Transition from point A to volume based image guided brachytherapy across a network of centers in India through workshop and mentoring.

Aim: To demonstrate how workshop and mentoring across a network of radiotherapy centers helped in transitioning from point A to volume-based image guided brachytherapy in carcinoma cervix.

Materials And Methods: Based on discussion with different centers across the network, the lapses in cervical cancer treatment were identified and a workshop was designed to change the practice pattern. The main focus of the workshop was to streamline EBRT dose prescription protocols and implement volume based image guided brachytherapy through mentoring and hands on training.

Prostate Brachytherapy With Cs-131: Long-term Results Compared With Published Stereotactic Body Radiotherapy Data.

Objective: We sought to compare our results of patients treated with Cs-131 prostate brachytherapy (PB) as monotherapy to recently published results of patients treated with stereotactic body radiotherapy.

Methods: We analyzed data from patients treated at our institution with Cs-131 PB as monotherapy who had at least 5 years of follow-up and who prospectively completed expanded prostate cancer index composite questionnaires at baseline, 1 year, 2 years, and 5 years. We compared our data with the recently published data from radiation therapy oncology group (RTOG) 0938 and PACE-B (NCT01584258).

Dose finding, bioavailability, and PK-PD of oral triapine with concurrent chemoradiation for locally advanced cervical cancer and vaginal cancer (ETCTN 9892).

Background: The addition of IV triapine to chemoradiation appeared active in phase I and II studies but drug delivery is cumbersome. We examined PO triapine with cisplatin chemoradiation.

Methods: We implemented a 3 + 3 design for PO triapine dose escalation with expansion, starting at 100 mg, five days a week for five weeks while receiving radiation with weekly IV cisplatin for locally advanced cervical or vaginal cancer.

A Castration-Resistant Prostate Tumor With Unusual Anatomy Treated Using Daily Online Adaptive Radiotherapy.

Daily online adaptive radiotherapy (OART) is useful in radiotherapy of prostate cancer to reduce doses to the rectum and bladder which pose a challenge because of daily variation in shape and size. It also helps to reduce target margins while still maintaining target coverage. We present a case of prostate cancer resistant to androgen deprivation therapy and systemic therapy which was difficult to treat with definitive radiotherapy because of the unusual anatomical shape of the tumor impinging into the rectum.

Acceptability of and satisfaction with continuous glucose monitoring in pregnant women with type 2 diabetes mellitus: A service improvement project.

Background: There are limited data regarding intermittently scanned continuous glucose monitoring (isCGM) in pregnancy for women with Type 2 diabetes. We have tested the acceptability and feasibility of an isCGM method using Libre device.

Method: In a hospital-based service improvement project, 23 pregnant women (March 2022-April 2023), with Type 2 diabetes got isCGM for monitoring from 20 weeks until delivery.

HN-SIB-BPI: A single click, sub-site specific, dosimetric scorecard tuned RapidPlan model created from a foundation model for treating head and neck with bilateral neck.

To develop a Knowledge Based Planning (KBP) model for creating quantifiably high quality VMAT treatment plans in a single click for head and neck cases treated Simultaneous Integrated Boost (SIB) with bilateral parotid involvement (BPI) where both parotids are near, abutting or partially overlapping target volume. Eclipse RapidPlan and the publicly available PlanScorecard tool were used to assess existing Head and Neck RapidPlan models on two representative cases. The best performer was used as a foundation model to assist in creating new initial training set doses from previously treated cases.

Evaluation of a deep image-to-image network (DI2IN) auto-segmentation algorithm across a network of cancer centers.

Purpose/objective S: Due to manual OAR contouring challenges, various automatic contouring solutions have been introduced. Historically, common clinical auto-segmentation algorithms used were atlas-based, which required maintaining a library of self-made contours. Searching the collection was computationally intensive and could take several minutes to complete.

Surgical Margins After Neoadjuvant Radiation for Locally Advanced Vulvar Carcinoma: What is an Adequate Margin?

Objective: We aim to explore whether the surgical tumor free margin is important for overall survival (OS) and local control in patients who undergo neoadjuvant radiation (RT) for vulvar cancer.

Methods: A retrospective review from 2004 to 2021 of patients who underwent RT followed by surgical resection was performed. Patients were categorized into groups based on margin status (no residual disease, >8 mm, close margins defined as 1 to 7 mm, or positive).

Role of simulation-based training and assessment to improve brachytherapy competency among radiation oncology residents.

Simulation is a technique used in healthcare to replicate clinical scenarios and improve patient safety, efficacy, and efficiency. Simulation-based medical education facilitates training and assessment in healthcare without increasing risk to patients, supported by ample evidence from surgical/procedural specialties. Simulation in radiation oncology has been leveraged to an extent, with successful examples of both screen-based and hands-on simulators that have improved confidence and performance in trainees.

Review of Deep Learning Based Autosegmentation for Clinical Target Volume: Current Status and Future Directions.

Purpose: Manual contour work for radiation treatment planning takes significant time to ensure volumes are accurately delineated. The use of artificial intelligence with deep learning based autosegmentation (DLAS) models has made itself known in recent years to alleviate this workload. It is used for organs at risk contouring with significant consistency in performance and time saving.

EXERT-BC: A pilot study of an exercise regimen designed to improve functional mobility, body composition, and strength after the treatment for breast cancer.

Purpose: Resistance training may offer several unique advantages within breast cancer (BC) survivorship care; however, safety concerns have limited the application of high-intensity compound movements necessary to elicit optimal changes in body composition, strength, and quality of life in this population. The EXERT-BC trial assesses the safety and feasibility of an evidence-based, dose-escalated resistance training regimen among BC survivors, with the goal of improving physical and metabolic function, mobility, muscle mass, and body composition.

Methods: Participants included women with breast cancer underwent a 3-month thrice weekly exercise regimen involving dose escalation of high-intensity compound exercises.

Multicenter Study of Pelvic Nodal Autosegmentation Algorithm of Siemens Healthineers: Comparison of Male Versus Female Pelvis.

Purpose: The autosegmentation algorithm of Siemens Healthineers version VA 30 (AASH) (Siemens Healthineers, Erlangen, Germany) was trained and developed in the male pelvis, with no published data on its usability in the female pelvis. This is the first multi-institutional study to describe and evaluate an artificial intelligence algorithm for autosegmentation of the pelvic nodal region by gender.

Methods And Materials: We retrospectively evaluated AASH pelvic nodal autosegmentation in both male and female patients treated at our network of institutions.

Quality of Radiotherapy Workforce Training within the USA.

The training, competency requirements and scope of practice of professionals within a radiation oncology department vary across countries. The purpose of this review is to shed light on the current status of radiotherapy training in the USA by discussing current benchmarks for medical residency, physics residency, radiation therapy and dosimetry training programmes. Although there are notable strengths, the US radiotherapy workforce training system also faces several challenges when it comes to standardising education to develop a competent workforce that meets societal needs.

EXERT-BC: Prospective Study of an Exercise Regimen After Treatment for Breast Cancer.

EXERT-BC is a dose-escalated resistance training regimen created to improve body composition, strength, and balance in women treated for breast cancer (BC). Herein, we report the interim analysis. Women treated for BC underwent this 3-month exercise regimen in an exercise oncology facility with continual monitoring of load and strength.

Prognostic Effect of Mismatch Repair Status in Early-Stage Endometrial Cancer Treated With Adjuvant Radiation: A Multi-institutional Analysis.

Purpose: The aim of this work was to report the effect of mismatch repair (MMR) status on outcomes of patients with stage I-II endometrioid endometrial adenocarcinoma (EEC) who receive adjuvant radiation therapy.

Methods And Materials: This is a multi-institutional retrospective cohort study across 11 institutions in North America. Patients with known MMR status and stage I-II EEC status postsurgical staging were included.

The role of obesity in treatment planning for early-stage cervical cancer.

Objectives: Optimal management of obese patients with early-stage cervical cancer is debated despite evidence of non-inferior survival in obese patients undergoing radical hysterectomy with pelvic lymphadenectomy (RH) compared to primary radiation with or without radiosensitizing chemotherapy (RT). Objectives included describing patient factors affecting disposition to RH versus RT; comparing RH outcomes for obese (BMI >30 mg/m) and non-obese patients; and comparing differences in recurrence free survival (RFS) and overall survival (OS).

Methods: This was a single institution cohort study of all cervical cancer patients who underwent RH or were candidates for RH based on clinical stage.

Stereotactic Body Radiation Therapy for Gynecologic Malignancies: A Case-Based Radiosurgery Society Practice Review.

Purpose: The use of stereotactic body radiation therapy (SBRT) for gynecologic malignancies is controversial. We discuss certain circumstances when highly precise SBRT may be a useful tool to consider in the management of selected patients.

Methods And Materials: Case selection included the following scenarios, the first 2 with palliative intent, para-aortic nodal oligorecurrence of ovarian cancer, pelvic sidewall oligorecurrence of cervical cancer, and inoperable endometrial cancer boost after intensity modulated radiation to the pelvis treated with curative intent.

Redefining bladder neck dose in low-dose-rate prostate brachytherapy-Can we improve urinary toxicity without impacting disease control?

Background: We sought to assess the impact of bladder neck dose (BND) on patient reported urinary toxicity, and feasibility of relative urethral sparing technique in prostate brachytherapy (PB).

Methods And Materials: We retrospectively identified bladder neck as a point dose on post-implant CT scans in patients treated with Cs PB. Urinary symptoms were assessed through EPIC questionnaires.