Search Results (19)

Background: Radiotherapy is a critical component of effective cancer treatment, yet access remains limited in many low- and middle-income countries, including South Africa. This study explores structural quality indicators influencing radiotherapy access in Gauteng province, a region with a dual public–private healthcare system. Methods: A concurrent triangulation mixed-methods approach using a descriptive cross-sectional study was employed; for the quantitative phase, data from public and private radiotherapy facilities was analysed, and for the qualitative phase, insights were obtained from interviews with the heads of departments and members of three multidisciplinary professions in radiation oncology, namely radiation oncologists, radiation therapists, and medical physicists. Results: Findings reveal stark disparities in radiotherapy access. Gauteng province has only two major public radiotherapy facilities serving a large population, while multiple private facilities exist. The data indicate substantial differences in resource distribution, equipment accessibility, and personnel levels between public and private institutions. Bureaucratic inefficiencies, personnel shortages, and operational limitations in the public sector have surfaced as significant barriers to prompt equitable access to radiotherapy. This research shows the urgent need for focused strategies to address these systemic issues in order to improve access to radiation treatment in Gauteng province. The study’s findings will inform the development of a comprehensive framework to enhance radiotherapy access and contribute to more equitable cancer care delivery in South Africa. Full article

Soft tissue sarcoma (STS) has an 2–8% incidence for all malignant tumors in the adolescent and young adult (AYA) population, which are patients from ages 15 to 39. As most STS tumors are aggressive, they require multimodal management with surgery, radiation and chemotherapy. This article discusses the survivorship considerations in this young population of cancer patients who complete therapy. The lasting side effects include surgical and radiation-related morbidity, chemotherapy toxicity, early and late secondary effects on other organ systems, such as cardiac and endocrine dysfunction, and the development of secondary cancers. The long-term psychologic and practical impacts for those who have received a sarcoma diagnosis in the prime of their life include fertility, mental health, relationship, education and career implications. Although there is a paucity of data in some of these areas, we present existing management guidelines as available. This article serves as a comprehensive review of this wide array of treatment effects intended for all providers participating in the care of AYA sarcoma survivors, to include oncologists, primary care providers and therapists. Full article

Intraocular metastases represent the most common type of intraocular tumors in adults. In most cases, the metastases originate from primary breast and lung cancers. Effective management of patients with intraocular metastatic disease requires a multidisciplinary approach involving ophthalmologists, oncologists, and radiation therapists. The primary goals of treatment are disease control, maintenance of optimal quality of life, and preservation of functional vision. This article provides an in-depth overview of intraocular metastases, with special emphasis on the practical aspects of their diagnosis and treatment based on the most recent literature. Full article

Purpose: We constructed a prediction model to predict a 2-year locoregional recurrence based on the clinical features and radiomic features extracted from the machine learning method using computed tomography (CT) before definite chemoradiotherapy (dCRT) in locally advanced esophageal cancer. Patients and methods: A total of 264 patients (156 in Beijing, 87 in Tianjin, and 21 in Jiangsu) were included in this study. All those locally advanced esophageal cancer patients received definite radiotherapy and were randomly divided into five subgroups with a similar number and divided into training groups and validation groups by five cross-validations. The esophageal tumor and extratumoral esophagus were segmented to extract radiomic features from the gross tumor volume (GTV) drawn by radiation therapists before radiotherapy, and six clinical features associated with prognosis were added. T stage, N stage, M stage, total TNM stage, GTV, and GTVnd volume were included to construct a prediction model to predict the 2-year locoregional recurrence of patients after definitive radiotherapy. Results: A total of 264 patients were enrolled from August 2012 to April 2018, with a median age of 62 years and 81% were males. The 2-year locoregional recurrence rate was 52.6%, and the 2-year overall survival rate was 45.6%. About 66% of patients received concurrent chemotherapy. In total, we extracted 786 radiomic features from CT images and the Principal Component Analysis (PCA) method was used to screen out the maximum 30 features. Finally, the Support Vector Machine (SVM) method was used to construct the integrated prediction model combining radiomics and clinical features. In the five training groups for predicting locoregional recurrence, the mean value of C-index was 0.9841 (95%CI, 0.9809–0.9873), and in the five validation groups, the mean value was 0.744 (95%CI, 0.7437–0.7443). Conclusions: The integrated radiomics model could predict the 2-year locoregional recurrence after dCRT. The model showed promising results and could help guide treatment decisions by identifying high-risk patients and enabling strategies to prevent early recurrence. Full article

Background: Accurate delineation of tumors and organs at risk (OARs) is crucial for intensity-modulated radiation therapy. This study aimed to evaluate the performance of OncoStudio, an AI-based auto-segmentation tool developed for Korean patients, compared with Protégé AI, a globally developed tool that uses data from Korean cancer patients. Methods: A retrospective analysis of 1200 Korean cancer patients treated with radiotherapy was conducted. Auto-contours generated via OncoStudio and Protégé AI were compared with manual contours across the head and neck and thoracic, abdominal, and pelvic organs. Accuracy was assessed using the Dice similarity coefficient (DSC), mean surface distance (MSD), and 95% Hausdorff distance (HD). Feedback was obtained from 10 participants, including radiation oncologists, residents, and radiation therapists, via an online survey with a Turing test component. Results: OncoStudio outperformed Protégé AI in 85% of the evaluated OARs (p < 0.001). For head and neck organs, OncoStudio achieved a similar DSC (0.70 vs. 0.70, p = 0.637) but significantly lower MSD and 95% HD values (p < 0.001). In thoracic organs, OncoStudio performed excellently in 90% of cases, with a significantly greater DSC (male: 0.87 vs. 0.82, p < 0.001; female: 0.95 vs. 0.87, p < 0.001). OncoStudio also demonstrated superior accuracy in abdominal (DSC 0.88 vs. 0.81, p < 0.001) and pelvic organs (male: DSC 0.95 vs. 0.85, p < 0.001; female: DSC 0.82 vs. 0.73, p < 0.001). Clinicians favored OncoStudio in 70% of cases, with 90% endorsing its clinical suitability for Korean patients. Conclusions: OncoStudio, which is tailored for Korean patients, demonstrated superior segmentation accuracy across multiple anatomical regions, suggesting its suitability for radiotherapy planning in this population. Full article

Background/Objectives: Informed consent is crucial in medical practice, especially for complex treatments such as postoperative radiotherapy for patients with breast cancer. Conventional consent procedures are often based on verbal declarations with a highly condensed but nevertheless large amount of information, which can exceed the recording capacity of patients and lead to misunderstandings. The aim of this study was to develop and test an educational video on breast cancer patients to enhance the informed consent process by improving patients’ understanding and reducing the duration of the subsequent consultation. Methods: The educational video was created after the underlying content was determined by a modified Delphi method in which a panellist of radiation oncologists, nurses, radiation therapists, and former patients participated in successive rounds of topic scoring. After achieving content consent, the video included 19 items to cover key aspects of postoperative radiotherapy in a patient-friendly manner. Fifty breast cancer patients scheduled for postoperative radiotherapy were randomised to watch the video prior to their verbal consultation (n = 25) or to the control group participating in the traditional informed consent process only (n = 25). The duration of the informed consent processes in both arms was recorded. To assess the educational effect of the video, a multiple-choice test was created. In addition, patients’ satisfaction was recorded using a separate questionnaire. Both questionnaires were completed by the patients one to two hours after signing the consent form. Results: The patients in the video group evidenced significantly higher knowledge scores than those who received standard verbal explanations (median number of correct answers 9 vs. 8 out of 10, p = 0.0039). The whole informed consent process was also completed faster in the video group (mean duration 34.7 vs. 46.2 min, p < 0.001). Median satisfaction scores were high in both groups (34 vs. 33 out of 35 points), with no significant differences observed (p > 0.05). Conclusion: The educational video effectively improved patient understanding and streamlined the informed consent process without compromising patients’ satisfaction. This approach also helps to standardise the delivery of complex medical information, and it can also be adapted to improve the informed consent process for other cancer treatments. Full article

Background and Objectives: Patients with advanced head and neck tumors require salvage surgery as a last resort. These extensive surgeries pose the challenge of complex reconstructions. The head and neck surgeon undertaking such complex cases needs to master different flaps. The team managing these patients needs input from various specialists, along with otorhinolaryngologists, plastic surgeons, maxillofacial surgeons, vascular surgeons, experienced radiologists, dedicated pathologists, oncologists and radiation therapists. We focus on the optimum solution between oncologic resections and the future quality of life of patients and overall survival. Each complex case requires a personalized medicine approach. This scoping review aims to assess the efficacy and outcomes of complex reconstructions using various flaps for head and neck tumors, with a focus on free flaps and emerging techniques. Materials and Methods: A systematic search of the literature was conducted following PRISMA guidelines, resulting in the inclusion of 44 articles that met the predefined criteria in the last 10 years. Results: The included studies encompassed diverse patient populations and evaluated various surgical techniques, outcomes, complications, and advancements in head and neck reconstruction. The review identified a variety of flaps utilized in head and neck tumor reconstruction, including free flaps such as the radial forearm, anterolateral thigh, scapular tip, and myocutaneous flaps, among others. The success rates for free flap reconstructions ranged from 85% to 100%, with notable variations attributed to patient selection, tumor characteristics, and surgical expertise. Conclusions: Complications such as flap necrosis, infection, hematoma, and donor site morbidity were documented across studies, highlighting the importance of meticulous surgical planning and postoperative care. Furthermore, the review revealed emerging techniques such as computer-aided design, virtual surgery, stereolithographic models, customized implants, tissue engineering, and allotransplants, offering promising reconstructive armamentarium. Advances in surgical techniques and emerging technologies hold promise for further enhancing reconstructive outcomes, minimizing morbidity, and improving patient quality of life. Full article

Purpose: Errors and incidents may occur at any point within radiotherapy (RT). The aim of the present retrospective analysis is to evaluate the impact of a customized ARIA Visual Care Path (VCP) on quality assurance (QA) for the RT process. Materials and Methods: The ARIA VCP was implemented in June 2019. The following tasks were customized and independently verified (by independent checks from radiation oncologists, medical physics, and radiation therapists): simulation, treatment planning, treatment start verification, and treatment completion. A retrospective analysis of 105 random and unselected patients was performed, and 945 tasks were reviewed. Patients’ reports were categorized based on treatment years period: 2019–2020 (A); 2021 (B); and 2022–2023 (C). The QA metrics included data for timeliness of task completion and data for minor and major incidents. The major incidents were defined as incorrect prescriptions of RT dose, the use of different immobilization systems during RT compared to the simulation, the absence of surface-guided RT data for patients’ positioning, incorrect dosimetric QA for treatment plans, and failure to complete RT as originally planned. A sample size of approximately 100 was able to obtain an upper limit of 95% confidence interval below 5–10% in the case of zero or one major incident. Results: From June 2019 to December 2023, 5300 patients were treated in our RT department, an average of 1300 patients per year. For the purpose of this analysis, one hundred and five patients were chosen for the study and were subsequently evaluated. All RT staff achieved a 100% compliance rate in the ARIA VCP timely completion. A total of 36 patients were treated in Period A, 34 in Period B, and 35 in Period C. No major incidents were identified, demonstrating a major incident rate of 0.0% (95% CI 0.0–3.5%). A total of 26 out of 945 analyzed tasks (3.8%) were reported as minor incidents: absence of positioning photo in 32 cases, lack of patients’ photo, and absence of plan documents in 4 cases. When comparing periods, incidents were statistically less frequent in Period C. Conclusions: Although the present analysis has some limitations, its outcomes demonstrated that software for the RT workflow, which is fully integrated with both the record-and-verify and treatment planning systems, can effectively manage the patient’s care path. Implementing the ARIA VCP improved the efficiency of the RT care path workflow, reducing the risk of major and minor incidents. Full article

Caring for cancer patients is generally considered very rewarding work, but it can also be stressful and demanding. Therefore, it is important for oncology healthcare professionals to feel satisfied with their work environment in order to provide the best care possible. An ethics-approved 61-item staff satisfaction survey was developed in-house to gain insights regarding workplace satisfaction among all staff at The Ottawa Hospital Cancer Center. Descriptive statistics were used to analyze the responses. A total of 478 individuals completed the online survey, with 75.1% women, 23.2% men, and 1.7% preferring not to say. This represented the vast majority (>75%) of cancer center staff. The approximate breakdown according to healthcare professional type was as follows: 21% nurses, 20% radiation therapists, 18% physicians, 13% clerical staff, and 28% other types of staff. Almost all (97.4%) generally enjoyed their work, with 60% stating “very much” and 37.4% stating “a little bit”, and 93.3% found working with cancer patients rewarding. The overall satisfaction level at work was high, with 30.1% reporting “very satisfied” and 54.2% “somewhat satisfied”. However, in terms of their work being stressful, 18.6% stated it was “very much” and 62.1% “a little bit”. Also, in terms of their workload, 61.3% stated it was “very busy” and 10% stated it was “excessively busy”. The most enjoyable aspects of work were listed as interactions with colleagues, interactions with patients, and learning new things. The least enjoyable aspects of work were excessive workload, a perceived unsupportive work environment, and technology problems. Levels of satisfaction and stress at work varied according to role at the cancer center. Most cancer center staff seem to enjoy their work and find it rewarding. However, the work environment can be challenging and stressful. Areas for improvement include managing workloads, ensuring staff feel supported, and improving the user-friendliness of technology. Full article

Advanced oral squamous cell carcinomas represent a major challenge for maxillofacial surgeons, oncologists and radiation therapists. They also account for a large share of healthcare costs. They respond little and/or poorly to conventional therapies (surgery, radiotherapy and chemotherapy). Electrochemotherapy is a new method used as a palliative treatment in patients with advanced cancer of the neck/head region who are not eligible for standard therapies. It combines the use of cytotoxic drugs with the physical principle of electroporation; it effectively controls the tumour locally and preserves organ function. To date, ECT has been little used for oral mucosal tumours, as this is difficult to access for electrodes. We report six cases of advanced oral squamous cell carcinoma treated with electrochemotherapy. This study aims to assess the debulking effect of cancer via ECT in patients with advanced oral squamous cell carcinoma. It also aims to assess the safety and tolerability of this treatment. Full article

There has been an increasing interest in patient-reported outcome (PRO) measures in both the clinical and research settings to improve the quality of life among patients and to identify when clinical intervention may be needed. The primary purpose of this prospective study was to validate an acute breast skin toxicity PRO measure across a broad sample of patient body types undergoing radiation therapy. Between August 2018 and September 2019, 134 women undergoing adjuvant breast radiotherapy (RT) consented to completing serial PRO measures both during and post-RT treatment and to having their skin assessed by trained trial radiation therapists. There was high patient compliance, with 124 patients (92.5%) returning to the clinic post-RT for at least one staff skin assessment. Rates of moist desquamation (MD) in the infra-mammary fold (IMF) by PRO were compared with skin assessments completed by trial radiation therapists. There was high sensitivity (86.5%) and good specificity (79.4%) between PRO and staff-reported presence of MD in the IMF, and there was a moderate correlation between the peak severity of the MD reported by PRO and assessed by staff (rho = 0.61, p < 0.001). This prospective study validates a new PRO measure to monitor the presence of MD in the IMF among women receiving breast RT. Full article

With the implementation of MR-LINACs, real-time adaptive radiotherapy has become a possibility within the clinic. However, the process of adapting a patient’s plan is time consuming and often requires input from the entire clinical team, which translates to decreased throughput and limited patient access. In this study, the authors propose and simulate a workflow to address these inefficiencies in staffing and patient throughput. Two physicians, three radiation therapists (RTT), and a research fellow each adapted bladder and bowel contours for 20 fractions from 10 representative patient plans. Contouring ability was compared via calculation of a Dice Similarity Index (DSI). The DSI for bladder and bowel based on each potential physician–therapist pair, as well as an inter-physician comparison, exhibited good overlap amongst all comparisons (p = 0.868). Plan quality was compared through calculation of the conformity index (CI), as well as an evaluation of the plan’s dose to a ‘gold standard’ set of structures. Overall, non-physician plans passed 91.2% of the time. Of the eight non-physician plans that failed their clinical evaluation, six also failed their evaluation against the ‘gold standard’. Another two plans that passed their clinical evaluation subsequently failed in their evaluation against the ‘gold standard’. Thus, the PF-ROAR process has a success rate of 97.5%, with 78/80 plans correctly adapted to the gold standard or halted at treatment. These findings suggest that a physician-free workflow can be well tolerated provided RTTs continue to develop knowledge of MR anatomy and careful attention is given to understanding the complexity of the plan prior to treatment. Full article

One-fourth of all patients with metastatic non-small cell lung cancer presents with a limited number of metastases and relatively low systemic tumor burden. This oligometastatic state with limited systemic tumor burden may be associated with remarkably improved overall and progression-free survival if both primary tumor and metastases are treated radically combined with systemic therapy. This local aggressive therapy (LAT) requires a multidisciplinary approach including medical oncologists, radiation therapists, and thoracic surgeons. A surgical resection of the often advanced primary tumor should be part of the radical treatment whenever feasible. However, patient selection, timing, and a correct treatment allocation for LAT appear to be essential. In this review, we aimed to summarize and discuss the current evidence on patient selection criteria such as characteristics of the primary tumor and metastases, response to neoadjuvant or first-line treatment, molecular characteristics, mediastinal lymph node involvement, and other factors for LAT in oligometastatic NSCLC. Full article

Background: Anxiety impacts patient outcomes and quality of life in response to cancer diagnosis. A prospective phase 3 trial randomizing 126 patients was conducted to determine whether a specific one-on-one procedure announcement provided by a radiation therapist before CT scan simulation decreases anxiety for patients with breast cancer requiring radiotherapy. Material and Methods: Anxiety was measured using the STAI form, and the QLQ-C30 and BR-23 questionnaires were used to evaluate quality of life. Results: Mean trait or state anxiety scores before CT scan simulation, before the first and second sessions, and at the end of radiation treatment were not significantly different. We observed a decrease in the level of anxiety with time; however, no significant difference in mean state anxiety scores at any of the time intervals was detected. Factors, such as anxiety trait score, professional and marital status, age, and use of alternative therapy, did not significantly influence the evolution of anxiety status over time or the mean value. Anxiety was significantly influenced by the level of fatigue. Patients who benefited from the radiation therapists’ advice felt significantly better informed. Conclusions: The one-on-one program announcement occurring before CT scan simulation led to patients being more informed and greater satisfaction but did not decrease anxiety. Full article

Background: Haglund’s syndrome (HS) is a painful condition that is caused by an exostosis of the posterior superior part of the calcaneus coupled with Achilles tendinopathy and retrocalcaneal bursitis. Both for the proper musculoskeletal assessment and for the differential diagnosis process of possible concurrent diseases deriving from other anatomical areas, the diagnosis of HS is still a challenge. Case Presentation: A 41-year-old male amateur runner was diagnosed and treated for low back pain and referred leg pain by his general practitioner. Due to ineffective results, he self-presented to a physical therapist (PT) with intense right heel pain, radiating up to the leg and to the lumbopelvic region. Results: The PT’s examination and interview relating to the sports activities led to the correct diagnosis and a proper orthopedic referral. At the one-year follow-up, the patient reported regular pain-free marathon running. Discussion: This case report highlights the central role of PTs working in direct access environments as primary care healthcare professionals for the management of musculoskeletal diseases, and their abilities in identifying patients with suspected pathologic conditions that may need referral for imaging, medical assessment or surgical intervention. Full article