Author: Laura Dover
This practical analysis of 1688 cone-beam CT imaging performed during adaptive abdominal SBRT (where patients have at least two daily CBCT images roughly 20 minutes apart) confirms both that bowel gas streaks are a common frustration for deciphering a soft tissue target as well as reveals simply lying in the supine position for 10-20 minutes can greatly reduce artifact. This makes sense considering getting moving is the best way to get your bowels moving. The next time gas streaks pose a problem–in your console, not your personal life–have the patient get off the table and lie on a stretcher while you treat…
Bespoke prescriptions | van den Bosch, J Clin Oncol 2025 Top Line: De-escalation of radiation dose–as opposed to systemic therapy–remains an intriguing option for head and neck cancer.The Study: One reason is our detection of even small deposits of nodal disease have improved with modern imaging techniques making our “elective” nodal volumes more elective than ever. In the prospective UPGRADE-RT trial, 300 patients receiving definitive radiation alone for cT2-4N0-2M0 H&N mucosal squamous cell carcinoma were randomized 2:1 to standard versus de-escalated elective nodal irradiation. In both arms, gross disease received 68 Gy in 34 fractions over 5.5 weeks (6 fractions per week). In the standard…
This thought-piece on the very essence of why we prescribe and deliver radiotherapy doses as we do is a must-read, particularly for the philosophy majors out there (anybody? anybody..?). The truth is, while we know what dose is required to control a certain tumor type for a majority of a population, we don’t know what dose is required to control any one person’s tumor. Conventional wisdom suggests we aspire to ever-increasing doses to tumor and ever-decreasing doses to everything else via increasing technological prowess (and financial and human resources). In reality, precision radiation is “singularly focused on the technical requirements of delivering…
Top Line: Weekly cisplatin concurrent to head and neck radiation is back. The Study: This is an oft-used approach for patients in whom a more consolidated high dose (100 mg/m2) given every 3 weeks is likely to lead to unwanted treatment breaks, something that happens in roughly 40% of cases. A previous randomized trial at Tata Memorial failed to demonstrate non-inferiority of weekly cisplatin at 30 mg/m2 for locoregional control in the (mostly) adjuvant setting for (mostly) oral cavity cancer. We now have a Japanese trial to assuage the biggest critique of the former design: the weekly cisplatin dose was…
Top Line: Who’s covering the clinic tomorrow morning? The Final Rule: Most of us are familiar with the intricacies of Medicare supervision requirements specifying radiation as a therapeutic service that requires “direct” supervision in both hospital-outpatient departments and free-standing centers. Direct supervision basically means that a provider is “immediately available” to direct the service but doesn’t have to physically be present in the room. Now, CMS has released a final rule for 2020 that relaxes supervision requirements for all hospital-outpatient (as opposed to free-standing) clinics to “general.” General supervision means that the plan of care is directed and overseen by the treating physician, with no specific…
Here’s an informative educational piece on how regulations surrounding telemedicine have changed in recent months, as well as how capturing well-planned qualitative metrics can help us decipher which changes to hold onto long after the pandemic passes. | Royce, JAMA Oncol 2020
Top Line: We’re all keenly aware of the potential adverse cardiac effects of androgen deprivation therapy and their competing cause of mortality in some men with prostate cancer. The Study: It has been observed that cardiovascular effects may be less when using a GnRH antagonist, such as relugolix, instead of a LHRH/GnRH agonist, such as the better-known leuprolide. In the HERO trial, over 900 men with advanced prostate cancer (~50% with biochemical recurrence) were randomized to receive either leuprolide every 3 months or oral relugolix 120 mg daily, both for a total of 48 weeks. The trial had a number of very interesting outcomes. First,…
Top Line: Pathologic complete responses aren’t much of a thing in soft tissue sarcoma.The Study: Results presented in abstract form at ASTRO 2018 brought us hope with a novel agent NBTXR3 harnessing the properties of hafnium oxide. While we still only have half the -nium, we now have all the manuscript. As a reminder, this phase 2/3 trial randomized 180 patients to +/- a single NBTXR3 tumor injection 1-5 days prior to standard neoadjuvant radiation of 2 Gy x 25 preceding resection of a soft tissue sarcoma of the trunk or extremity. Patients with one of the pediatric histologies or with abdominal wall or excessively…
NBTXR3 is a brilliant, albeit not cleverly-named, ongologic concept merging into one novel drug all your least favorite basic sciences: Chemo 101, Orgo, and…dun dun dun…Rad Bio. NBTXR3 is a suspension of nanoparticles containing the inorganic insoluble compound hafnium-oxide, best known for it’s use in ceramics. And now in soft tissue sarcoma (STS). The key here is that hafnium-oxide happens to emit tons of electrons when bombarded with X-rays, making for lots of free radicals in irradiated organic compounds. This European phase 3 trial (LBA7) randomized 180 patients receiving neoadjuvant radiation for STS to +/- a single intratumoral injection of…