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Início Publicações / RSS - International Journal of Radiation Oncology, Biology, Physics

- International Journal of Radiation Oncology, Biology, Physics

International Journal of Radiation Oncology • Biology • Physics
International Journal of Radiation Oncology • Biology • Physics RSS feed.

  • The Impact of Set-Up Uncertainty on Dose-Response Estimates
  • It's the Team, Not the Beam
    At the conclusion of a recent office visit, one of our patients summarized his feelings and stated, with a sense of absolute conviction, “The only type of radiation therapy I am willing to undergo is proton therapy.” In contrast, another recent patient facing a similar situation stated, “I don't care which I get [proton or photon therapy]; to me, it sounds like it's the team, not the beam.” The former patient put his hope in a technology; the latter patient prioritized the experience of his care team over any particular technology.

  • De-Escalation Strategies in HPV-Associated Oropharynx Cancer—Are we Putting the Cart Before the Horse?
    Let's get to the punchline because it is a big one: Radiation therapy plus cetuximab led to inferior overall survival (OS) in human papilloma virus (HPV)-positive oropharyngeal squamous cell carcinoma (SCC). It is in light of the recently published results from Radiation Therapy Oncology Group (RTOG) 1016 and De-ESCALaTE HPV that we scope this issue's Oncology Scan to discuss the populist view that has prevailed among the head and neck cancer community for some time now: treatment de-intensification in HPV-positive oropharyngeal SCC (OPSCC).

  • Model Insurance Coverage Policies: The Power of Suggestion, the Force of Evidence
    In the current issue, Dr Roach and colleagues1 analyze regional and national insurance policies for stereotactic body radiation therapy (SBRT). They investigate the recent evolution of coverage for various clinical indications in relation to the indications that the American Society for Radiation Oncology's (ASTRO's) SBRT Model Policy recommends for coverage. The authors observe a trend toward higher concordance between ASTRO's recommendations and those accepted by payers as conditions of medical necessity for SBRT, although some discrepancies remain.

  • Early Bird Catches the Worm: PORT—A Compelling Treatment Strategy
    This patient is a candidate for aggressive postoperative therapy.1 We recommend sequential postoperative radiation therapy (PORT) after chemotherapy given the patient's young age, the multilevel mediastinal (pN2) lymph node involvement (anterior and inferior mediastinum), and the presence of extracapsular extension. Although routine use of PORT for pN2 disease has been controversial, the aforementioned factors portend a high risk of local recurrence and therefore a potential benefit of consolidative radiation therapy.

  • Check the Reports and Check the Brain
    There has been no recent randomized evidence justifying postoperative radiation therapy (PORT) in patients with non-small cell lung cancer who have undergone complete resection; it is not recommended for routine use, even in patients with mediastinal involvement (pN2).1,2 Adjuvant treatments such as chemotherapy and PORT should be discussed at a multidisciplinary board with complete surgical and pathologic reports, checking whether the nodal exploration was appropriate, the location and number of mediastinal nodes and hilar/intrapulmonary nodes that were resected, and whether resection was complete.

  • Thoracic Postoperative Radiation Therapy: To Treat or Not to Treat?
    A 41-year-old woman with a 5 pack-year smoking history presented with abdominal pain. Computed tomography (CT) of the abdomen incidentally revealed a left lower lobe lung nodule. Positron emission tomography/CT showed a 1.7-cm spiculated nodule in the left lower lobe of the lung, maximum standardized uptake value 4.9, 2 hypermetabolic station 10L lymph nodes measuring 1.3 cm, maximum standardized uptake value 5.6, and no evidence of metastatic disease. Follow-up CT scan without contrast re-demonstrated the spiculated nodule with no visible lymphadenopathy, although the lack of contrast limited nodal assessment.

  • Issue Highlights
    Anderson et al

  • The development of radiotherapy, image technology and chemotherapy prolongs the survival of patients with nasopharyngeal carcinoma: a cohort study with 20305 patients from 1990 to 2012
    Previous studies demonstrated that the radiotherapy, image technology and the application of chemotherapy have developed in last two decades. This study explored the survival trends and treatment failure patterns of patients with non-metastatic nasopharyngeal carcinoma (NPC) treated with radiotherapy. Furthermore, we evaluated the survival benefit brought by the development of radiotherapy, image technology and chemotherapy based on a large cohort from 1990 to 2012.

  • Long-Term Benefits of Dose-Escalation in Localized Prostate Cancer
    Before we have the honor of contextualizing the importance of this paper, the authors should first be congratulated for not simply conducting and completing a randomized controlled trial (RCT), but for following patients for nearly 2 decades and reporting the long-term results from their work.

  • Defining the Optimal Schedule for External Beam Partial Breast Irradiation
    Accelerated partial breast irradiation (APBI) has emerged as an attractive alternative to whole breast irradiation (WBI) in select patients with early-stage breast cancer. The appeal of APBI is based on the assumption that it will be as effective, or nearly as effective, as more protracted courses of WBI, with 2 notable benefits: a more convenient schedule and less normal-tissue toxicity.

  • The Insurance Approval Process for Proton Beam Therapy Must Change: Prior Authorization Is Crippling Access to Appropriate Health Care
    With almost 70 proton beam therapy (PBT) centers worldwide, of which 29 are operating in the US, and multiple centers under construction,1 it is increasingly important that the insurance coverage process for PBT is standardized to allow seamless approval, minimizing delays and the burden on patients and providers. With over 30 years of the US Food and Drug Administration–approved practice and research,2 PBT is not “experimental” or “investigational”; however, these terms are still commonly used in denial letters that are written by private insurance payers and third-party organizations that claim to provide medical benefit “management and solutions.” The basis for their coverage and the evidence cited in their policies are often out of date and not peer reviewed by clinical experts in the field.

  • The Role of Adjuvant Radiotherapy for Resected Non-Small Cell Lung Cancer in the Modern Era
    The role of adjuvant therapy in resected non-small cell lung cancer has been a contentious issue for decades. The current standard of adjuvant chemotherapy1 was only proven by the completion of a series of modern international trials when a first set of older trials failed to demonstrate significant benefit.2 The Lung Adjuvant Cisplatin Evaluation meta-analysis of modern trials demonstrated a significant overall survival improvement of ∼5%.3 This does not seem to extend to molecular targeted therapies for resected Epidermal Growth Factor Receptor or ALK+ non-small cell lung cancer because improvement is seen only for progression-free survival, not for overall survival.

  • Meetings
    August 16-17, 2019

  • Targeted intervention to improve the quality of head and neck radiotherapy treatment planning in the Netherlands: short and long-term impact
    A nationwide planning comparison for head and neck was conducted, followed by a targeted intervention and two more comparisons. Initial results showed large variation in OAR sparing, with up to >2x difference in OAR dose. The intervention reduced the variation, which sustained for following comparisons. Several centers adapted their planning protocol and this planning comparison is now repeated biannually. High quality treatment planning is important for individual patients, but also for clinical trials.

  • Phase II study of neoadjuvant treatment of sequential S-1-based concurrent chemoradiotherapy followed by systemic chemotherapy with gemcitabine for borderline resectable pancreatic adenocarcinoma (HOPS-BR 01)
    We conducted a multicenter one-armed phase II study to investigate the efficacy of neoadjuvant treatment of upfront CRT followed by systemic CT for BR-PC. A long duration of preoperative treatment using upfront S-1-based concurrent chemoraidotherapy followed by gemcitabine-based systemic chemotherapy achieves a high rate of margin negative resection and assurance of safety. A good survival time was obtained in patients who successfully underwent pancreatectomy.

  • Radiation Oncology APM: Why us? Why now?
  • Biologic Dose and Imaging Changes in Pediatric Brain Tumor Patients Receiving Spot Scanning Proton Therapy
    Our institution utilizes both biologic and standard dose models in spot scanning proton treatment planning. This analysis examines the rates of post-treatment radiologic change as detected on post-treatment MRI scans, and toxicities for pediatric brain tumor patients treated during the first year of our institution’s experience. Our novel biologic dose model was found to demonstrate greater volumetric overlap with the post-treatment radiologic changes, than the standard dose model.

  • Quality Assurance of Dose Escalated Radiation Therapy in a Randomized Trial for Locally Advanced Oesophageal Cancer
    We performed a benchmark case procedure as part of a quality assurance procedure of the ongoing XXX trial assessing dose escalated radiation therapy in oesophageal cancer. Inconsistencies in delineating target and OARs volumes were found. Only one third of the plans were protocol compliant. The majority of deviations were minor and involved the CTVs cranio-caudal margins and dose constraints to the heart. More plans were accepted when IMRT was performed.

  • Clinical-Genomic Models of Node-Positive Breast Cancer: Training, Testing, and Validation
    Two clinical-genomic models can stratify node-positive patients into low- and high-risk groups regardless of breast cancer subtype. The recurrence index [RI]-distant recurrence model was better at partitioning N1–N2 patients into low- and high-risk groups according to the relapse-free survival, whereas the RI-local recurrence model was superior for predicting local/regional recurrence.

  • Executive Summary of the ARS Appropriate Use Criteria for Treatment of Anal Cancer
    The American Radium Society Appropriate Use Criteria (ARS AUC) presented in this manuscript are evidence-based guidelines for curative- intent treatment of non-metastatic anal squamous cell cancer that are developed by a multidisciplinary expert panel.

  • A Dose of Reality: How 20 years of incomplete physics and dosimetry reporting in radiobiology studies may have contributed to the reproducibility crisis
    A large proportion of pre-clinical or translational studies utilizing radiation have poor replicability. For a study involving radiation exposure to be replicable, interpretable, and comparable, its experimental methodology must be well reported, particularly in terms of irradiation protocol including the amount, rate, quality, and geometry of radiation delivery. Here we perform the first large-scale literature review of the current state of reporting of essential experimental physics and dosimetry details in the scientific literature.

  • Single-Fraction Stereotactic Radiosurgery vs. Hippocampal-Avoidance Whole Brain Radiotherapy for Patients with 10-30 Brain Metastases: A Dosimetric Analysis
    This retrospective planning study of 10 patients with 10-30 brain metastases demonstrates that stereotactic radiosurgery significantly improves hippocampal and normal brain dosimetry compared with hippocampal-avoidance whole brain radiotherapy.

  • Palliative radiotherapy in bladder cancer – importance of patient selection: A retrospective multicenter study
    Palliative pelvic radiotherapy is an effective way to manage symptoms in patients with bladder cancer. This retrospective study investigates the role of palliative radiotherapy in this group of patients and highlights factors to consider preventing patients from receiving futile treatment. These include performance status, co-morbidities and stage. We conclude that patient selection and comprehensive assessment are crucial in preventing futile treatment.

  • Multi-institutional Analysis of Prostate-Specific Antigen Kinetics Following Stereotactic Body Radiotherapy (SBRT)
    Prostate-specific antigen kinetics after definitive stereotactic body radiotherapy (SBRT) for low- and intermediate-risk prostate cancer are studied in a multi-institutional fashion to aid in the management and counseling of prostate cancer patients. SBRT led to low PSA nadirs, consistent with prostatic ablation, as well as frequent benign PSA bounces, occurring as late as several years after treatment.

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