Abdominal compression was effective for reducing the amplitude of tumor motion. However, in most of the authors' patients, the use of abdominal compression seemed to increase the interfraction variation in tumor position, despite reducing lung tumor motion. The daily tumor position deviated more systematically from the tumor position in the planning CT scan in the lateral and longitudinal directions in patients treated with abdominal compression compared to those treated without compression. Therefore, target matching is required to correct or minimize the interfraction variation.
This study aimed to evaluate the self-reported prevalence of burnout and psychological morbidity among radiation oncologists members of the Kyoto Radiation Oncology Study Group (KROSG) and to identify factors contributing to burnout. We mailed an anonymous survey to 125 radiation oncologists members of the KROSG. The survey included; the demographic data, the Maslach Burnout Inventory – Human Services Survey (MBI-HSS) and the 12-item General Health Questionnaire (GHQ-12). There were 87 responses out of 125 eligible respondents (69.6% response rate). In terms of burnout, three participants (3.4%) fulfilled the MBI-HSS criteria of having simultaneously high emotional exhaustion (EE), high depersonalization (DP) and low sense of personal accomplishment (PA). Eighteen (20.6%) reported a high score for either EE or DP meeting the alternative criteria for burnout with three of these simultaneously having high EE and high DP. The prevalence of psychological morbidity estimated using GHQ-12 was 32%. A high level of EE and low level of PA significantly correlated with high level of psychological morbidity with P < 0.001 and <0.01 respectively. Having palliative care activities other than radiotherapy and number of patients treated per year were the only factors associated with burnout. This is the first study investigating the prevalence of burnout and psychological morbidity among radiation oncologists in Japan. Compared with other studies involving radiation oncologists, the prevalence of low personal accomplishment was particularly high in the present study. The prevalence of psychological morbidity was almost the double that of the Japanese general population and was significantly associated with low PA and high EE.
The aim of this study was to evaluate the impact of abdominal compression (AC) on outcome in patients treated with stereotactic body radiotherapy (SBRT) for primary lung cancer. We retrospectively reviewed data for 47 patients with histologically proven non-small cell lung cancer and lung tumour motion ≥8 mm treated with SBRT. Setup error was corrected based on bony structure. The differences in overall survival (OS), local control (LC) and disease-free survival (DFS) were evaluated to compare patients treated with AC (n = 22) and without AC (n = 25). The median follow-up was 42.6 months (range, 1.4–94.6 months). The differences in the 3-year OS, LC and DFS rate between the two groups were not statistically significant (P = 0.909, 0.209 and 0.639, respectively). However, the largest difference was observed in the LC rate, which was 82.5% (95% CI, 54.9–94.0%) for patients treated without AC and 65.4% (95% CI, 40.2–82.0%) for those treated with AC. After stratifying the patients into prognostic groups based on sex and T-stage, the LC difference increased in the group with an unfavourable prognosis. The present study suggests that AC might be associated with a worse LC rate after SBRT using a bony-structure-based set-up.
The purpose of this study was to evaluate the difference in dose‐volumetric data between the analytical anisotropic algorithms (AAA) and the two dose reporting modes of the Acuros XB, namely, the dose to water (AXB−normalDw) and dose to medium (AXB−normalDm) in lung stereotactic body radiotherapy (SBRT). Thirty‐eight plans were generated using the AXB−normalDm in Eclipse Treatment Planning System (TPS) and then recalculated with the AXB−normalDw and AAA, using identical beam setup. A dose of 50 Gy in 4 fractions was prescribed to the isocenter and the planning target volume (PTV) D95%. The isocenter was always inside the PTV. The following dose‐volumetric parameters were evaluated; D2%, D50%, D95%, and D98% for the internal target volume (ITV) and the PTV. Two‐tailed paired Student's t‐tests determined the statistical significance. Although for most of the parameters evaluated, the mean differences observed between the AAA, AXB−normalDmand AXB−normalDw were statistically significant (p<0.05), absolute differences were rather small, in general less than 5% points. The maximum mean difference was observed in the ITV D50% between the AXB−normalDm and the AAA and was 1.7% points under the isocenter prescription and 3.3% points under the D95 prescription. AXB−normalDm produced higher values than AXB−normalDw with differences ranging from 0.4 to 1.1% points under isocenter prescription and 0.0 to 0.7% points under the PTV D95% prescription. The differences observed under the PTV D95% prescription were larger compared to those observed for the isocenter prescription between AXB−normalDm and AAA, AXB−normalDm and AXB−normalDw, and AXB−normalDw and AAA. Although statistically significant, the mean differences between the three algorithms are within 3.3% points.PACS number(s): 87.55.x, 87.55.D‐, 87.55.dk
The abscopal effect describes the ability of locally administered radiotherapy to induce systemic antitumor effects. Although mentioned for the first time in the 1950s, records of abscopal effects, considered to be immune-mediated, are scarce with radiotherapy alone. However, with the continued development and use of immunotherapy, reports on the abscopal effect have become increasingly frequent during the last decade. Here, we report a patient with advanced malignant pleural mesothelioma who had progressive disease while on the anti-PDL1 inhibitor pembrolizumab and showed an abscopal response after palliative radiotherapy.
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