Stereotactic Body Radiation Therapy: A Radiosurgery Society Guide to the Treatment of Localized Prostate Cancer Illustrated by Challenging Cases.

Traditionally, external beam radiotherapy (EBRT) for localized prostate cancer (PCa) involved lengthy courses with low daily doses. However, advancements in radiation delivery and a better understanding of prostate radiobiology have enabled the development of shorter courses of EBRT. Ultrahypofractionated radiotherapy, administering doses greater than 5 Gy per fraction, is now considered a standard of care regimen for localized PCa, particularly for intermediate-risk disease.

A Medicare Claims Analysis of Racial and Ethnic Disparities in the Access to Radiation Therapy Services.

Purpose: Reduced access and utilization of radiation therapy (RT) is a well-documented healthcare disparity observed among racial and ethnic minority groups in the USA and a contributor to the inferior health outcomes observed among Black, Hispanic, and Native American patient groups. What is less understood are the points during the process of care following RT consultation at which patients either fail to complete their prescribed treatment or encounter delays. Identification of those points where significant differences exist among different patient groups may help identify opportunities to close gaps in the access of clinically indicated RT.

An Overview of the Radiation Oncology Alternative Payment Model and Impact on Practices Serving Vulnerable Populations.

Radiation oncology reimbursement methodology has been largely unchanged over the past 30 years, and new approaches are of great interest to practicing radiation oncologists and other health care stakeholders. Traditional radiation oncology reimbursement is based on a series of individual codes for evaluation and management (professional) and technical services, yielding a complex reimbursement system. In an attempt to move toward a simpler, episodic payment model, bundling all of the codes into a single payment, an alternative payment model for radiation oncology was developed.

Radiation Oncology's Place in Payment Reform: ASTRO Advocates for a Place at the Table.

In its current form, the Radiation Oncology Model (RO Model) prioritizes payment cuts over true value-based payment transformation. With significant modifications to the payment methodology, the reporting requirements, and recognition of the unique challenges faced by disadvantaged populations, the RO Model can protect patient access to care, preserve the physician-patient decision-making process, and ensure the delivery of high-quality, efficient radiation therapy treatment. The American Society for Radiation Oncology has spent several years advocating for a meaningful alternative payment model for radiation oncology and continues to push The Center for Medicare and Medicaid Innovation for changes to the RO Model that will recognize these key outcomes.

Multicenter Trial of Stereotactic Body Radiation Therapy for Low- and Intermediate-Risk Prostate Cancer: Survival and Toxicity Endpoints.

Purpose: The radiobiology of prostate cancer may favor the extreme hypofractionation inherent in stereotactic body radiation therapy (SBRT); however, data from a large multicenter study are lacking. We therefore examined the hypothesis that dose-escalated SBRT can be safely administered across multiple institutions, with favorable 5-year disease-free survival (DFS) rates compared with historical controls.

Methods And Materials: Twenty-one centers enrolled 309 patients with prostate adenocarcinoma: 172 with low-risk (LR) and 137 with intermediate-risk (IR) disease.

Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): An American Society for Radiation Oncology evidence-based guideline.

Purpose: To systematically review the evidence for the radiotherapeutic and surgical management of patients newly diagnosed with intraparenchymal brain metastases.

Methods And Materials: Key clinical questions to be addressed in this evidence-based Guideline were identified. Fully published randomized controlled trials dealing with the management of newly diagnosed intraparenchymal brain metastases were searched systematically and reviewed.

Predictors of response to sildenafil citrate following radiation therapy for prostate cancer.

Introduction: Phosphodiesterase type 5 inhibitor (PDE5) use is a treatment strategy for prostate cancer patients with post-radiation therapy (RT) erectile dysfunction (ED).

Aim: To define the predictors of sildenafil response in men treated with RT for prostate cancer.

Main Outcome Measures: International Index of Erectile Function (IIEF).

The role of physicians and medical organizations in the development, analysis, and implementation of health care policy.

Health policy is developed in the United States through a complicated interplay of governmental and private agencies and businesses, physician organizations, and societies as well as a host of other private ventures. The end result is rarely precisely what any individual or group may desire as the consequences of any action are never entirely predictable. There are many pathways to influence policy development within this system, and many of these are influenced by physicians as individuals and through organized medical societies.

Analysis of the impact of androgen deprivation therapy on sildenafil citrate response following radiation therapy for prostate cancer.

Purpose: Radiation therapy is a widely accepted strategy for prostate cancer. Erectile dysfunction is a common complication of radiation therapy. Adjuvant androgen deprivation was shown to prolong survival in select patients.

Long-term follow-up of 111In-capromab pendetide (ProstaScint) scan as pretreatment assessment in patients who undergo salvage radiotherapy for rising prostate-specific antigen after radical prostatectomy for prostate cancer.

Purpose: To evaluate the long-term failure patterns in patients who underwent an (111)In-capromab pendetide (ProstaScint) scan as part of their pretreatment assessment for a rising prostate-specific antigen (PSA) level after prostatectomy and subsequently received local radiotherapy (RT) to the prostate bed.

Methods: Fifty-eight patients were referred for evaluation of a rising PSA level after radical prostatectomy. All patients had negative findings for metastatic disease after abdominal/pelvis imaging with CT and isotope bone scans.

The hemodynamics of erectile dysfunction following external beam radiation for prostate cancer.

Introduction: Radiation to the pelvis is associated with erectile dysfunction (ED). The mechanisms include neural injury, vascular alterations, and corporal smooth structural changes. There exists little data on the vascular assessment of men who present with ED following radiation therapy for prostate cancer.

Evidence-based review of three-dimensional conformal radiotherapy for localized prostate cancer: an ASTRO outcomes initiative.

Purpose: To perform a systematic review of the evidence to determine the efficacy and effectiveness of three-dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer; provide a clear presentation of the key clinical outcome questions related to the use of 3D-CRT in the treatment of localized prostate cancer that may be answered by a formal literature review; and provide concise information on whether 3D-CRT improves the clinical outcomes in the treatment of localized prostate cancer compared with conventional RT.

Methods And Materials: We performed a systematic review of the literature through a structured process developed by the American Society for Therapeutic Radiology and Oncology's Outcomes Committee that involved the creation of a multidisciplinary task force, development of clinical outcome questions, a formal literature review and data abstraction, data review, and outside peer review.

Results: Seven key clinical questions were identified.

Neoadjuvant chemoradiotherapy for locally advanced esophageal cancer: experience at a single institution.

Hypothesis: Patients receiving neoadjuvant chemoradiotherapy followed by surgery (CRS) undergo downstaging of their tumor and have improved survival when compared with patients undergoing surgery followed by adjuvant chemoradiotherapy (SCR).

Design: Retrospective study.

Setting: Tertiary-care university medical center.

Is an 192Ir permanent seed implant feasible for prostate brachytherapy?

Purpose: (125)I permanent seed brachytherapy for prostate cancer produces good clinical outcomes and limits radiation exposure to medical staff and patients' families. However, (125)I seeds cost thousands of dollars per implant. An encapsulated (192)Ir permanent seed possibly could cost less than 10 dollars.

Assessment of different IMRT boost delivery methods on target coverage and normal-tissue sparing.

Purpose: Because of biologic, medical, and sometimes logistic reasons, patients may be treated with 3D conformal therapy or intensity-modulated radiation therapy (IMRT) for the initial treatment volume (PTV(1)) followed by a sequential IMRT boost dose delivered to the boost volume (PTV(2)). In some patients, both PTV(1) and PTV(2) may be simultaneously treated by IMRT (simultaneous integrated boost technique). The purpose of this work was to assess the sequential and simultaneous integrated boost IMRT delivery techniques on target coverage and normal-tissue sparing.

Second primary cancers in patients with laryngeal cancer: a population-based study.

Background: Literature regarding incidence of site-specific second cancers after laryngeal cancer is limited. Risk factors associated with second primaries are unknown.

Methods: Second primaries after laryngeal cancer in the SEER database (1973-1996) were analyzed for incidence, relative risk compared with the general population, and potential risk factors, including radiotherapy.

Role of IMRT in reducing penile doses in dose escalation for prostate cancer.

Purpose: In three-dimensional conformal radiotherapy (3D-CRT), penile tissues adjacent to the prostate are exposed to significant doses of radiation. This is likely to be a factor in development of posttreatment erectile dysfunction. In this study, we investigate whether intensity-modulated radiation therapy (IMRT) leads to lower radiation exposure to proximal penile tissues (PPT) when compared with 3D-CRT.

Effect of prostatic edema on CT-based postimplant dosimetry.

Purpose: To investigate the magnitude of edema after prostate brachytherapy and its effect on the CT-based postimplant dosimetry based on the sequential CT scans using dose-volume histograms, dose conformity, and homogeneity indices in patients with prostate cancer.

Methods And Materials: CT scans were obtained for 25 patients who underwent prostate brachytherapy with 125I or 103Pd before implant and postimplant Day 1, Day 7, and Day 28. The prostate, rectum, and bladder volumes on each scan were contoured by the same physician.

Radiation exposure to the corporeal bodies during 3-dimensional conformal radiation therapy for prostate cancer.

Purpose: Radiation therapy for prostate cancer is associated with the development of post-treatment erectile dysfunction. Use of 3-dimensional (D) conformal delivery techniques has reduced delivery of radiation to periprostatic tissues. However, the exact magnitude of radiation that the corporeal bodies are exposed to using this delivery technique is currently unknown.