Communication and collaboration skills training in radiation oncology: A quantitative validation survey.

INTRODUCTION: Communication and collaboration are integral in radiation oncology practice. A recently published qualitative study identified several deficiencies in skills development for Australian/New Zealand trainees. We aim to validate these findings to guide curriculum development. METHODS: A quantitative survey was developed through an iterative process, using themes identified in the previous qualitative investigation. This survey was distributed to radiation oncologists and trainees across Australia and New Zealand via email. Data collection and management utilised the REDCap system. Question types varied to maximise richness of data, including ranking, likert-scales and free-text questions. Results are primarily reported descriptively. RESULTS: Totally 35 participants submitted completed survey responses with broad representation across geography, gender and clinician seniority. To learn communication, participants reported strong preferences towards informal observation (60% agreement) and self-reflection (49% agreement), and against online learning (77% disagreement) methodologies. Nearly 35% acknowledge poor communication at least weekly, with time pressure being a major barrier (63% agreement). Clinical uncertainty and existing patient/family assumptions (both 74% agreement) contribute to difficulties in breaking bad news, with online learning being the only negatively perceived training modality (23% agreement). No participants reported any formal training/mentoring in multi-disciplinary team (MDT) engagement. Conflict was commonly witnessed/experienced (97%) and 26% of participants avoid MDTs due to difficulties experienced. CONCLUSIONS: This study validates the themes previously identified. We identified a strong preference for informal learning methodologies and against online modules, discordant to published literature. Effective collaboration within MDTs is identified as a particular area of need. We recommend future curriculum modification considers these results to maximise efficacy.

Extreme hypofractionation in radiation therapy for patients with early breast cancer: what is the optimal technique?

Many radiation techniques have been employed in the trend of moving towards more hypofractionated regimens in the treatment of early breast cancer. This editorial articulates the advantages of using multi-catheter interstitial brachytherapy when delivering extreme hypofractionation for partial breast radiation.

Comparison of TG43 and Hounsfield Unit-based TG186 brachytherapy dose metrics in Oncentra Brachy for 100 patients receiving interstitial partial breast irradiation.

PURPOSE: The aim of the study was to conduct a retrospective analysis of 100 patients who received interstitial accelerated partial breast irradiation at a single institution, comparing the standard American Association of Physicists in Medicine Task Group (TG) 43 dose calculation algorithm to the model-based dose calculation algorithms (MBDCAs) available in the Oncentra Brachy treatment planning system. METHODS AND MATERIALS: Dose-volume histogram parameters were compared between the different dose calculation algorithms for the planning target volume and organs at risk. and a statistical analysis was performed. The resulting changes in isodose distribution were assessed, with the worst-case data presented. RESULTS: The TG43 algorithm calculated higher doses to all structures compared with the MBDCAs. The largest discrepancy was observed for the skin, with maximum doses on average 2.0% lower with the MBDCA. The newly released Hounsfield Unit-based algorithm further decreased the skin dose compared with TG43 by <0.5%. CONCLUSIONS: This study demonstrates that the differences between TG43 and MBDCA as implemented in Oncentra Brachy for accelerated partial breast irradiation are clinically insignificant in the treatment area and nearby organs at risk. Justification for investing in MBDCAs for this treatment site is limited when considering the additional calculation time, introduced uncertainties, and cost.

Current indications for post-mastectomy radiation.

It has been long established that post-mastectomy radiotherapy reduces the risk of locoregional failure. A survival advantage, however, has only recently been demonstrated. We here provide a review of the literature as regards to the current indications for post-mastectomy radiotherapy.

Hemiablative Focal Low Dose Rate Brachytherapy: A Phase II Trial Protocol.

BACKGROUND: The objective of focal brachytherapy (BT) is to provide effective prostate cancer control for low-risk disease but with reduced genitourinary, gastrointestinal and sexual side effects in a cost-effective way. OBJECTIVE: The aim of this study is to describe a phase II study examining technical and dosimetric feasibility and toxicity, quality of life changes, and local control with post-treatment biopsy outcomes in men with early stage low volume prostate cancer treated with focal iodine-125 seed BT. METHODS: The study design is a prospective, multicenter trial with a planned sample size of 20 patients including men with a minimum age of 60 years, a life expectancy estimated to be greater than 10 years, with low or low-tier intermediate risk prostate cancer, unilateral disease on the biopsy, and a Gleason score of ≤3+4 and <25% cores involved. The investigations specific for the study are multi-parametric magnetic resonance imaging (Mp-MRI) baseline, at 20 and 36 months to rule out high grade disease and a transperineal mapping biopsy (baseline and at 36 months) for more accurate patient selection. The hemigland region will receive 144 Gy. Standard normal tissue constraints will be considered as for a whole gland (WG) implant. Dosimetric parameters will be evaluated at day 30 after the implant. Toxicity and quality of life will be evaluated with international validated questionnaires focusing on urinary, rectal, sexual domain, and general health-related quality of life. The patients will complete this assessment at baseline and then approximately every 6 months after the implant up to 10 years. RESULTS: To date, one patient is involved in the trial. He underwent the pre-implant investigations which found bilateral disease. Therefore, a standard seed implant was performed. If the results from this trial provide evidence that the treatment is safe, feasible, and improves toxicity, funding will be sought to conduct a large, multicenter, randomized controlled trial (RCT). CONCLUSIONS: This protocol is designed to show feasibility in delivering hemigland focal therapy with seed BT. It may answer crucial questions and obtain data which will enable downstream decisions on focal low dose rate (LDR) prostate BT. CLINICALTRIAL: Clinicaltrial.gov NCT02643511; https://www.clinicaltrials.gov/ct2/show/NCT02643511 (Archived by Webcite at http://www.webcitation.org/6ghLCzIhY).

The risk of second malignancies after 125I prostate brachytherapy as monotherapy in a single Australian institution.

PURPOSE: To report the incidence of second primary cancer (SPC) after 125I brachytherapy (BT) for early prostate cancer in an Australian institution. METHODS AND MATERIALS: All the patients in our cohort had a cystoscopy before the implant. Data were prospectively collected on all subsequent SPC diagnoses. Standardized incidence ratios (SIRs) were calculated to compare data with the Australian population. Kaplan-Meier analysis was used to determine the actuarial second malignancy and pelvic malignancy rates and the death from SPC and from any cause. RESULTS: A total of 889 patients were followed up for a median of 4.16 (0-13) years with 370 (42%) patients having ≥5 years of followup. Sixty patients subsequently developed an SPC of which 11 were pelvic malignancies. The 5- and 10-year cumulative incidences were 1.3% (95% confidence interval [CI]: 0.6-3) and 3.3% (95% CI: 1-7) for any pelvic malignancy and 1% (95% CI: 0.4-2) and 2.6% (1-6) for bladder cancer, respectively. The SIR was significantly higher than expected for all bladder cancers at 2.9 (95% CI: 1-6) and close to significance (SIR, 3.0; 95% CI: 0.97-7) for bladder cancers within the first 5 years of followup in the subgroup analysis. On multivariate analysis, older age was associated with increased SPC risk and older age and positive smoking status were associated with increased overall mortality, mortality due to SPC, and mortality from second malignancy (p < 0.05). CONCLUSIONS: There may be a small increased risk of bladder SPC after prostate BT. A tendency toward a higher risk of bladder SPC after BT was found within the first 5 years of followup probably reflecting screening bias.

The effect of adjuvant postmastectomy radiotherapy bolus technique on local recurrence.

PURPOSE: Postmastectomy radiotherapy bolus is heterogenous, with little evidence to guide clinical practise. This study explores the effect of chest wall bolus technique on chest wall recurrence. METHODS AND MATERIALS: This was a retrospective cohort study of 254 patients treated with adjuvant postmastectomy radiotherapy between 1993 and 2003. Patient and treatment characteristics including bolus details were extracted. Outcomes considered were treatment toxicities, treatment delivery, and local recurrence. RESULTS: In all, 143 patients received radiotherapy with whole chest wall bolus, 88 patients with parascar bolus, and 23 with no bolus. Twenty patients did not complete radiotherapy because of acute skin toxicity: 17 in the whole chest wall bolus group, 2 in the parascar bolus group, and 1 in the group not treated with bolus. On multivariate analysis, whole chest wall bolus and chemotherapy were found to be significant predictors for early cessation of radiotherapy resulting from acute skin toxicity. There were 19 chest wall failures: 13 in the whole chest wall bolus group, 4 in the parascar bolus group, and 2 in the no-bolus group. On multivariate analysis, lymphovascular invasion and failure to complete radiotherapy because of acute skin toxicity were associated with chest wall recurrence. CONCLUSIONS: From our results, parascar bolus and no bolus performed no worse than did whole chest wall bolus with regard to chest wall recurrence. However, bolus may have an impact on early cessation of radiotherapy caused by skin toxicity, which then may influence chest wall recurrence.