Choline-PET/CT has a high global sensitivity while WB-DW-MRI has a high specificity, and so they are complementary techniques. Future studies with more enrolled patients and a longer follow-up period will be required to confirm these data. The initial data show that the best technique for evaluating response after SBRT is choline-PET/CT. Trial registration number NCT02858128.
Background: Care overburden makes it difficult to perform comprehensive geriatric assessments (CGAs) in oncology settings. We analyzed if screening tools modified radiotherapy in oncogeriatric patients. Methods: Patients ≥ 65 years, irradiated between December 2020 and March 2021 at the Hospital Provincial de Castellón, completed the frailty G8 and estimated survival Charlson questionnaires. The cohort was stratified between G8 score ≤ 14 (fragile) or >14 (robust); the cutoff point for the Charlson index was established at five. Results: Of 161 patients; 69.4% were male, the median age was 75 years (range 65–91), and the prevailing performance status (PS) was 0–1 (83.1%). Overall, 28.7% of the cohort were frail based on G8 scores, while the estimated survival at 10 years was 2.25% based on the Charlson test. The treatment administered changed up to 21% after frailty analysis. The therapies prescribed were 5.8 times more likely to be modified in frail patients based on the G8 test. In addition, patients ≥ 85 years (p = 0.01), a PS ≥ 2 (p = 0.008), and limited mobility (p = 0.024) were also associated with a potential change. Conclusions: CGAs remain the optimal assessment tool in oncogeriatry. However, we found that the G8 fragility screening test, which is easier to integrate into patient consultations, is a reliable and efficient aid to rapid decision making.
The aim of this study was to develop a deformable image registration (DIR)-based offline ART protocol capable of identifying significant dosimetric changes in the first treatment fractions to determine when adaptive replanning is needed. A total of 240 images (24 planning CT (pCT) and 216 kilovoltage cone-beam CT (CBCT)) were prospectively acquired from 24 patients with prostate adenocarcinoma during the first three weeks of their treatment (76 Gy in 38 fractions). This set of images was used to plan a hypofractionated virtual treatment (57.3 Gy in 15 fractions); correlation with the DIR of pCT and each CBCT allowed to translate planned doses to each CBCT, and finally mapped back to the pCT to compare with those actually administered. In 37.5% of patients, doses administered in 50% of the rectum (D50) would have exceeded the dose limitation to 50% of the rectum (R50). We first observed a significant variation of the planned rectal volume in the CBCTs of fractions 1, 3, and 5. Then, we found a significant relationship between the D50 accumulated in fractions 1, 3, and 5 and the lack of compliance with the R50. Finally, we found that a D50 variation rate [100 × (administered D50 − planned D50/planned D50)] > 1% in fraction three can reliably identify variations in administered doses that will lead to exceeding rectal dose constraint.
Materials/Methods: After Institutional Review Board approval, a survey was distributed to approximately 4,000 medical physicists and 4,050 medical dosimetrists in the United States. Respondents reported the planning techniques (volumetric modulated arc therapy (VMAT), dynamic conformal arcs (DCA), static intensity modulated radiotherapy (IMRT), or static 3D conformal), planning parameters, and treatment planning time for the last 10 lung SBRT cases. Paired t-test and Fisher Exact Tests were performed to determine if there were statistically significant differences between values reported by dosimetrists and physicists. Results: A total of 445 individuals responded to the survey, with 204 medical physicists and 241 medical dosimetrists. An average of 4 to 5 lung SBRT cases were seen per month. Overall, the vast majority of cases used VMAT (nearly 72% of cases planned by physicists and 78% of cases planned by dosimetrists). Respondents reported the most important reasons for choosing VMAT as "easier to conform to irregular shapes", "easier to avoid avoidance structures" and "shorter treatment delivery time." The distribution of remaining cases was similar among physicists and dosimetrists, with use of DCA, static 3D conformal and static IMRT in order of decreasing frequency. In comparing the utilization rates of these techniques, physicists reported a significantly higher rate of 3D conformal use with 10.7% of cases compared to dosimetrists with 5.7% of cases (p Z 0.017); differences in reported rates of other techniques were not statistically significant. The most popular dose fractionations for peripherally located tumors was either 18 Gy  3 fractions, or 10 Gy  5 fractions; the latter was the preferred regimen for either centrally located tumors or those close to the chest wall. Four-dimensional scanning for simulation was nearly universal. In terms of other planning parameters, the majority of respondents used coplanar (as opposed to non-coplanar) 6MV flatteningfilter-free (FFF) beams. Overall, the average VMAT case took about an hour more to plan and similar QA time compared to the average DCA plan. Conclusion: The planning and delivery of stereotactic body radiation therapy (SBRT) for non-small cell lung cancer (NSCLC) in the United States has now shifted to utilize predominantly 6MV flattening-filter-free beams and volumetric modulated arc therapy (VMAT), options that have only recently become widespread.
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