Predicting 2-year survival in stage I-III non-small cell lung cancer: the development and validation of a scoring system from an Australian cohort.

BACKGROUND: There are limited data on survival prediction models in contemporary inoperable non-small cell lung cancer (NSCLC) patients. The objective of this study was to develop and validate a survival prediction model in a cohort of inoperable stage I-III NSCLC patients treated with radiotherapy. METHODS: Data from inoperable stage I-III NSCLC patients diagnosed from 1/1/2016 to 31/12/2017 were collected from three radiation oncology clinics. Patient, tumour and treatment-related variables were selected for model inclusion using univariate and multivariate analysis. Cox proportional hazards regression was used to develop a 2-year overall survival prediction model, the South West Sydney Model (SWSM) in one clinic (n = 117) and validated in the other clinics (n = 144). Model performance, assessed internally and on one independent dataset, was expressed as Harrell's concordance index (c-index). RESULTS: The SWSM contained five variables: Eastern Cooperative Oncology Group performance status, diffusing capacity of the lung for carbon monoxide, histological diagnosis, tumour lobe and equivalent dose in 2 Gy fractions. The SWSM yielded a c-index of 0.70 on internal validation and 0.72 on external validation. Survival probability could be stratified into three groups using a risk score derived from the model. CONCLUSIONS: A 2-year survival model with good discrimination was developed. The model included tumour lobe as a novel variable and has the potential to guide treatment decisions. Further validation is needed in a larger patient cohort.

MRI in radiotherapy for lung cancer: A free-breathing protocol at 3T.

Imaging plays a significant role in radiation therapy. Improvements in treatment delivery require sophisticated imaging technologies to define tumor volume accurately. Magnetic resonance imaging scans can provide morphological and functional information and are increasingly being used in imaging for radiation therapy; however, for lung cancer, most protocols are based on breath-hold imaging and noncompliance to breath-hold maneuver can lead to significant artifacts. For patients presenting for lung cancer radiation therapy, maintaining a breath hold can be impossible. This paper describes a completely free-breathing lung magnetic resonance imaging protocol for use in radiation therapy for lung cancer.

Survey of image-guided radiotherapy use in Australia.

INTRODUCTION: This study aimed to evaluate the current use of imaging technologies for planning and delivery of radiotherapy (RT) in Australia. METHODS: An online survey was emailed to all Australian RT centres in August 2015. The survey inquired about imaging practices during planning and treatment delivery processes. Participants were asked about the types of image-guided RT (IGRT) technologies and the disease sites they were used for, reasons for implementation, frequency of imaging and future plans for IGRT use in their department. RESULTS: The survey was completed by 71% of Australian RT centres. All respondents had access to computed tomography (CT) simulators and regularly co-registered the following scans to the RT: diagnostic CT (50%), diagnostic magnetic resonance imaging (MRI) (95%), planning MRI (34%), planning positron emission tomography (PET) (26%) and diagnostic PET (97%) to aid in tumour delineation. The main reason for in-room IGRT implementation was the use of highly conformal techniques, while the most common reason for under-utilisation was lack of equipment capability. The most commonly used IGRT modalities were kilovoltage (kV) cone-beam CT (CBCT) (97%), kV electronic portal image (EPI) (89%) and megavoltage (MV) EPI (75%). Overall, participants planned to increase IGRT use in planning (33%) and treatment delivery (36%). CONCLUSIONS: IGRT is widely used among Australian RT centres. On the basis of future plans of respondents, the installation of new imaging modalities is expected to increase for both planning and treatment.

Multisource feedback for radiation oncologists.

INTRODUCTION: Multisource feedback (MSF) is an assessment of performance through evaluation of an individual's competence from multiple perspectives. It is mandated in many specialist training schemes in medicine. The aim of this study was to test the feasibility of implementing MSF for consultant radiation oncologists. METHODS: A validated tool consisting of a self-assessment questionnaire, medical colleague questionnaire, co-worker questionnaire and patient questionnaire was used for MSF. Statements were rated on a 5-point Likert scale with 1 being a low rating and 5 a high rating. Seven radiation oncologists volunteered to undergo MSF. They each nominated 10 medical colleagues, 10 co-workers and 10 patients to be surveyed. Clinician feedback was provided as an individual report with a mean score and range for each data item. RESULTS: Two hundred ten surveys were mailed out and seven self-assessments were completed. The response rate was 87% for medical colleagues, 89% for co-workers and 79% for patients. The mean feedback scores averaged for the radiation oncologists ranged from 4.4 to 4.9, significantly higher than self-assessments scores which ranged from 3.2 to 3.7. MSF identified areas for potential improvement including communication and collaboration with co-workers and accessibility to and adequacy of clinic space for patients. All radiation oncologists found the MSF a positive experience, and five planned to make changes in their practice in response to this. CONCLUSIONS: The high response rate to the surveys has shown that it is feasible to implement MSF for radiation oncologists. This could potentially be used as a method for ongoing revalidation.