PURPOSE: Recent national policies have championed new standards in family and medical leave for graduate medical trainees. We hypothesize there remains variability in residency program leave policies. Project PARENT aime...PURPOSE: Recent national policies have championed new standards in family and medical leave for graduate medical trainees. We hypothesize there remains variability in residency program leave policies. Project PARENT aimed to create a database of parental leave policies at US radiation oncology and medical physics residency programs. METHODS AND MATERIALS: A mixed methods design was used in this study. A 29-question survey was distributed in 2024 to all US radiation oncology physician (RO) and medical physics (MP) residency programs by email and remained open for 6 weeks. For programs that did not supply a survey response, document analysis (data abstraction) was performed with information from program websites. All programs were offered a data verification opportunity. RESULTS: The survey was distributed to 84 US RO, 107 MP therapy, and 43 MP imaging residency programs. Composite survey responses were completed by 32 of 84 (38%) physician residencies and 75 of 100 (50%) MP programs (62 therapy + 13 imaging). Altogether, website data abstraction for programs without responses resulted in a final program representation of 99% and 100% in RO and MP programs, respectively. Among programs who provided a specific value, the median 'maximum parental leave' provided was 12 weeks (IQR, 8-12) for RO birthing parents, 12 weeks (IQR, 12-12) for MP birthing parents, 12 weeks (IQR, 6-12) for RO non-birthing parents, and 12 weeks (IQR, 8-12) for MP non-birthing parents; the median length of paid leave provided to all parents in RO and MP residency programs was 6 weeks. CONCLUSIONS: Project PARENT is the first comprehensive parental leave information source in any medical specialty. We anticipate this family leave program policy database will empower residency program leaders and applicants to navigate family leave policies to the mutual benefit of all.
PURPOSE: Radiation therapy (RT) positioning and planning are vital to minimizing toxicity in patients with synchronous bilateral breast cancer (SBBC). We studied clinical outcomes and setup reproducibility in SBBC patien...PURPOSE: Radiation therapy (RT) positioning and planning are vital to minimizing toxicity in patients with synchronous bilateral breast cancer (SBBC). We studied clinical outcomes and setup reproducibility in SBBC patients treated in the prone position. METHODS AND MATERIALS: This retrospective study analyzed SBBC patients treated prone between 2012 and 2022. Demographics, clinical RT dose/field, dosimetry, on-treatment imaging, toxicity, and outcomes data were collected. RT delivery was standardized, with the left breast treated first. After 2014, radiochromic (GaF) films were placed for fractions 1 to 5 to evaluate field overlap, prompting resimulation or replanning if consistent overlap was detected. Positional shifts during setup were collected for bilateral whole breast irradiation (WBI) and partial breast irradiation (PBI). RESULTS: Forty-five patients were included. Median age was 67 years, and median follow-up was 64 months. Thirty-five, 5, and 5 patients received bilateral WBI (1 with low axilla), bilateral PBI, and a combination of WBI and PBI, respectively. The most common WBI dose was 40.5 Gy, with a simultaneous tumor bed boost to 48 Gy. PBI patients received 30 Gy in 5 fractions (n = 4) or 40.05 Gy in 15 fractions (n = 1). All patients who developed grade 2 (17.7%) and grade 3 (2%) dermatitis received bilateral WBI except for 1. Six patients had acute dermatitis in the sternal area, with overlap on GaF seen in 2 patients. Of 20 patients with late toxicity follow-up, 25% had late grade 1 to 2 dermatitis (20% received WBI). One patient recurred locally and distantly. Mean positional shifts were mostly subcentimeter or subdegree. Only 10% of patients had field overlap on GaF. CONCLUSIONS: To our knowledge, this is the first study examining patients treated for SBBC in the prone position. Prone bilateral RT is feasible with minimal shifts and overlap. However, higher rates of acute dermatitis occurred in bilateral WBI patients (vs PBI), and overlap was not seen on GaF in all patients who developed midline dermatitis.
PURPOSE: We sought to characterize outcomes from a large institutional database of patients treated with 3-fraction spine stereotactic body radiation therapy (SBRT) after prior overlapping radiation therapy. METHODS AND...PURPOSE: We sought to characterize outcomes from a large institutional database of patients treated with 3-fraction spine stereotactic body radiation therapy (SBRT) after prior overlapping radiation therapy. METHODS AND MATERIALS: The primary outcome of interest was local failure (LF) in the treated lesion, defined based on magnetic resonance imaging. We also characterized toxicities such as vertebral compression fracture and radiation myelitis. RESULTS: There were 83 patients treated to 87 spinal lesions between 2014 and 2023. Median follow-up was 14.2 (IQR, 6-29.4) months, and median overall survival was 20.5 (95% CI, 16.5-29.9) months. Most lesions were treated with 27 Gy in 3 fractions (n = 78; 90%). Most lesions had been treated with prior conventionally fractionated radiation therapy (59%), and the most common histology was prostate cancer (n = 15; 17%). The 1- and 2-year LF rate was 8.4% (95% CI, 3.7%-16%) and 15% (95% CI, 8.1%-24%), respectively. On univariable analysis, lower minimum dose to the planning target volume (hazard ratio, 0.85, 95% CI, 0.74-0.99, P = .03) and colorectal, cholangio-, or hepatocellular carcinoma histology (hazard ratio 5.6, 95% CI, 1.11-28.4, P = .037) were associated with risk of LF. There was 1 case of radiation myelitis (1.3%) and 5 cases (5.5%) of vertebral compression fracture. CONCLUSION: Reirradiation with spine SBRT in 3 fractions appears safe and is associated with a 2-year local control rate of 85%. Lower planning target volume, lower minimum dose, and gastrointestinal histology were associated with increased risk of LF. Further work is needed to identify the optimal dose-fractionation regimen for reirradiation with spine SBRT.
PURPOSE: Anthropomorphic phantoms are needed to support training, workflow validation, and imaging studies in gynecologic brachytherapy, particularly in settings with limited access to commercial models. This study descr...PURPOSE: Anthropomorphic phantoms are needed to support training, workflow validation, and imaging studies in gynecologic brachytherapy, particularly in settings with limited access to commercial models. This study describes the design and validation of a low-cost multimodal female pelvic phantom that replicates pelvic anatomy and tissue properties relevant to brachytherapy. METHODS AND MATERIALS: A custom phantom was constructed with embedded uterus, cervix, bladder, rectum/sigmoid, and tumor structures using agar tissue-mimicking materials and three-dimensional (3D) printed molds derived from patient contours. The phantom was designed to be compatible with computed tomography, magnetic resonance imaging, planar ultrasound (US), and 3D transabdominal and transrectal US, and to accommodate standard intracavitary and interstitial applicators. Imaging properties, including speed of sound, Hounsfield units, and electron density, were measured and compared to clinical reference values. Three trained raters performed repeated segmentations on all modalities to assess segmentation properties and variability. RESULTS: The phantom provided clear visualization of internal structures on all imaging modalities and maintained structural integrity during repeated use and applicator insertion. Measured speed of sound values differed by less than 2.6% from the 1540 m/s reference, with the largest deviation producing an axial measurement uncertainty of 1.3 mm. Hounsfield unit values ranged from 31.7 to 53.4, and electron density values differed by under 0.5% from institutional standards. The most consistent segmentations were produced with magnetic resonance imaging, whereas the greatest variability was observed in 3D transrectal US for small structures. The total material cost to create the phantom was approximately $150 Canadian dollars. CONCLUSIONS: The developed phantom supports realistic brachytherapy applicator placement, multimodal imaging, image segmentation, and has potential for future integration into dose planning studies.
PURPOSE: The role of preoperative radiation therapy (RT) in retroperitoneal sarcoma (RPS) remains controversial across histologic subtypes. Conventional fractionated RT (ConvRT) is the current standard, but hypofractiona...PURPOSE: The role of preoperative radiation therapy (RT) in retroperitoneal sarcoma (RPS) remains controversial across histologic subtypes. Conventional fractionated RT (ConvRT) is the current standard, but hypofractionated RT (HypoRT) is gaining interest, particularly for soft-tissue sarcomas. This study aimed to compare the safety and efficacy of HypoRT (10 fractions) with ConvRT in patients with RPS. METHODS AND MATERIALS: We retrospectively reviewed 55 patients with RPS who received preoperative RT followed by surgery at a single tertiary institution between 2017 and 2024. All patients underwent intensity modulated RT with simultaneous integrated boost techniques. The HypoRT group (n = 15) received 50/35 Gy in 10 fractions, and the ConvRT group (n = 40) received 62.5/45 Gy in 25 fractions. We assessed surgical complications (Clavien-Dindo grade ≥3) and prolonged postoperative hospitalization (≥14 days). RESULTS: Baseline characteristics were comparable. HypoRT did not increase grade ≥3 complications (33.3% vs 25.0%, P = .735) or hospital stay (median, 16 vs 13 days; P = .684). Older age was associated with severe complications (P = .027), whereas larger tumors and longer operation time correlated with extended hospitalization (P = .018 and P = .024, respectively). With a median follow-up of 33 months, 3-year local recurrence-free survival (71.5% vs 48.9%, P = .329), progression-free survival (59.3% vs 44.4%, P = .612), and overall survival (84.9% vs 80.0%, P = .578) were comparable between groups. CONCLUSIONS: HypoRT in 10 fractions appears feasible, without an apparent increase in perioperative morbidity and may offer a potential alternative to ConvRT in patients with resectable RPS.
Liao D, Aminilari M, Ye XY
… +13 more, Metser U, Singnurkar A, Bhella S, Crump M, Kridel R, Kukreti V, Kuruvilla J, Prica A, Vijenthira A, Cheung M, Rodin D, Tsao M, Hodgson D
PURPOSE: To evaluate real-world management strategies and outcomes for patients with Hodgkin lymphoma (HL) with a partial metabolic response (PMR) on an end-of-chemotherapy (EOC) fluorodeoxyglucose-positron emission tomo...PURPOSE: To evaluate real-world management strategies and outcomes for patients with Hodgkin lymphoma (HL) with a partial metabolic response (PMR) on an end-of-chemotherapy (EOC) fluorodeoxyglucose-positron emission tomography (PET) scan and assess whether dynamic changes in maximum standardized uptake value (SUVmax) could refine risk stratification. METHODS AND MATERIALS: Multicenter, retrospective cohort study of patients with HL treated from January 1, 2009, to September 30, 2021. PMR was defined as a Deauville score of 4 on the EOC-PET scan, with an SUVmax value lower than the staging PET scan. First-line chemotherapy was predominantly adriamycin, bleomycin, vinblastine, and dacarbazine (62.7%), or adriamycin, bleomycin, vinblastine, and dacarbazine-escalated bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisolone (28.4%). The primary endpoint was progression-free survival (PFS). Cox proportional hazards models adjusted for stage and EOC-avid sites quantified outcomes; SUVmax value kinetics (interim-to-EOC) were explored within the radiation therapy (RT) cohort. RESULTS: Among 836 patients with EOC-PET scans, 67 met PMR criteria; median follow-up was 3.2 years (range, 0.1-12.6). Post-EOC-PET scan management included involved-site RT (n = 38), salvage chemotherapy ± autologous stem-cell transplantation (n = 14), or observation with serial PET scans (n = 12). RT recipients had more early-stage disease (55.3% vs 21.4%), fewer EOC-avid sites (median, 1 vs 2), and lower EOC SUVmax values (median, 4.7 vs 10.2) than those receiving systemic therapy. Two-year PFS was 84.2% after RT, 52.7% after salvage chemotherapy, and 74.1% with observation (log-rank P = .057). On multivariable analysis, salvage chemotherapy (hazard ratio [HR], 5.82; 95% CI, 1.14-29.81; P = .03) and observation (HR, 5.74; 95% CI, 1.12-29.39; P = .03) were associated with higher progression risk versus RT. Within the RT cohort, rising SUVmax values between interim and EOC-PET scans (HR, 7.21; 95% CI, 1.17-44.35; P = .033) and higher absolute EOC SUVmax values (HR per unit, 1.35; 95% CI, 1.02-1.79; P = .036) predicted inferior PFS. CONCLUSIONS: Most patients with HL with PMR achieve durable remission with consolidative RT alone, avoiding salvage chemotherapy and transplantation. Dynamic changes in SUVmax values-especially a rising SUVmax value between interim and EOC-PET scans-identify a high-risk subset potentially warranting treatment intensification. Prospective studies integrating novel agents and PET scan metrics are needed to personalize therapy for this population.
PURPOSE: Keloids are scars that grow beyond their original margins, typically presenting as pigmented, thickened lesions accompanied by pain and pruritus that affects patients' quality of life. Keloids can be resectable...PURPOSE: Keloids are scars that grow beyond their original margins, typically presenting as pigmented, thickened lesions accompanied by pain and pruritus that affects patients' quality of life. Keloids can be resectable or unresectable, and currently, no gold standard treatment exists for widespread or unresectable keloids. Radiation therapy is effective for keloids, but the efficacy and safety of primary radiation therapy for unresectable keloids have rarely been reported. Our study aims to evaluate the clinical outcomes of primary radiation therapy as a definitive treatment for widespread or unresectable keloids. The primary endpoint is radiation therapy response, including symptomatic and cosmetic improvement. The secondary endpoint is the recurrence rate after radiation therapy. METHODS AND MATERIALS: We retrospectively reviewed 35 patients with 64 keloid lesions treated with primary radiation therapy between January 2010 and July 2023. All received 30 Gy in 6 fractions. Treatment modalities, including 6 MeV or 9 MeV electrons and photon-based intensity modulated radiation therapy, were individualized according to lesion thickness and anatomic complexity. Clinical improvements were evaluated using the Visual Analog Scale, Vancouver Scar Scale, and Japan Scar Workshop Scar Scale. Longitudinal outcomes were analyzed using generalized estimating equations. RESULTS: Prominent symptomatic relief and cosmetic improvement were achieved with primary radiation therapy, with significant and sustained reductions in the Visual Analog Scale, Vancouver Scar Scale, and Japan Scar Workshop scores during follow-up. Disease control was excellent, with no cases of recurrence or serious adverse events. CONCLUSION: Primary radiation therapy is safe and effective for unresectable or extensive keloids. Both electron and photon beams provided reliable symptomatic relief, local control, and favorable cosmetic outcomes. Modern radiation therapy techniques, such as intensity modulated radiation therapy, provide similar efficacy with greater adaptability and may offer an innovative therapeutic option for challenging keloid cases. These findings highlight the expanding role of radiation therapy for benign but symptomatic dermatologic conditions.
Radiation-induced oral mucositis is a complication of head and neck cancer therapy that may persist beyond the expected timelines and become refractory to conventional management, adversely affecting patients' quality of...Radiation-induced oral mucositis is a complication of head and neck cancer therapy that may persist beyond the expected timelines and become refractory to conventional management, adversely affecting patients' quality of life. Radiation therapy for infiltrative tumors can also result in soft tissue necrosis, which may complicate post-treatment recovery. There are currently no therapies approved by the U.S. Food and Drug Administration for persistent radiation-induced soft tissue injury. Herein, we describe 2 patients with head and neck cancer with recalcitrant radiation therapy-associated oral ulcerations who experienced complete healing and resolution of symptoms with lenalidomide therapy.
PURPOSE: Childhood cancer survivors face an increased risk of dental anomalies with both chemotherapy and radiation therapy (RT) contributing to these late adverse effects (AEs), particularly when RT doses >20 Gy are del...PURPOSE: Childhood cancer survivors face an increased risk of dental anomalies with both chemotherapy and radiation therapy (RT) contributing to these late adverse effects (AEs), particularly when RT doses >20 Gy are delivered. This systematic review aims to: (1) provide an overview of late dental AEs reported after childhood RT, (2) report the prevalence of these AEs in survivors who received head and/or neck RT during childhood, and (3) describe dose-response evidence and the use of AE grading protocols. METHODS AND MATERIALS: A comprehensive search was conducted in Embase and PubMed. Extracted data included study characteristics, treatment details, and outcomes. Heterogeneity was assessed qualitatively, and risk of bias was evaluated using the Cochrane Childhood Cancer tool. RESULTS: Forty-four studies published between 1985 and 2024 were included, comprising 7299 participants (age range 3-16.5 years). The median prescribed RT dose was 50.4 Gy (range 10.0-67.5 Gy), with a median follow-up of 8.35 years. Reported dental AEs included agenesis, microdontia, and root stunting. Higher prescribed radiation doses were associated with increased AE risk. Dental outcomes were assessed clinically and radiographically. CONCLUSIONS: There is a clear need for standardized definitions, assessment methods, grading criteria, and data reporting for late dental AEs in childhood head and/or neck cancer survivors. Accurate documentation of RT regimens and pretreatment dental status is essential to support dose minimization strategies, tailored patient education, and long-term dental follow-up, ultimately improving survivorship care.
PURPOSE: This study aimed to present the clinical workflow developed for stereotactic arrhythmia radioablation, with a particular focus on the inHEART multimodality platform used for cardiac imaging integration and 3-dim...PURPOSE: This study aimed to present the clinical workflow developed for stereotactic arrhythmia radioablation, with a particular focus on the inHEART multimodality platform used for cardiac imaging integration and 3-dimensional substrate segmentation. We also report the clinical outcomes and dosimetric results of the initial 18 patients treated. METHODS AND MATERIALS: All patients underwent contrast-enhanced cardiac computed tomography, including late-enhancement imaging and optional cardiac magnetic resonance imaging. Imaging data were processed using the inHEART multimodality platform for specific imaging in cardiology (MUSIC), which enabled automatic 3-dimensional segmentation of cardiac anatomy, identification of the scar substrate, and integration of electrophysiological data to define the clinical target volume. The stereotactic body radiation therapy inHEART module exported target structures in digital imaging and communications in medicine-radiation therapy format to the Eclipse Treatment Planning System. Three-dimensional computed tomography simulation scans were acquired to account for cardiorespiratory motion, and an internal target volume/planning target volume (PTV) was derived accordingly on expiratory phases. Treatment was delivered with volumetric modulated arc therapy in a single fraction of 25 Gy to the PTV using a TrueBeam STx linac. Clinical effectiveness was assessed through ventricular tachycardia (VT) burden and implantable cardioverter defibrillators shock reduction. RESULTS: Median clinical target volume, internal target volume, and PTV volume were 14.50 cc (range, 4.32-32.6 cc), 22.13 cc (range, 5.15-49.15 cc), and 58.42 cc (range, 20.87-109.76 cc), respectively. Excellent dose coverage was achieved, median PTV D99% was 25.25 Gy (range, 21.94-27.51 Gy), with a mean Paddick conformity index of 0.89 ± 0.08. All organs at risk met the dose constraints. At 12 months, 78% of patients showed >75% VT reduction, and 94% of surviving patients experienced a limited number of shocks (<2). CONCLUSIONS: Integrating the inHEART stereotactic body radiation therapy module within a standardized multimodal imaging workflow enables accurate stereotactic arrhythmia radioablation planning and delivery. This approach proved feasible, robust, and safe for managing refractory VT.