Author: QuadShot News

With AI as first-assist. This look at two prospective randomized trials in China reports a decrease in adenoma detection rate from 14% to 6% when colonoscopies are performed in the morning versus afternoon time slots, a discrepancy that vanishes with the assistance of artificial intelligence (22-23% either way). Citation(s) Lu, JAMA Open Netw 2023

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This dosimetric analysis demonstrates that carbon fiber implants (with similar density to bone) caused virtually no imaging artifacts and minimal dose attenuation which we all know was as opposed to titanium-alloy implants. When intramedullary fixation precedes planned radiation, which it almost always does in the malignant setting, talk to your ortho colleagues about a carbon fiber alternative. Citation(s) Depauw, Pract Radiat Oncol 2023

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Top Line: Do older patients tolerate BID dose escalation for SCLC as well as younger patients? The Study: Back in 2021, the randomized, phase 2 THORA trial reported an increase in overall survival with 60 Gy in 40 BID fractions compared to 45 Gy in 30 BID fractions for limited stage SCLC. The survival improvement was rather impressive at 74.1% v 48.1% at 2 years and median OS 37 v 23 months. Some might say this was a little too impressive given that there were no significant differences in local failure, distant failure, or disease progression. There was also no…

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This NCDB study found that between ages 69 and 70, there was a significant drop in the utilization of adjuvant RT for breast cancer from ~90% for those between 50 and 69 to ~80% for those age 70. Citation(s) Talcott, Int J Radiat Oncol Biol Phys 2023

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In the single-arm phase 2 2SMART trial, 30 men with low (7%) or intermediate (93%) risk prostate cancer were treated with 2-fraction SBRT. The targets included the dominant intraprostatic nodule and the prostate CTV with a 2-3 mm margin. The prostate was prescribed 26 Gy in 2 fractions while the nodule received a 32 Gy simultaneous integrated boost. Median PSA nadir was 0.25 at a median 37 months. One patient (3%) had a biochemical failure. There was no grade 3 toxicity. The rates of minimally clinically important change in urinary, bowel, and sexual QOL domains were 33%, 20%, and 10%.…

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Top Line: Are local control outcomes with interstitial brachytherapy ABPI comparable to whole breast radiation? The Study: There are multiple techniques for delivering accelerated partial breast irradiation. Randomized trials of various APBI techniques have had mixed results with respect to local control and cosmesis. Here we have 10-year outcomes from the GEC-ESTRO trial comparing exclusive interstitial brachytherapy APBI and whole breast radiation. 1184 patients eligible for analysis had ≤3 cm tumors with ≤pNmi disease, no LVI, and at least 2 mm margins (5mm for any DCIS). In the WBRT arm, everyone received 50-50.4 Gy in 25-28 fractions with a 10…

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This population-based study out of Minnesota reports patients treated with anthracyclines for breast cancer or lymphoma had twice the rate of later congestive heart failure than age-matched controls, while receipt of radiation appeared to have no effect. Citation(s) Larsen, JAMA Netw Open 2023

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The same group again shows that immune checkpoint inhibition is fine during radiosurgery. What’s more interesting was the clear correlation with incidence of radionecrosis and volume of brain receiving ≥12 Gy (V12 Gy). Here the V12 Gy included the target volume and did not need to be contiguous. Risks of radionecrosis at one and two years when V12 Gy was <12 cc were 4% and 8%, when 12-20 cc were 10% and 14%, and when >20 cc were 13% and 15%. Citation(s) Lehrer, Int J Radiat Oncol 2023

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Top Line: There have now been lots of studies suggesting total neoadjuvant therapy is the best sequencing of treatment for locally-advanced rectal cancer. The Study: If you recall, RAPIDO was a large randomized trial demonstrating an improvement in disease-free survival with this approach due to a lower rate of distant progression. The unfortunate thing about the design was the TNT arm received short-course radiation while the control arm received standard long-course radiation with concurrent capecitabine. And this was among specifically “high-risk” patients with cT4a/4b tumor, mesorectal fascia involvement, extramural vascular invasion, N2 disease, or lateral node involvement. In other words,…

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February 03, 2023 Field medicine. Most glioblastoma multiforme (GBM) failures are in-field, leading many people to push for tighter clinical target volumes closer to 1 cm or even 0.5 cm. A prospective study at Stanford took this concept a step further by treating newly-diagnosed GBM with a 0.5 cm clinical margin with no additional planning margin using standard stereotactic brain techniques. The total dose was delivered over 5 fractions to a total dose escalated from 25 Gy to 40 Gy. At a median follow-up of 15 months, only one of 27 progressions occurred outside of a minimum EQD2 of 48…

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