Intensity modulated radiation therapy (IMRT): a new promising technology in radiation oncology. (1/250)

Intensity modulated radiation therapy (IMRT) is a new technology in radiation oncology that delivers radiation more precisely to the tumor while relatively sparing the surrounding normal tissues. It also introduces new concepts of inverse planning and computer-controlled radiation deposition and normal tissue avoidance in contrast to the conventional trial-and-error approach. IMRT has wide application in most aspects of radiation oncology because of its ability to create multiple targets and multiple avoidance structures, to treat different targets simultaneously to different doses as well as to weight targets and avoidance structures according to their importance. By delivering radiation with greater precision, IMRT has been shown to minimize acute treatment-related morbidity, making dose escalation feasible which may ultimately improve local tumor control. IMRT has also introduced a new accelerated fractionation scheme known as SMART (simultaneous modulated accelerated radiation therapy) boost. By shortening the overall treatment time, SMART boost has the potential of improving tumor control in addition to offering patient convenience and cost savings.  (+info)

Communication between primary care physicians and radiation oncologists regarding patients with cancer treated with palliative radiotherapy. (2/250)

PURPOSE: The purpose of this study was to assess the satisfaction and information needs of primary care physicians (PCPs) regarding communication with radiation oncologists (ROs), with respect to patients who receive palliative radiotherapy (RT). A selected objective was to evaluate the agreement between PCPs' expectations and the content of the RO letter sent after completion of RT. PCPs' knowledge of the role of palliative RT and their awareness of available patient support services were also determined. METHODS: The PCPs of patients discharged from the Cross Cancer Institute after receiving palliative RT were surveyed using a mail-out questionnaire. Questions regarding communication, RT knowledge, and awareness of support services were asked. The corresponding RO letter was reviewed. RESULTS: A total of 148 PCPs were identified and were mailed questionnaires, with 114 (77%) responding. Overall, 80% (87 of 109) of PCPs found the RO letter to be useful in patient management. However, there was poor (< 53%) agreement between PCPs' expectations and the actual content of the RO letter. Knowledge of the indications and effectiveness of palliative RT was limited, with PCPs obtaining a median score of 4 of a possible 8. Only 27% (31 of 114) of PCPs were aware of all five of the patient support services listed. CONCLUSION: Results show that although the majority of PCPs found the RO letter useful, they believed that the letter lacked important information while containing unnecessary details. Communication between PCPs and ROs needs improvement, especially considering that PCPs seem to have limited knowledge of palliative RT.  (+info)

Waiting lists for radiation therapy: a case study. (3/250)

BACKGROUND: Why waiting lists arise and how to address them remains unclear, and an improved understanding of these waiting list "dynamics" could lead to better management. The purpose of this study is to understand how the current shortage in radiation therapy in Ontario developed; the implications of prolonged waits; who is held accountable for managing such delays; and short, intermediate, and long-term solutions. METHODS: A case study of the radiation therapy shortage in 1998-99 at Princess Margaret Hospital, Toronto, Ontario, Canada. Relevant documents were collected; semi-structured, face-to-face interviews with ten administrators, health care workers, and patients were conducted, audio-taped and transcribed; and relevant meetings were observed. RESULTS: The radiation therapy shortage arose from a complex interplay of factors including: rising cancer incidence rates; broadening indications for radiation therapy; human resources management issues; government funding decisions; and responsiveness to previous planning recommendations. Implications of delays include poorer cancer control rates; patient suffering; and strained doctor-patient relationships. An incompatible relationship exists between moral responsibility, borne by government, and legal liability, borne by physicians. Short-term solutions include re-referral to centers with available resources; long-term solutions include training and recruiting health care workers, improving workload standards, increasing compensation, and making changes to the funding formula. CONCLUSION: Human resource planning plays a critical role in the causes and solutions of waiting lists. Waiting lists have harsh implications for patients. Accountability relationships require realignment.  (+info)

Assessing portal design skills in the radiation oncology interactive case management examination. (4/250)

The American Board of Radiology is developing a computerized interactive case management examination to be used to evaluate the clinical skills of radiation oncologists. In the past, these skills have been evaluated by a pencil and paper written examination and an oral examination. With the increasing capabilities of computers, these skills can be easily, and perhaps even better, evaluated digitally. The aim is to develop an examination, which will be based on actual clinical cases, and be interactive so that it better mimics the clinical practice of a radiation oncologist than a written examination. It will also be less labor-intensive and less expensive than an oral examination. One of the most important skills of a radiation oncologist is the ability to design treatment portals that will encompass the entire cancer and yet minimize the irradiation of critical tissues and normal organs. Important parameters for radiation oncologists include the direction of the treatment beam, the size and shape of the portals, and the location of the margins of the field relative to patient anatomy and tumor location. In order to evaluate a physician's ability to design treatment portals, the computer-based examination has the capability to interactively construct field lines. The computer interface allows the candidate to draw field lines on a digitized x-ray image in a manner similar to practice. After the candidate illustrates the field lines, the evaluation of the response must be performed quickly to avoid interrupting the flow of the examination. The answer key is stored as a lossless compressed image. The key contains three regions consisting of (1) the must include region, which contains the tumor; (2) the must-exclude region, which contains tissues that if damaged would affect patient vitality and quality of life; and (3) the envelope of acceptable curves. Each region is assigned a unique byte code. The candidate's response is assigned a fourth byte code. Using basic logic operations, the response is swiftly evaluated. The scoring algorithm scores a candidate's action as correct if his/her drawn area encompasses all of the "must-include region" and is within the "envelope of acceptable curves." It scores a candidate's action as incorrect if his/her drawn area overlaps any part of the "exclude region" and/or exceeds at any point the "envelope of acceptable curves."  (+info)

Variation in delivery of palliative radiotherapy to persons dying of cancer in nova scotia, 1994 to 1998. (5/250)

PURPOSE: To examine sociodemographic and clinical variables associated with provision of palliative radiotherapy (RT) to persons dying of cancer. METHODS: The Nova Scotia Cancer Registry was used to identify 9,978 adults who were dying of cancer between 1994 and 1998 in the Canadian province of Nova Scotia. RT records from between April 1992 and December 1998 were obtained from the provincial treatment database. Multivariate analysis identified factors associated with two sequential decisions determining provision of palliative RT in the last 9 months of life: likelihood of receiving an RT consultation with a radiation oncologist and, given a consultation, likelihood of being treated with palliative RT. RESULTS: The likelihood of having a consultation decreased with age (20 to 59 years v. 80+ years: odds ratio [OR], 4.43 [95% confidence interval, 3.80 to 5.15]), increased with community median household income (> $50,000 v. < $20,000: OR, 1.31 [1.02 to 1.70]), was higher for residents closer to the cancer center (< 25 km v 200+ km: OR, 2.47 [2.16 to 2.83]), increased between 1994 and 1998 (OR, 1.34 [1.16 to 1.56]), varied by cause of death (relative to thoracic cancers, head and neck: OR, 1.75 [1.31 to 2.33]; gynecologic: OR, 0.35 [0.27 to 0.44]), and was greater for those who had prior RT (OR, 2.20 [1.89 to 2.56]). Similar associations were observed when outcome was the provision of palliative RT given a consult, with one notable exception: prior RT was associated with a lower likelihood of receiving palliative RT (OR, 0.48 [0.40 to 0.58]). CONCLUSION: Variations observed in delivery of palliative RT should prompt further investigation into equity of access to clinically appropriate, palliative radiation consultation and treatment.  (+info)

Cancer physicians' attitudes toward colorectal cancer follow-up. (6/250)

BACKGROUND: The optimal follow-up strategy for colorectal cancer is unknown. MATERIALS AND METHODS: We surveyed all Canadian radiation oncologists, medical oncologists and surgeons specializing in colorectal cancer to assess their recommendations for follow-up after potentially curative treatment, the beliefs and attitudes underlying these practices, and the cost implications of different follow-up strategies. RESULTS: One hundred and sixty practitioners (58%) returned completed surveys. Most recommended clinical assessments every 3-4 months in the first 2 years including carcino-embryonic antigen testing, gradually decreasing in frequency over 5 years. Ninety per cent recommend a surveillance colonoscopy in the first year. The majority felt that specialist involvement in follow-up was important because of the increased opportunities for patients to contribute to research (76%) and teaching (73%). About half felt that specialists were more efficient at providing follow-up than primary care physicians, but these same physicians recommended significantly longer and more expensive follow-up routines on average than others. Primary care physicians were felt to be important allies, especially in managing the psychosocial concerns of patients. CONCLUSIONS: Surveillance practices are generally in keeping with published recommendations. Most specialists feel that they should remain involved in follow-up, but this may result in increased resource utilization.  (+info)

A survey of intensity-modulated radiation therapy use in the United States. (7/250)

BACKGROUND: The objective of this study was to assess the current level of intensity-modulated radiation therapy (IMRT) use in the United States. METHODS: Three-hundred thirty-three randomly selected radiation oncologists were sent a 13-question survey regarding IMRT use. IMRT users were asked about the number of patients and sites treated, their reasons for adopting IMRT, and future plans for its use. Physicians who did not use IMRT were asked about their reasons for not using IMRT; whether they intended to adopt it in the future; and, if so, their reasons. RESULTS: One-hundred sixty-eight responses (50.5%) were received. Fifty-four respondents (32.1%) stated that they currently used IMRT. Most IMRT users (79.6%) had adopted IMRT since 2000. Academic physicians were more likely to use IMRT (P = 0.003) compared with private practitioners. The percent of physicians using IMRT in practices comprised of 1 physician, 2-4 physicians, or > 4 physicians were 15.4%, 28.4%, and 44.2%, respectively (P = 0.02). The most common sites treated were head and neck malignancies and genitourinary tumors. Of the 114 IMRT nonusers, 96.5% planned to use IMRT in the future, with 91.8% planning to use IMRT within 3 years. Among IMRT nonusers, the most common reason cited for not using IMRT was lack of necessary equipment. The most common reasons for adopting IMRT (users) or wanting to adopt IMRT (nonusers) were to improve delivery of conventional doses and to escalate dose. CONCLUSIONS: Approximately one-third of radiation oncologists in the United States use IMRT. However, this number appears to be growing rapidly. Efforts to ensure the safe and appropriate application of this new technology are warranted.  (+info)

Effect of education level on outcome of patients treated on Radiation Therapy Oncology Group Protocol 90-03. (8/250)

BACKGROUND: It has been hypothesized that people in lower socioeconomic groups have worse outcomes because they present with advanced-stage cancers or receive inadequate treatment. The authors investigated this hypothesis by using education level as a proxy for socioeconomic status in patients treated on Radiation Therapy Oncology Group (RTOG) Protocol 90-03. METHODS: RTOG 90-03 was a Phase III randomized trial investigating four different radiation fractionation schedules in the treatment of locally advanced head and neck carcinomas. Overall survival and locoregional control rates were analyzed by education level as measured by patient response on the demographic form at study entry. RESULTS: A significant difference was observed in the distribution of patients by education level between the standard fractionated radiation treatment arm and the hyperfractionated radiation treatment arm. More patients in the standard fractionated treatment arm had a higher education level (P = 0.018). Patients attending college had highly and significantly better overall survival and locoregional control than the other groups combined (P = 0.0056 and P = 0.025, respectively: from Cox proportional hazards models stratified by assigned treatment with educational level, T classification, N classification, Karnofsky performance status, primary site, and race). Multivariate analysis revealed that education level was significant for predicting both overall survival and locoregional control when comparing attended college/technical school compared with all other education levels. CONCLUSIONS: Patients attending college or technical school had improved overall survival and locoregional control. These differences cannot be explained by differences in tumor stage or treatment. Poorer overall health or lack of support systems contributing to these results needs to be investigated further.  (+info)