changes, which aim to increase the value of care and curb rising spending. Multiple models have been proposed or implemented, with mixed results for cost...PURPOSE: Radiation and medical oncology face pressure from payment changes, which aim to increase the value of care and curb rising spending. Multiple models have been proposed or implemented, with mixed results for cost saving and financial stability. Whereas previous studies have quantified changes in Medicare reimbursement for radiation oncology on a per-code basis, this has not been done in medical oncology to our knowledge, and no direct comparisons have been made between oncology subspecialties at this level. Our study aims to quantify and analyze Medicare reimbursement changes for medical and radiation oncology billing codes. METHODS AND MATERIALS: In this longitudinal study of reimbursement, the publicly available Physician/Supplier Procedure Summary database was used to obtain Medicare reimbursement data for 2010, 2016, and 2020. All reimbursement for providers with primary provider codes 92 (radiation oncology), 83 (hematology oncology), and 90 (medical oncology) were analyzed, combining hematology and medical oncology. Inflation- and utilization-adjusted changes in reimbursement were calculated from 2010 to 2020 and 2016 to 2020 on a per-code basis with results grouped by specialty and billing category. RESULTS: From 2010 to 2020, inflation- and utilization-adjusted Medicare reimbursement decreased by $1.2 billion (-16%) for all codes, $705 million (-29%) for radiation oncology-specific codes, and $541 million (-10%) for medical oncology-specific codes. From 2016 to 2020, inflation- and utilization-adjusted reimbursement decreased by $299 million (-3%) for all codes, $108 million (-5.6%) for radiation oncology-specific codes, and $191 million (-2.2%) for medical oncology-specific codes. Chemotherapy (-40%) and radiation therapy (-33%) saw the largest decreases in inflation- and utilization-adjusted reimbursement from 2010 to 2020, whereas immunotherapy (+21%) saw the largest increase. CONCLUSIONS: Our analysis shows continually decreasing Medicare reimbursement for both radiation and medical oncology from 2010 to 2020 and 2016 to 2020. This decade-long continuous decline highlights the need for payment system stabilization-whether through episode-based payment models or another avenue.
Logar HBZ, Montero A, Hernando O
… +14 more, Lopez M, Valero J, Ciervide R, Alvarez B, Chen-Zhao X, Sanchez E, Garcia-Aranda M, Saiz C, Zucca D, Alonso L, Sanchez M, Alonso R, Fernandez-Leton P, Rubio C
PURPOSE: This study evaluated the feasibility and tolerability of SABR in patients with high- and very-high-risk prostate cancer. METHODS AND MATERIALS: A prospective study included patients with high-risk and N1 prostat...PURPOSE: This study evaluated the feasibility and tolerability of SABR in patients with high- and very-high-risk prostate cancer. METHODS AND MATERIALS: A prospective study included patients with high-risk and N1 prostate cancer. SABR was delivered as 40 Gy in 8 Gy fractions, with optional elective nodal irradiation (26 Gy in 5.2 Gy fractions) and a 40 Gy nodal boost for N1 disease. The treatment protocol involved 24 to 36 months of androgen deprivation therapy, premedication with alpha-1 receptor antagonists, and dexamethasone (4 mg on treatment days). Adverse events were graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events v5.0, while quality of life was assessed using the EORTC QLQ-C30 and QLQ-PR25 questionnaires at the final check-up. RESULTS: The study included 96 patients (median age 77.2 years) with a median follow-up of 29.8 months. Elective nodal radiation therapy was delivered to 66.7% of patients, and 16.8% received a nodal boost. Acute grade 2 (G2) genitourinary and gastrointestinal (GI) events occurred in 5.2% and 7.3% of patients, respectively, with no grade ≥3 acute events. Late grade ≥2 genitourinary and GI events were observed in 7.8% and 15.7% of patients, respectively, including 1 grade 4 GI event. Common late symptoms included nocturia and rectal bleeding. Most patients (86.5%) reported no or minor difficulties posttreatment, though challenges with sexual activity, nocturia, and incontinence were noted. Physicians underestimated urgency and nocturia and overestimated rectal bleeding. CONCLUSIONS: SABR delivering 40 Gy in 5 fractions is feasible and well-tolerated for high-risk prostate cancer, with minimal additional toxicity from elective nodal irradiation and a boost to N1 disease. These findings support SABR as an effective treatment, warranting further long-term studies.
PURPOSE: We hypothesized that online adaptive radiation therapy (oART) could eliminate errors associated with interfractional deformation in gastric mucosa-associated lymphoid tissue (MALT) lymphoma, but errors in intraf...PURPOSE: We hypothesized that online adaptive radiation therapy (oART) could eliminate errors associated with interfractional deformation in gastric mucosa-associated lymphoid tissue (MALT) lymphoma, but errors in intrafractional deformation remained in 6 directions (anterior, posterior, superior, inferior, left, and right). This study aimed to quantify the anisotropic deformation errors of the clinical target volume (CTV) for MALT lymphoma using oART to determine deformations in the planning target volume (PTV) margins. METHODS AND MATERIALS: Thirty fractional scans from 4 consecutive patients (a total of 120 cone beam computed tomography scans) with gastric MALT lymphoma treated with oART were chosen for this retrospective study. The CTV contours were manually delineated on the pretreatment and posttreatment cone beam computed tomography images. The center-of-mass matching of the CTVs was performed following the bone anatomy matching. Systematic and random errors of intrafractional deformations of the CTV were quantified using displacement vectors between the pretreatment and posttreatment CTV surfaces for each fraction. The PTV margins for oART were anisotropically calculated using the van Herk formula: 2.5Σ + 0.7σ, accounting for intrafractional errors. RESULTS: For intrafractional deformation, the means of standard deviations of systematic errors ranged from 1.2 mm to 2.2 mm, whereas those of random errors ranged from 2.9 mm to 3.6 mm. The PTV margins were up to 13.1 mm in the inferior direction, whereas in other directions, they ranged from 9.7 mm to 12.8 mm. The PTV margin in integer achieved posttreatment CTV coverage for 90% of the fractions, with undercoverage volumes remaining below 0.6 cm in all fractions. CONCLUSIONS: This study suggests that the impact of intrafractional CTV deformation can not be eliminated even with oART. This highlights the need to set the appropriate anisotropic PTV margins.
OBJECTIVES: This study aimed to evaluate the feasibility and safety of online MR guided single-fraction stereotactic ablative radiation therapy (SABR) and to assess acute changes in pulmonary function tests (PFTs), infla...OBJECTIVES: This study aimed to evaluate the feasibility and safety of online MR guided single-fraction stereotactic ablative radiation therapy (SABR) and to assess acute changes in pulmonary function tests (PFTs), inflammatory markers, patient-reported quality of life (QoL), and dosimetric outcomes. METHODS AND MATERIALS: Patients with lung metastases were included in this single-center prospective study. Patients underwent MR guided single-fraction SABR. The primary endpoints encompassed local control (LC) and overall survival. Secondary endpoints included acute toxicity (Common Terminology Criteria for Adverse Events version 5.0), changes in PFTs, inflammatory markers, QoL, and dosimetric outcomes. RESULTS: Between 10/2020 and 10/2022, 26 patients with 30 lung metastases were prospectively enrolled. At a median follow-up of 19.9 months (range, 16.1 to 25.6 months), the 1- and 2-year LC rates were 96.2% (95% CI, 88.7% to 100.0%) and 77.5% (95% CI, 55.9% to 99.1%). No Common Terminology Criteria for Adverse Events grade 3+ side effects were observed. While there was a slight median reduction of 4% in forced expiratory volume in 1 second (L) (P = .009, range, -24% to 20%), other PFT parameters remained stable. The neutrophil-to-lymphocyte ratio increased by a median of 13% (P = .002, range, -10% to 207%), while serum C-reactive protein and albumin levels remained unchanged. Patient-reported QoL did not exhibit significant changes, except for a minimal increase in the median score for cognitive functioning from 1 to 1.5 (P = .041). CONCLUSIONS: MR guided single-fraction SABR is a safe and effective treatment option for peripheral lung metastases, demonstrating encouraging LC.
Krc R, Baniel CC, Lichter K
… +15 more, Jatar S, Peters GW, Taswell CS, Ponce SB, MacDuffie E, LeCompte MC, Chen JJ, Wang K, LoTemplio A, Saripalli A, Kaya E, Barry P, Masters AH, Jagsi R, Kahn JM
PURPOSE: The Society for Women in Radiation Oncology (SWRO) was founded in 2017 with a mission to promote representation and gender equity in the field of radiation oncology (RO). We aimed to assess the current experienc...PURPOSE: The Society for Women in Radiation Oncology (SWRO) was founded in 2017 with a mission to promote representation and gender equity in the field of radiation oncology (RO). We aimed to assess the current experiences of SWRO members 5 years after the founding of SWRO using a comprehensive survey of gender-related workforce issues. METHODS AND MATERIALS: From January to February 2023, an anonymous survey was distributed to all current SWRO members. Questions included demographics, family planning/fertility issues, perceptions of the field, and membership needs. Results pertaining to demographics, job satisfaction, mentorship, SWRO membership satisfaction, and future directions are reported in this analysis. Descriptive statistics were used to summarize frequencies of the multiple-choice items on the survey. RESULTS: The survey was distributed to 461 SWRO members, with a total of 144 responses, resulting in a response rate of 31.3%. The majority of respondents identified as female (96.5%), RO attending physicians (54.2%), located in the United States (76.4%), and with employment in either a private or community-based practice (50.7%). Top reasons for SWRO membership included networking (91%), leadership/professional development (83%), and mentorship (79%). After clinical responsibilities, insufficient institutional mentorship was cited as the second most common limitation to professional productivity, and only a minority of respondents (46.5%) reported being either "extremely" or "somewhat" satisfied with the current mentorship available to them at their current institution. A majority (69.3%) reported seeking female mentorship outside their current institution. Unwanted sexual comments, attention, or advances by superiors or colleagues were reported by 35.7% of respondents, and 53.6% reported either "strongly" or "somewhat" agreeing that gender-specific biases exist within their program. CONCLUSIONS: This study highlights opportunities for improvement related to gender-based obstacles, education and advocacy, support of family-friendly culture shifts, mentorship, and increased physicist engagement which will ultimately promote representation, inclusivity, and gender equity in RO.
PURPOSE: This review aims to evaluate the efficacy and safety of combining immune checkpoint inhibitors (ICI) with RT in the treatment of non-metastatic MIBC, focusing on neoadjuvant and bladder preservation strategies....PURPOSE: This review aims to evaluate the efficacy and safety of combining immune checkpoint inhibitors (ICI) with RT in the treatment of non-metastatic MIBC, focusing on neoadjuvant and bladder preservation strategies. METHODS AND MATERIALS: A systematic literature review was conducted from January 2000 to December 2023 using PubMed and Clinicaltrials.gov databases. Studies investigating outcomes after combining immunotherapy with RT for non-metastatic MIBC were selected. Data extraction included study identifiers, patient characteristics, intervention and control arm details, and primary outcomes. RESULTS: Among 28 selected studies, diverse approaches were observed, including neoadjuvant and bladder preservation strategies. Neoadjuvant trials, such as RACE IT, explored the feasibility of combining ICI with RT before radical cystectomy, showing promising efficacy and safety outcomes. In bladder preservation strategies, completed as well as ongoing trials demonstrated acceptable toxicity profiles and promising early efficacy data for combining ICI with chemoradiotherapy or RT alone. CONCLUSIONS: Combining ICI with RT holds significant promise as a treatment strategy for non-metastatic MIBC. Preliminary evidence suggests favorable efficacy and safety profiles, supporting further exploration and potential integration into standard care. Ongoing phase III trials will provide crucial insights into the comparative effectiveness of adding ICI to conventional definitive treatments. In the evolving landscape of MIBC management, the combination of ICI and RT has the potential to reshape therapeutic paradigms and improve outcomes for patients.
Simulation-free radiation therapy (SFRT) is an emerging patient-centered paradigm for palliative radiation therapy. Feasibility and clinical benefits have been demonstrated by several groups; however, guidance to overcom...Simulation-free radiation therapy (SFRT) is an emerging patient-centered paradigm for palliative radiation therapy. Feasibility and clinical benefits have been demonstrated by several groups; however, guidance to overcome technical barriers to adoption is limited. This report describes practical recommendations for offline preliminary studies, patient selection, image selection and formatting, planning and treatment considerations, and quality control. These suggestions aim to enable safe, scalable, and effective clinical implementation of SFRT.
PURPOSE: Radiopharmaceutical therapy (RPT) is the latest topic in a series of white papers published by ASTRO addressing quality processes and patient safety. The availability of radiopharmaceutical agents for therapeuti...PURPOSE: Radiopharmaceutical therapy (RPT) is the latest topic in a series of white papers published by ASTRO addressing quality processes and patient safety. The availability of radiopharmaceutical agents for therapeutic use has broadened patient treatment options; although generally administered systemically, their effects are targeted to cellular receptors or the tumor microenvironment. Radiation oncology is well suited to delivering RPT because clinicians are already experienced in radiation safety, treatment delivery, and ongoing patient care. This paper focuses on the logistics of initiating and/or maintaining an RPT program in radiation oncology and includes collaborating with other medical specialties. The white paper addresses the safety processes and workflow considerations for alpha- and beta-emitting radionuclides used for RPT. METHODS: ASTRO convened a multidisciplinary task force, composed of experts from radiation oncology, nuclear medicine, medical and health physics, to provide consensus on key workflows and processes for RPT. Recommendations were created using a consensus-building methodology and task force members indicated their level of agreement based on a 5-point Likert scale, from "strongly agree" to "strongly disagree." A prespecified threshold of ≥75% of raters who select "strongly agree" or "agree" indicated consensus. Content not meeting this threshold was removed or revised. SUMMARY: Establishing an RPT program in radiation oncology requires specific infrastructure for receiving, storing, preparing, and administering radiopharmaceuticals by staff with expertise in specific infusion methods. RPT cases benefit from a multidisciplinary approach led by a radiation medicine physician and authorized user with support from additional personnel trained in RPT. A comprehensive quality management program must be developed to comply with applicable regulations and standards, including the handling of radioactive materials. Participation in incident reporting and external audits of a practice's overall quality assurance processes is encouraged. Using the guidance provided, authorized users can assess the viability of starting an RPT program, develop the necessary infrastructure, and sustain a safe, high-quality RPT program that includes radiation oncology.
PURPOSE: In 2023, the American Society of Radiologic Technologists and the American Registry of Radiologic Technologists conducted a Professional Workforce Survey to define current and assess future practices of radiatio...PURPOSE: In 2023, the American Society of Radiologic Technologists and the American Registry of Radiologic Technologists conducted a Professional Workforce Survey to define current and assess future practices of radiation therapists. The survey focused on the evolving role of radiation therapists, amid staffing constraints and advancements in radiation oncology technologies, exploring clinical duties, knowledge levels, comfort with specific tasks, and the call for advanced practice roles. METHODS AND MATERIALS: In October 2023, the American Registry of Radiologic Technologists sent 14,822 survey invitations to certified radiation therapists, using a questionnaire based on the American Society of Radiologic Technologists' 2016 pilot survey and current trends in technology and practice. By November 2023, 403 responses were received, resulting in a 2.7% response rate. With an estimated 23,000 radiation therapists, the sample size of 403 provides a ±4.8% margin of error at a 95% confidence level. RESULTS: The survey identifies areas where radiation therapist's excel with high knowledge, comfort, and low supervision while highlighting opportunities to strengthen clinical and technical skills to meet evolving technology and standards. It emphasized the need to define advanced practice roles (advanced practice radiation therapist) for radiation therapists to improve care delivery, address staffing shortages, and provide career growth. Expanding radiation therapy's scope in research and care coordination could help fill gaps, alleviate workforce challenges, and improve outcomes. CONCLUSIONS: The findings suggest that the future of radiation therapy practice lies in maximizing the potential of radiation therapists, with additional development needed to define new clinical career pathways and improve patient outcomes. Further research and resources are necessary to establish evidence-based models that leverage radiation therapists' expertise to the level of advanced practice.