Pro-active risk analysis of an in-house developed deep learning based autoplanning tool for breast Volumetric Modulated Arc Therapy.

Background And Purpose: With the increasing amount of in-house created deep learning models in radiotherapy, it is important to know how to minimise the risks associated with the local clinical implementation prior to clinical use. The goal of this study is to give an example of how to identify the risks and find mitigation strategies to reduce these risks in an implemented workflow containing a deep learning based planning tool for breast Volumetric Modulated Arc Therapy.

Materials And Methods: The deep learning model ran on a private Google Cloud environment for adequate computational capacity and was integrated into a workflow that could be initiated within the clinical Treatment Planning System (TPS).

The EORTC 22922/10925 trial investigating regional nodal irradiation in stage I-III breast cancer: Outcomes according to locoregional and systemic therapies.

Unlabelled: The EORTC 22922/10925 trial aimed to investigate the impact on overall survival (OS) of elective internal mammary and medial supraclavicular (IM-MS) radiation therapy (RT) in breast cancer stage I-III. Surgery for the primary tumour and axillary lymph nodes, chest wall RT, boost RT after whole breast RT in breast conserving therapy (BCT), RT to operated axilla, and systemic therapy were per physician's preference. The aim of the current analysis is to assess breast cancer outcomes according to different locoregional and systemic therapy used in the trial.

From guidelines to clinical practice in care for ischaemic stroke patients: A systematic review and expert opinion.

Background And Purpose: Guidelines help physicians to provide optimal care for stroke patients, but implementation is challenging due to the quantity of recommendations. Therefore a practical overview related to applicability of recommendations can be of assistance.

Methods: A systematic review was performed on ischaemic stroke guidelines published in scientific journals, covering the whole acute care process for patients with ischaemic stroke.

Coverage with evidence development program on stereotactic body radiotherapy in Belgium (2013-2019): a nationwide registry-based prospective study.

Background: Although stereotactic body radiotherapy (SBRT) was progressively adopted in clinical practice in Belgium, a reimbursement request in 2011 was not granted because of remaining clinical and economic uncertainty. A coverage with evidence development (CED) program on SBRT started in 2013, with the aim to assess clinical and technical patterns-of-care in Belgium and monitor survival per indication, in view of supporting inclusion in the reimbursement system.

Methods: The Belgian National Institute for Health and Disability Insurance (NIHDI) initiated this prospective observational registry.

Development of a set of measurable outcome indicators for Flemish patients with inflammatory bowel disease.

Objective: Uniform and standardised quality measurement allows care assessment and improvement. Following a pragmatic consensus method we aimed to agree on a selection of measurable quality indicators that can be used to assess, benchmark and gradually improve inflammatory bowel disease (IBD) care in Flanders.

Methods: Of 49 structures, 135 processes and 37 outcome indicators identified through literature, 58 were preselected and reformulated into measurable outcome indicators by four IBD physicians.

High-grade HER2-positive mucoepidermoid carcinoma of the breast: a case report and review of the literature.

Background: Mucoepidermoid carcinoma of the breast is a rare special type of salivary gland-like tumor of the breast, usually displaying triple-negative phenotype. To date, only 64 cases have been reported in the English literature. Herein, we report the first case of mucoepidermoid carcinoma of the breast with human epidermal growth factor receptor 2 gene amplification.

Deep learning based MLC aperture and monitor unit prediction as a warm start for breast VMAT optimisation.

. Automated treatment planning today is focussed on non-exact, two-step procedures. Firstly, dose-volume histograms (DVHs) or 3D dose distributions are predicted from the patient anatomy.

Comparison of prone and supine positioning for breast cancer radiotherapy using REQUITE data: dosimetry, acute and two years physician and patient-reported outcomes.

Objective: Most patients receive whole breast radiotherapy in a supine position. However, two randomised trials showed lower acute toxicity in prone position. Furthermore, in most patients, prone positioning reduced doses to the organs at risk.

Genome-wide association study of treatment-related toxicity two years following radiotherapy for breast cancer.

Background And Purpose: Up to a quarter of breast cancer patients treated by surgery and radiotherapy experience clinically significant toxicity. If patients at high risk of adverse effects could be identified at diagnosis, their treatment could be tailored accordingly. This study was designed to identify common single nucleotide polymorphisms (SNPs) associated with toxicity two years following whole breast radiotherapy.

Mapping the location of local and regional recurrences according to breast cancer surgery and radiation therapy: Results from EORTC 22922/10925.

Unlabelled: The purpose of this study is to evaluate the influence of the extent of surgery and radiation therapy (RT) on the rates and sites of local (LR) and regional recurrences (RR) in the EORTC 22922/10925 trial.

Patients And Methods: All data were extracted from the trial's individual patients' case report forms (CRF) and analysed with a median follow-up of 15.7 years.

Mortality and Major Adverse Cardiac Events in Patients With Breast Cancer Receiving Radiotherapy: The First Decade.

Background Treatment for breast cancer (BC) frequently involves radiotherapy. Guidelines recommend screening for cardiac adverse events starting 10 years after radiotherapy. The rationale for this interval is unclear.

Radiotherapy-specific quality indicators at national level: How to make it happen.

Purpose /objective: To promote best practice and quality of care, the Belgian College of Physicians for Radiotherapy Centers established a set of radiotherapy specific quality indicators for benchmarking on a national level. This paper describes the development, the collected QIs, the observed trends and the departments' evaluation of this initiative.

Material And Methods: The Donabedian approach was used, focussing on structural, process and outcome QIs.

Variation in stroke care at the hospital level: A cross-sectional multicenter study.

Introduction: Stroke is one of the leading causes of mortality and disability. Improving patient outcomes can be achieved by improving stroke care and adherence to guidelines. Since wide variation in adherence rates for stroke guidelines still exists, we aimed to describe and compare stroke care variability within Belgian hospitals.

Elevated CA 15.3 in Newly Diagnosed Breast Cancer: A Retrospective Study.

Purpose: To examine the relationship between baseline elevated CA 15.3 (>30 kU/L) and the prevalence of primary or secondary metastatic disease in breast cancer.

Methods: We performed a retrospective, single-center cohort study on patients with newly diagnosed breast cancer and baseline CA 15.

Development and Optimization of a Machine-Learning Prediction Model for Acute Desquamation After Breast Radiation Therapy in the Multicenter REQUITE Cohort.

Purpose: Some patients with breast cancer treated by surgery and radiation therapy experience clinically significant toxicity, which may adversely affect cosmesis and quality of life. There is a paucity of validated clinical prediction models for radiation toxicity. We used machine learning (ML) algorithms to develop and optimise a clinical prediction model for acute breast desquamation after whole breast external beam radiation therapy in the prospective multicenter REQUITE cohort study.

The association of internal mammary and medial supraclavicular lymph node radiation technique with clinical outcomes: Results from the EORTC 22922/10925 randomised trial.

Background And Purpose: The multicentre EORTC 22922/10925 trial (ClinicalTrials.gov, NCT00002851) was conducted between 1996 and 2004. The trial evaluated the effect of irradiation of the internal mammary and medial supraclavicular lymph node chains (IM-MS) vs no further radiation therapy (RT) on survival and cause of death in breast cancer stage I-III patients.

Validation of a prognostic scoring system for postmastectomy locoregional recurrence in breast cancer.

Background: To date, it remains unclear which patients with breast cancer (BC) benefit from post-mastectomy radiotherapy (PMRT). Cheng et al. developed and validated a scoring system based on 4 prognostic factors for locoregional recurrence (LRR) to identify patients in need for PMRT.

Clinical evaluation of a deep learning model for segmentation of target volumes in breast cancer radiotherapy.

Purpose/objective(s): Precise segmentation of clinical target volumes (CTV) in breast cancer is indispensable for state-of-the art radiotherapy. Despite international guidelines, significant intra- and interobserver variability exists, negatively impacting treatment outcomes. The aim of this study is to evaluate the performance and efficiency of segmentation of CTVs in planning CT images of breast cancer patients using a 3D convolutional neural network (CNN) compared to the manual process.

Intra-fraction motion monitoring during fast modulated radiotherapy delivery in a closed-bore gantry linac.

Background And Purpose: New closed-bore linacs allow for highly streamlined workflows and fast treatment delivery resulting in brief treatment sessions. Motion management technology has only recently been integrated inside the bore, yet is required in future online adaptive workflows. We measured patient motion during every step of the workflow: image acquisition, evaluation and treatment delivery using surface scanning.

Side Effects 15 Years After Lymph Node Irradiation in Breast Cancer: Randomized EORTC Trial 22922/10925.

Background: Uncertainty about the benefit-risk ratio of regional lymph node irradiation led to varying clinical protocols. We investigated long-term late side effects after internal mammary and medial supraclavicular (IM-MS) lymph node irradiation to improve shared decision making.

Methods: The multicenter European Organization for Research and Treatment of Cancer trial (ClinicalTrials.

Detection of secondary metastatic breast cancer by measurement of plasma CA 15.3.

Background: Most current guidelines do not recommend the serial analysis of tumour marker CA 15.3 in the follow-up of asymptomatic patients treated for early breast cancer (EBC). These guidelines are based on small-scale studies carried out in an era with more limited treatment options than today.

A nurse-led multicomponent intervention supported by advanced electronic health records to improve the acute management of stroke patients: A pre- and post-intervention study.

Background: Management of temperature, glycaemia and dysphagia, reffered to as the Fever, Sugar, Swallowing (FeSS) protocol, improves outcome in patients with acute stroke. Electronic health records can assist in efficient alignment of such clinical treatment protocol with daily patient care.

Objectives: To assess the association between the implementation of the FeSS protocol, facilitated by an advanced electronic health record (EHR), and protocol adherence and outcome 90 days after hospital admission.

Concordance between results of inexpensive statistical models and multigene signatures in patients with ER+/HER2- early breast cancer.

Multigene signatures (MGS) are used to guide adjuvant chemotherapy (aCT) decisions in patients diagnosed with estrogen receptor (ER)-positive HER2-negative early breast cancer. We used results from three MGS (Oncotype DX® (ODX), MammaPrint® (MP) or Prosigna®) and assessed the concordance between high or low risk of recurrence and the predicted risk of recurrence based on statistical models. In addition, we looked at the impact of MGS results on final aCT administration during the multidisciplinary meeting (MDM).

Spirometer-guided breath-hold breast VMAT verified with portal images and surface tracking.

Background And Purpose: Fast rotating closed-bore gantry linacs are ideally suited for breath-hold treatments due to reduced imaging and delivery times. We evaluated the reproducibility and stability of spirometer-guided breath-hold breast treatments, using intra-bore surface monitoring and portal imaging on Halcyon (Varian Medical Systems).

Materials And Methods: Seven left-sided breast cancer patients were treated in breath-hold using the SDX spirometer (Dyn'R) with an integrated boost volumetric arc protocol on Halcyon.