Hypofractionated Radiotherapy for Hematologic Malignancies during the COVID-19 Pandemic and Beyond.

Purpose: Radiotherapy is integral in the management of hematological malignancies (HM). Standard radiotherapy dose fractionation regimens range between 20 and 50 Gy in 10-25 fractions over 2-5 weeks. This study presents the outcomes of patients with HM treated with hypofractionation radiotherapy (HFRT) during the COVID-19 pandemic.

Factors Associated with Long-Term Prostate Cancer Survival after Palliative Radiotherapy to a Bone Metastasis and Contemporary Palliative Systemic Therapy: A Retrospective, Population-Based Study.

Background: Radiation therapy (RT) is an established palliative treatment for bone metastases; however, little is known about post-radiation survival and factors which impact it. The aim of this study was to assess a population-based sample of metastatic prostate cancer patients receiving palliative radiation therapy to bone metastases and contemporary palliative systemic therapy and identify factors that impact long-term survival.

Materials/methods: This retrospective, population-based, cohort study assessed all prostate cancer patients receiving palliative RT for bone metastases at a Canadian provincial Cancer program during a contemporary time period.

Merkel Cell Carcinoma of the Head and Neck.

Merkel cell carcinoma (MCC) of the head and neck is a rare and aggressive non-melanoma skin cancer. The objective of this study was to assess the oncological outcome of MCC by retrospective review of electronic and paper records of a population-based cohort of 17 consecutive cases of the head and neck MCC without distant metastasis, diagnosed in Manitoba between 2004 and 2016. The average age of the patients at initial presentation was 74.

Metformin for Prevention of Anthropometric and Metabolic Complications of Androgen Deprivation Therapy in Prostate Cancer Patients Receiving Radical Radiotherapy: A Phase II Randomized Controlled Trial.

Background: Patients with prostate cancer undergoing treatment with radical radiation therapy (RT) plus androgen deprivation therapy (ADT) experience a constellation of deleterious metabolic and anthropometric changes related to hypogonadism that are associated with increased morbidity and mortality. We assessed the effect of metformin versus placebo to blunt the adverse effects of ADT on body weight, waist circumference, and other metabolic parameters.

Methods And Materials: This phase 2, multicenter, randomized controlled trial (RCT) randomized normoglycemic men with locally advanced prostate cancer receiving radical RT and ADT (18-36 months) in a 1:1 ratio to receive metformin 500 mg by mouth 3 times a day (for 30-36 months) versus identical placebo.

Do Sustainable Palliative Single Fraction Radiotherapy Practices Proliferate or Perish 2 Years after a Knowledge Translation Campaign?

In early 2017, the Canadian Partnership Against Cancer and CancerCare Manitoba undertook a comprehensive knowledge translation (KT) campaign to improve the utilization of single fraction radiotherapy (SFRT) over multiple fraction radiotherapy (MFRT) for palliative management of bone metastases. The campaign significantly increased short-term SFRT utilization. We assess the time-dependent effects of KT-derived SFRT utilization 12-24 months removed from the KT campaign in a Provincial Cancer Program.

Optical scan and 3D printing guided radiation therapy - an application and provincial experience in cutaneous nasal carcinoma.

Background: Single field Orthovoltage radiation is an acceptable modality used for the treatment of nasal cutaneous cancer. However, this technique has dosimetric pitfalls and unnecessary excessive exposure of radiation to organs at risk (OAR). We present the clinical outcome of a case series of cutaneous nasal tumours using a novel technique incorporating an optical scanner and a 3-dimensional (3D) printer to deliver treatments using parallel opposed (POP) fields.

A retrospective study on clinical factors influencing intra-fraction motion using volumetric imaging for spine stereotactic body radiotherapy.

Objectives: Stereotactic body radiation therapy (SBRT) for the spine is challenging due to high-dose gradients sparing the cord in the treatment plans. We present our findings of initial setup error and intrafraction motion from Cone-beam computed tomography (CBCT) imaging.

Materials And Methods: A total of 47 patients treated with spine SBRT with a total of 154 fractions following a fractionation schedule of 16 Gy in 1, 24 Gy in 2, and 30 Gy in 5 fractions were part of this study.

Gastrointestinal and genitourinary toxicity profiles of metformin versus placebo in men with prostate cancer receiving prostate radiotherapy: interim toxicity results of a double-blinded, multicenter, phase II randomized controlled trial.

Androgen deprivation therapy (ADT) used for prostate cancer (PCa) management is associated with metabolic and anthropometric toxicity. Metformin given concurrent to ADT is hypothesized to counteract these changes. This planned interim analysis reports the gastrointestinal and genitourinary toxicity profiles of PCa patients receiving ADT and prostate/pelvic radiotherapy plus metformin versus placebo as part of a phase 2 randomized controlled trial.

Stereotactic Radiotherapy for Oligoprogression in Metastatic Renal Cell Cancer Patients Receiving Tyrosine Kinase Inhibitor Therapy: A Phase 2 Prospective Multicenter Study.

Background: Despite the paucity of prospective evidence, stereotactic radiotherapy (SRT) is increasingly being considered in the setting of oligoprogression to delay the need to change systemic therapy.

Objective: To determine the local control (LC), progression-free survival (PFS), cumulative incidence of changing systemic therapy, and overall survival (OS) after SRT to oligoprogressive metastatic renal cell carcinoma (mRCC) lesions in patients who are on tyrosine kinase inhibitor (TKI) therapy.

Design, Setting, And Participants: A prospective multicenter study was performed to evaluate the use of SRT in oligoprogressive mRCC patients.

Clinical Outcomes After Stereotactic Body Radiation Therapy for Early Stage Non-Small Cell Lung Cancer: A Single Institutional Study.

Introduction The standard of care for early-stage non-small cell lung cancer (NSCLC) is surgery. However, for medical inoperable patients stereotactic body radiation therapy (SBRT) is an alternative method. The aim of the study is to assess the overall survival (OS), progression-free survival (PFS) and local control (LC) of patients diagnosed with NSCLC in Manitoba, Canada, between 2013 and 2017 and managed with SBRT.

Outcome of Locally Advanced Esophageal Cancer Patients Treated With Perioperative Chemotherapy and Chemoradiotherapy Followed by Surgery.

Objectives: Perioperative chemotherapy (P-CT) or neoadjuvant chemoradiation (C-RT) followed by surgical resection is the standard of care for locally advanced esophageal cancer (LAEC). We present an institutional review and outcome of patients with LAEC treated with neoadjuvant C-RT or P-CT followed by surgery.

Methods: Patients were identified through the Manitoba Cancer Registry.

Population-based Assessment of Intermittent Androgen Deprivation Therapy Utilization for Relapsed, Nonmetastatic, Hormone-sensitive Adenocarcinoma of the Prostate.

Objectives: Androgen deprivation therapy (ADT) is the standard of care for men with nonmetastatic hormone-sensitive prostate cancer (nmHSPC) after treatment failure. Although intermittent ADT (iADT) is noninferior to continuous ADT for prostate cancer outcomes, with superior quality of life and cost-to-benefit ratio, little is known regarding its real-world utilization. The authors aimed to determine the utilization of iADT in a Canadian Provincial Cancer Program for relapsed nmHSPC and identified risk factors associated with the nonreceipt of iADT.

Do Coordinated Knowledge Translation Campaigns Persuade Radiation Oncologists to Use Single-Fraction Radiation Therapy Compared With Multiple-Fraction Radiation Therapy for Bone Metastases?

Purpose: Although level 1 evidence supports the use of single-fraction radiation therapy (SFRT) compared with multiple-fraction radiation therapy (MFRT) for the palliative management of bone metastases, SFRT is underused. In early 2017, the Canadian Partnership Against Cancer and CancerCare Manitoba undertook a comprehensive knowledge translation campaign in Manitoba, Canada featuring educational outreach visits, local consensus meetings, and audit and feedback interventions to encourage greater use of SFRT. This study assessed the impact of this campaign on SFRT use and identified variables associated with MFRT usage.

Bracing for impact with new 4R's in the COVID-19 pandemic - A provincial thoracic radiation oncology consensus.

As COVID-19 pandemic continues to explode, cancer centers worldwide are trying to adapt and are struggling with this constantly changing scenario. Intending to ensure patient safety and deliver quality care, we sought consensus on the preferred thoracic radiation regimen in a Canadian province with 4 new R's of COVID era.

A modern mold room: Meshing 3D surface scanning, digital design, and 3D printing with bolus fabrication.

Purpose: This case series represents an initial experience with implementing 3-dimensional (3D) surface scanning, digital design, and 3D printing for bolus fabrication for patients with complex surface anatomy where traditional approaches are challenging.

Methods And Materials: For 10 patients requiring bolus in regions with complex contours, bolus was designed digitally from 3D surface scanning data or computed tomography (CT) images using either a treatment planning system or mesh editing software. Boluses were printed using a fused deposition modeling printer with polylactic acid.

Role of thoracic consolidation radiation in extensive stage small cell lung cancer: A systematic review and meta-analysis of randomised controlled trials.

Extensive stage small cell lung cancer (ES-SCLC) carries a poor prognosis, and the thoracic progression is common. Consolidation radiation to thoracic disease (cRT) could improve progression-free survival (PFS) and overall survival (OS). We conducted an electronic search of PubMed and Embase with no language, year or publication status restrictions and evaluated randomised controlled trials (RCTs) addressing the role of cRT in ES-SCLC.

Clinical Characteristics and Prognosis of Primary Tracheal Cancer: A Single Institution Experience.

Primary tracheal cancers (PTCs) are rare and current evidence-based understanding is limited to retrospective reports and national databases. We present single institutional study of a historical cohort of PTC from Canadian provincial cancer registry database. After institutional research ethics board approval, all PTC patients diagnosed from 1980 to 2014 were identified through the Canadian provincial cancer registry.

Role of Stereotactic Body Radiation Therapy in Early Stage Small Cell Lung Cancer in the Era of Lung Cancer Screening: A Systematic Review.

With the obvious benefit from low dose computed tomography to reduce the lung cancer-specific mortality, lung cancer screening is on the rise. With the implementation of the screening programs, diagnosis of early stage lung cancer is expected to increase, and small cell lung cancer (SCLC) would account for 10% of screen-detected lung cancer. Apart from Concurrent chemoradiation (CRT), the present guidelines virtually do not support other options for radiation (RT).

Low-cost optical scanner and 3-dimensional printing technology to create lead shielding for radiation therapy of facial skin cancer: First clinical case series.

Purpose: Three-dimensional printing has been implemented at our institution to create customized treatment accessories, including lead shields used during radiation therapy for facial skin cancer. To effectively use 3-dimensional printing, the topography of the patient must first be acquired. We evaluated a low-cost, structured-light, 3-dimensional, optical scanner to assess the clinical viability of this technology.

Comparison of 7th and 8th editions of the UICC/AJCC TNM staging for non-small cell lung cancer in a non-metastatic North American cohort undergoing primary radiation treatment.

Background: We compared the performance of 7th and 8th edition of the Union for International Cancer Control (UICC) / American Joint Committee on Cancer (AJCC) TNM staging for non-small cell lung cancer (NSCLC) in non-metastatic (stage I-III) North American cohort undergoing primary radiation treatment.

Methods: Newly diagnosed NSCLC between (Jan 2011 - Dec 2014) were screened through a Canadian Provincial Cancer Registry. Clinico-radiologically and pathologically confirmed non-metastatic NSCLC undergoing primary radiation treatment were included.

Clinical Implementation of a Model-Based In Vivo Dose Verification System for Stereotactic Body Radiation Therapy-Volumetric Modulated Arc Therapy Treatments Using the Electronic Portal Imaging Device.

Purpose: To report findings from an in vivo dosimetry program implemented for all stereotactic body radiation therapy patients over a 31-month period and discuss the value and challenges of utilizing in vivo electronic portal imaging device (EPID) dosimetry clinically.

Methods And Materials: From December 2013 to July 2016, 117 stereotactic body radiation therapy-volumetric modulated arc therapy patients (100 lung, 15 spine, and 2 liver) underwent 602 EPID-based in vivo dose verification events. A developed model-based dose reconstruction algorithm calculates the 3-dimensional dose distribution to the patient by back-projecting the primary fluence measured by the EPID during treatment.

Diagnosis and Management of Spinal Metastasis of Glioblastoma.

Background: When patients with cranial glioblastoma develop weakness, a rare differential diagnosis is spinal metastases.

Methods: Chart and literature reviews were performed.

Results: The reported patient had delayed onset spinal drop metastasis that was only detected by magnetic resonance imaging (MRI).

Overall Quality of Life Assessment in the Patients Undergoing External Beam Radiation in Outpatient Radiation Oncology Department.

Background: The impact of treatment on cancer patients' quality of life (QoL) has been the focus of a variety of longitudinal studies in English literature for past decade. The measurement of patient-reported outcomes which includes health-related quality of life is a new important initiative which has emerged and grown over the past three decades. Following the development of reliable and valid self-reported questionnaires, health-related quality of life has been assessed in tens of thousands of patients and a wide variety of cancers.