The Impact of Disease Progression on Health-Related Quality of Life Outcomes in Patients With Oligometastatic Disease at 12 Months Post Stereotactic Body Radiation Therapy.

PURPOSE: There is a paucity of published health-related quality of life (HRQOL) outcomes in patients with oligometastatic disease (OMD) who receive stereotactic body radiation therapy (SBRT) and no available data assessing the effect of disease progression post-SBRT on HRQOL in this patient population. METHODS AND MATERIALS: Patients with OMD who received SBRT in a phase II single-arm research ethics board approved study were included. HRQOL was a secondary outcome. This study hypothesized that there is a different pattern of change from baseline HRQOL in patients with OMD treated with SBRT that have disease progression by 12 months (progressors) compared with those that do not progress by 12 months (nonprogressors), as measured by the European Organisation of Research and Treatment in Cancer Quality of Life Questionnaire Core 30. RESULTS: A total of 107 patients were included in this analysis, 41 without progression and 66 with progression by 12 months; median time to progression was 7.7 (0.3-57) months. A statistically significant decline in the mean global health/quality of life (GHQOL) score (73 [SD, 21.8] to 67.2 [SD, 27.1]; P = .04) from baseline in the entire population at the 12-month follow-up was found. Mean GHQOL change score in nonprogressors was -0.8 and in progressors was -8.8 (P = .07). However, only progressors demonstrated a difference between baseline and 12-month mean GHQOL scores (71.2 vs 62.4; P = .01), which was both statistically and clinically significant (-8.8) in the range of small minimal clinically important difference. There was a higher proportion of patients who experienced a minimal clinically important difference deterioration in progressors compared with nonprogressors (37.4% vs 24.4%; P = .14). CONCLUSIONS: Patients who progressed by 12 months did not have a statistical or clinically significant difference in mean GHQOL change score compared with nonprogressors. However, there were signals to suggest that patients who progressed by 12 months post-SBRT experienced a different pattern of change compared with nonprogressors, which was worse compared with baseline.

Evaluation of Bony Anatomy Versus Endobiliary Stents as Surrogates for Volumetric Image Guidance in Pancreatic Cancer.

PURPOSE: Online treatment setup verification through cone-beam computed tomography (CBCT) in pancreatic cancer patients is limited by low soft tissue contrast. This study aims to quantify the relative positional displacements between bony anatomy and endobiliary stents as surrogates for pancreatic cancers. METHODS: Under ethics approval, 258 localization CBCT images from 15 pancreatic patients with endobiliary stents were evaluated. CBCTs were registered through two methods to assess translations and rotations: target adjacent bony anatomy through automatic registration and automatic stent registration through a shaped region of interest. Displacement vector differences between surrogate registrations were calculated and analysed. RESULTS: Mean (±standard deviation) translational displacements in the right/left, superior/inferior, anterior/posterior directions were 0.9 ± 3.1 mm, 1.8 ± 4.2 mm, and 0.4 ± 2.5 mm for bone registrations, respectively, and 0.9 ± 5.6 mm, -1.5 ± 5.7 mm, and -0.5 ± 4.3 mm for stent registrations, respectively. Mean (±standard deviation) rotational displacements for pitch, roll, and yaw were 0.16 ± 0.97°, -0.32 ± 0.96°, and -0.77 ± 1.8° for bone registrations, respectively, and -0.94 ± 4.6°, -0.4 ± 7.4°, and -0.13 ± 6.64° for stent registrations, respectively. Mean displacement vector between surrogates was 4 mm, with 43% of fractions measuring displacement vectors >5 mm. A maximum displacement vector of 22.6 mm between surrogates was observed. CONCLUSIONS: Varying positional differences were observed between bone and stent registration for pancreas CBCT-image-guided radiation therapy. Setup errors for stent matching were larger than bone registrations. Further research is required to determine if endobiliary stent position is equivalent to the pancreas' location to determine its suitability as a surrogate.

Inter-professional variability in the assignment and recording of acute toxicity grade using the RTOG system during prostate radiotherapy.

BACKGROUND AND PURPOSE: To compare the routine acute toxicity documentation practices of therapists and oncologists using the RTOG lower GI and GU scales. METHODS AND MATERIALS: Ninety consecutive prostate radiotherapy patients were identified. The weekly urinary and rectal acute toxicity grades routinely documented by therapists and oncologists were collected retrospectively from radiotherapy charts. These data were paired together, and compared between the professional groups. RESULTS: Only RTOG acute toxicity grades between 0 and 2 were recorded by either group. The overall rate of documentation was high (97% therapists/86% oncologists), but the rate of quantitative documentation was low from the oncologists (46%) who used a free-form text field for recording purposes. There was no significant difference in the incidence of maximum grade of acute toxicity reported by either professional group (p>0.1). There was good RTOG score concordance between the observer groups (kappa=0.756), with pair-wise absolute agreement in 76%. Pair-wise discrepancies between the observers were commonly attributable to differences in the time/date of assessment. CONCLUSIONS: Despite some methodological limitations, this study found that therapist-assessed RTOG acute toxicity grades demonstrated a good level of agreement with the grades assigned by their oncologist colleagues.