ESTRO-ACROP guideline for positioning, immobilisation and setup verification for local and loco-regional photon breast cancer irradiation.
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SUBMITTER: Mast ME
PROVIDER: S-EPMC10511493 | biostudies-literature | 2023 Dec
REPOSITORIES: biostudies-literature
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ESTRO-ACROP guideline for positioning, immobilisation and setup verification for local and loco-regional photon breast cancer irradiation.
Mast M E ME Leong A A Korreman S S SS Lee G G Probst H H Scherer P P Tsang Y Y
Technical innovations & patient support in radiation oncology 20230912
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Project description:Background and purposeOver the last decade, the management of locally advanced head and neck cancers (HNCs) has seen a substantial increase in the use of chemoradiation. These guidelines have been developed to assist Radiation TherapisTs (RTTs) in positioning, immobilisation and position verification for head and neck cancer patients.Materials and methodsA critical review of the literature was undertaken by the writing committee.Based on the literature review, a survey was developed to ascertain the current positioning, immobilisation and position verification methods for head and neck radiation therapy across Europe. The survey was translated into Italian, German, Greek, Portuguese, Russian, Croatian, French and Spanish.Guidelines were subsequently developed by the writing committee.ResultsResults from the survey indicated that a wide variety of treatment practices and treatment verification protocols are in operation for head and neck cancer patients across Europe currently.The guidelines developed are based on the experience and expertise of the writing committee, remaining cognisant of the variations in imaging and immobilisation techniques used currently in Europe.ConclusionsThese guidelines have been developed to provide RTTs with guidance on positioning, immobilisation and position verification of HNC patients. The guidelines will also provide RTTs with the means to critically reflect on their own daily clinical practice with this patient group.
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Project description:PurposeTo issue consensus recommendations for contact X-Ray brachytherapy (CXB) for rectal cancer covering pre-treatment evaluation, treatment, dosimetric issues and follow-up. These recommendations cover CXB in the definitive and palliative setting.MethodsMembers of GEC ESTRO with expertise in rectal CXB issued consensus-based recommendations for CXB based on literature review and clinical experience. Levels of evidence according to the Oxford Centre for Evidence based medicine guidance are presented where possible.ResultsThe GEC ESTRO ACROP consensus recommendations support the use of CXB to increase the chances of clinical complete remission and cure for patients who are elderly with high surgical risk, surgically unfit or refusing surgery. For palliative treatment, the use of CXB is recommended for symptomatic relief and disease control. The use of CXB in an organ-preservation setting in surgically fit patients is recommended within the setting of a clinical trial or registry.ConclusionsThe GEC ESTRO ACROP recommendations for CXB are provided. Recommendations towards standardisation of reporting and prescription are given. Practitioners are encouraged to follow these recommendations and to develop further clinical trials to examine this treatment modality and increase the evidence base for its use. The routine collection of outcomes both clinical and patient-reported is also encouraged.
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Project description:BackgroundThe European Society for Radiotherapy & Oncology (ESTRO) Advisory Committee for Radiation Oncology Practice (ACROP) panel on prostate bed delineation reflected on macroscopic local recurrences in patients referred for postoperative radiotherapy (PORT), a challenging situation without standardized approach, and decided to propose a consensus recommendation on target volume selection and definition.MethodsAn ESTRO ACROP contouring consensus panel consisting of 12 radiation oncologists and one radiologist, all with subspecialty expertise in prostate cancer, was established. Participants were asked to delineate the prostate bed clinical target volumes (CTVs) in two separate clinically relevant scenarios: a local recurrence at the seminal vesicle bed and one apically at the level of the anastomosis. Both recurrences were prostate-specific membrane antigen (PSMA)-avid and had an anatomical correlate on magnetic resonance imaging (MRI). Participants also answered case-specific questionnaires addressing detailed recommendations on target delineation. Discussions via electronic mails and videoconferences for final editing and consensus were performed.ResultsContouring of the two cases confirmed considerable variation among the panelists. Finally, however, a consensus recommendation could be agreed upon. Firstly, it was proposed to always delineate the entire prostate bed as clinical target volume and not the local recurrence alone. The panel judged the risk of further microscopic disease outside of the visible recurrence too high to safely exclude the rest of the prostate bed from the CTV. A focused, "stereotactic" approach should be reserved for re-irradiation after previous PORT. Secondly, the option of a focal boost on the recurrence was discussed.ConclusionRadiation oncologists are increasingly confronted with macroscopic local recurrences visible on imaging in patients referred for postoperative radiotherapy. It was recommended to always delineate and irradiate the entire prostate bed, and not the local recurrence alone, whatever the exact location of that recurrence. Secondly, specific dose-escalation on the macroscopic recurrence should only be considered if an anatomic correlate is visible. Such a focal boost is probably feasible, provided that OAR constraints are prioritized. Possible dose is also dependent on the location of the recurrence. Its potential benefit should urgently be investigated in prospective clinical trials.
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Project description:Two-photon absorption (TPA) has been widely applied for three-dimensional imaging and nanoprinting; however, the efficiency of TPA imaging and nanoprinting using laser scanning techniques is limited by its trade-off to reach high resolution. Here, we unveil a concept, few-photon irradiated TPA, supported by a spatiotemporal model based on the principle of wave-particle duality of light. This model describes the precise time-dependent mechanism of TPA under ultralow photon irradiance with a single tightly focused femtosecond laser pulse. We demonstrate that a feature size of 26 nm (1/20 λ) and a pattern period of 0.41 λ with a laser wavelength of 517 nm can be achieved by performing digital optical projection nanolithography under few-photon irradiation using the in-situ multiple exposure technique, improving printing efficiency by 5 orders of magnitude. We show deeper insights into the TPA mechanism and encourage the exploration of potential applications for TPA in nanoprinting and nanoimaging.
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Project description:Background and purposeLoco-regionally recurrent head and neck cancer (HNC) in the setting of prior radiotherapy carries significant morbidity and mortality. The role of re-irradiation (re-RT) remains unclear due to toxicity. We determined prognostic factors for loco-regional control (LRC) and formulated a nomogram to help clinicians select re-RT candidates.Material and methodsFrom July 1996 to April 2011, 257 patients with recurrent HNC underwent fractionated re-RT. Median prior dose was 65 Gy and median time between RT was 32.4 months. One hundred fifteen patients (44%) had salvage surgery and 172 (67%) received concurrent chemotherapy. Median re-RT dose was 59.4 Gy and 201 (78%) patients received IMRT. Multivariate Cox proportional hazards were used to identify independent predictors of LRC and a nomogram for 2-year LRC was constructed.ResultsMedian follow-up was 32.6 months. Two-year LRC and overall survival (OS) were 47% and 43%, respectively. Recurrent stage (P=0.005), non-oral cavity subsite (P<0.001), absent organ dysfunction (P<0.001), salvage surgery (P<0.001), and dose >50 Gy (P=0.006) were independently associated with improved LRC. We generated a nomogram with concordance index of 0.68.ConclusionRe-RT can be curative, and our nomogram can help determine a priori which patients may benefit.
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Project description:A broad range of shoulder pathologies are treated with shoulder arthroscopy due to its minimally invasive nature. Mastering the fundamentals is critical for high-quality care; this includes patient positioning. Surgeons must consider the advantages and disadvantages of the 2 most prominent patient positions: lateral decubitus and beach chair. The beach-chair position offers an intuitive anatomic view with the advantage of shoulder maneuverability. Understanding the associated pitfalls related to patient hemodynamics; head, neck, and shoulder positioning; and protection of bony prominences can guide the operative care team to obtaining a safe position for the patient. The purpose of this Technical Note and video is to present and demonstrate a reproducible and teachable method for safely positioning a patient in the beach-chair position for shoulder arthroscopy, as well as to describe the associated advantages and disadvantages.
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Project description:Shoulder arthroscopy is one of the most common orthopaedic procedures. Since its introduction in the 1970s, significant advances have been made in surgical techniques and instrumentation. Shoulder arthroscopy is often performed in either the beach-chair or lateral decubitus position, and each positioning technique has its own benefits. In this work, we will describe the history of lateral decubitus positioning for shoulder arthroscopy. We outline a detailed guide for safe and consistent lateral decubitus positioning, and key steps of lateral decubitus positioning will be emphasized. Pearls, pitfalls, advantages, and disadvantages of this positioning technique will also be discussed. With appropriate technique, lateral decubitus positioning is safe and effective for arthroscopic treatment of various shoulder pathologies.
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