Concerns have been raised about potential toxic interactions when colony-stimulating factors (CSFs) and chemoradiation are concurrently performed. In 2006, the ASCO guidelines advised against their concomitant use. Nevertheless, with the development of modern radiotherapy techniques and supportive care, the therapeutic index of combined chemotherapy, radiotherapy, and CSFs is worth reassessing. Recent clinical trials testing chemoradiation in lung cancer let investigators free to decide the use of concomitant CSFs or not. No abnormal infield event was reported after the use of modern radiotherapy techniques and concomitant chemotherapy regimens. These elements call for further investigation to set new recommendations in favour of the association of chemoradiation and CSFs. Moreover, radiotherapy could induce anticancer systemic effects mediated by the immune system in vitro and in vivo. With combined CSFs, this effect was reinforced in preclinical and clinical trials introducing innovative radioimmunotherapy models. So far, the association of radiation with CSFs has not been combined with immunotherapy. However, it might play a major role in triggering an immune response against cancer cells, leading to abscopal effects. The present article reassesses the therapeutic index of the combination CSFs-chemoradiation through an updated review on its safety and efficacy. It also provides a special focus on radioimmunotherapy.

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Background: In most clinical trials, gold fiducial markers are implanted in the prostate to tune the table position before each radiation beam. Yet, it is unclear if a cone-beam computed tomography (CBCT) should be performed before each beam to monitor a possible variation of the organs at risk (OARs) fullness, especially in case of rectoprostatic spacer implantation. The present study aimed at assessing the inter-and intra-fraction movements of prostate, bladder and rectum in patients implanted with a hyaluronic acid spacer and undergoing prostate stereotactic body radiotherapy (SBRT). Methods: Data about consecutive patients undergoing prostate SBRT were prospectively collected between 2015 and 2019. Inter-and intra-fraction prostate displacements and volume variation of organs at risk (OARs) were assessed with CBCTs. Results: Eight patients were included. They underwent prostate SBRT (37.5Gy, 5 fractions of 7.5Gy) guided by prostate gold fiducial markers. Inter-fraction variation of the bladder volume was insignificant. Intra-fraction mean increase of the bladder volume was modest (29 cc) but significant (p < 0.001). Both inter-and intra-fraction variations of the rectum volume were insignificant but for one patient. He had no rectal toxicity. The magnitude of table displacement necessary to match the prostate gold fiducial marker frequently exceeded the CTV/PTV margins (0.4 cm) before the first (35%) and the second arc (15%). Inter-and intra-fraction bladder and rectum volume variations did not correlate with prostate displacement. Conclusion: Major prostate position variations were reported. In-room kV fiducial imaging before each arc seems mandatory. Intra-fraction imaging of the OARs appears unnecessary. We suggest that only one CBCT is needed before the first arc.

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Purpose/Objective(s): Limited opportunities are available for medical students to gain early exposure to radiation oncology. In 2018, our department began offering two-week electives for clerkship-level medical students with broad specialty interests. Herein, we report our experiences one year after program initiation. Materials/Methods: Clerkship-level medical students at our institution were offered the opportunity to select a two-week elective in radiation oncology. Students underwent an abbreviated introductory curriculum followed by a longitudinal clinical experience. Medical students were provided checklists to identify newly acquired skills and exposure to evidence-based practice. End-of-rotation assignments included independent completion of an oncologic history and management plan and anonymous feedback using a Likert-type 5 point scoring scale. Results: Over one year, 13 medical students participated in the elective, nine of whom were in their first six months of clerkship and expressed limited comfort performing core elements of the patient interview and examination. Eleven (85%) medical students either agreed or strongly agreed (score 4-5 out of 5) that the course complemented their clerkship learning and 10 (77%) rated the experience as either very good or excellent (score 4-5 out of 5). Nine (69%) chose the elective out of curiosity, two (15%) intended to use the experience to supplement their future non-radiation oncology specialty interest, and none (0%) had initial interest in pursuing radiation oncology. All medical students reported shadowing as a component of their experience, six (46%) reported observing radiation therapy planning, and four (31%) highlighted participation in brachytherapy procedures and radiation treatments. The most commonly reported strengths were the educational value of the rotation (46%) and positive impact of working with residents (46%). The most common constructive feedback was to increase opportunities for student participation beyond shadowing in clinic. Indeed, only six students (54%) agreed or strongly agreed (score 4-5 out of 5) that the elective advanced their clinical skills. Conclusion: Two-week radiation oncology electives early in medical school offer unique opportunities to engage students undergoing specialty exploration. Clerkship-level students appreciate working with residents and are primarily interested in general oncologic knowledge and increased participation in clinic. This may be challenging for those who are early in their clerkship rotations, but focusing on reinforcing and/or introducing core skills such as preparing patient histories, physical exams, and delivering patient presentations may be future possibilities. Other directions include increasing mentorship opportunities and identifying clerkship students who would be likely to enroll in four-week rotations and encourage their application into radiation oncology residency.