Background and purpose:Stereotactic radiotherapy (SRT) is a standard approach for treating multiple brain metastases. However, variation in planning practices may impact treatment quality. This study assessed planning consistency and dose-volume-based outcomes across radiation oncology centers. Materials and methods:A Computed Tomography (CT) scan of an anthropomorphic phantom with structure set was distributed to participating centers. Each center created SRT plans as for a clinical case. Dose distributions were evaluated based on Planning Target Volume (PTV) coverage (V100% (PTV)), dose to 95% of Gross Target Volume (GTV) volume (D95% (GTV)), maximal PTV dose (Dmax), conformity index (CI), gradient index (GI), brain volume receiving different percentages of the prescribed dose, and doses delivered to 0.035 cm3 and 0.5 cm3 of the brainstem. Results:Twenty-four centers, using 30 treatment units, submitted plans. The V100% (PTV) ranged from 95% to 100%, with Dmax between 110% and 150% of the prescribed dose. Mean GTV dose ranged from 110% to 135%, and 81% of GTVs had D95% between 110% and 120%. High conformity was achieved in 74% of plans (CI < 1.1), while 67% had a GI between 3.4 and 5. All plans met clinical dose constraints for the brainstem and uninvolved brain. Conclusion:This interinstitutional comparison demonstrated high plan quality and adherence to critical organ constraints, despite variability in planning strategies. These findings support nationwide planning and quality assurance standards to ensure consistently high-quality SRT.
Loneliness is a growing public health concern among older adults (aged 65 and older) but remains understudied and under-recognised in geriatric oncology. This Health Policy paper presents survey-based Delphi consensus statements developed by a global panel of experts from the Multinational Association of Supportive Care in Cancer Geriatrics Study Group on the definition, assessment, and management of loneliness in older adults with cancer, to inform research and clinical practice. A consensus was reached on the definitions of loneliness, emphasising upon both emotional and social components, and including contextual factors such as life events and community structures. Multidisciplinary assessment using brief evaluation tools at the time of cancer diagnosis was highlighted. Community-based interventions such as support groups, home visits, and psychological counselling were prioritised over technology-driven approaches for future research. Outcomes considered the most relevant for research on loneliness included quality of life, treatment adherence, and survival. These statements could guide future clinical and research initiatives targeting loneliness in geriatric oncology.
The expansion of clinical research beyond academic hospitals into private hospitals is reshaping the way new therapies are tested and implemented. Traditionally, university and public hospitals have been the primary drivers of clinical research, yet private hospitals are increasingly positioned to contribute meaningfully to this landscape. This perspective explores the opportunities and complexities of establishing a clinical trial unit within a private setting, highlighting strategies to conduct innovative studies and deliver high-quality, patient-centered research. While private hospitals may face initial challenges related to infrastructure, regulatory compliance, and quality assurance, they offer important advantages, including more rapid decision-making, streamlined administrative pathways, and efficiency in initiating and conducting studies, all while adhering to the same regulatory requirements. By positioning themselves as complementary partners to academic institutions, private hospitals can provide efficient and fast paced environments for industry-sponsored trials, ultimately enriching the broader research ecosystem. Most importantly, these developments enable the realization of personalized medicine, where cutting-edge, individualized therapies, particularly in oncology, can be directly tailored and delivered to patients, transforming the promise of precision medicine into real clinical outcomes.
Purpose/Objective(s) Accurate prediction of skin toxicity remains challenging in prone breast radiotherapy due to uncertainties in the build-up region and potential dose perturbations introduced by immobilization devices. This study, based on the APBI-IMRT-Florence clinical protocol, is designed to evaluate skin dose in prone tomotherapy fixed beam treatments using a 3D-printed personalized immobilization system. Materials/Methods A controlled treatment planning study was performed using prone breast CT images of a commercial anthropomorphic phantom (Rando) with and without the shell. Five clinically relevant targets were delineated following APBI-IMRT-Florence criteria (GTV ≤ 2.5 cm) in each breast quadrant on both CT datasets near the skin. A hypo-fractionated schedule of 30 Gy in 5 fractions was prescribed. PTVs were generated using a 5 mm isotropic margin and cropped 5 mm from the external body contour. Skin structures were defined as a 5 mm inner ring extending 5 cm around the breast region. Ten treatment plans were generated for a treatment delivery system using tomotherapy fixed beam with three optimization runs on the treatment planning system and normalized to prescription dose. DVH parameters including PTV_eval_V95%, Conformity Index (CI), Dmax, Skin_V29Gy, Ipsilateral Lung V10Gy and Heart Dmean were extracted and compared. Results Implementation of the shell maintained robust PTV coverage (mean ΔPTV_eval_V95% = 0.45±0.59%; mean ΔCI = −0.05±0.03). No statistically significant increase in high-dose skin exposure was observed between configurations (mean ΔSkin_V29Gy = +1.52±1.64 cc; p = 0.18), although a small-to-moderate effect size was noted (r = 0.28). No clinically relevant impact was observed for ipsilateral lung dose (mean ΔV10Gy = 0.00±0.04%; range −0.06% to +0.05%) and cardiac dose variation was minimal (ΔHeart Dmean = 0.00±0.01 Gy; range 0.000–0.014 Gy). All values remained well below Florence-APBI constraints (Lung V10 ≤ 20%, Heart Dmean ≤ 2.5 Gy). Conclusion Across all cases,the shell did not adversely affect skin dose, cardiopulmonary sparing, or PTV coverage. Build-up perturbations remained within clinically acceptable limits, confirming its dosimetric safety. Given its high positioning reproducibility and target stability, PTV margin reduction may be feasible, potentially decreasing OAR dose and treatment-related toxicity.
Antibody-drug conjugates (ADCs) such as trastuzumab deruxtecan (T-DXd) and sacituzumab govitecan (SG) have revolutionized breast cancer (BC) treatment, providing superior efficacy that allows for extended treatment durations. Nausea and vomiting (NV) are among the most frequent adverse effects associated with T-DXd and SG, with nausea rates of >70% for T-DXd and >60% for SG in BC clinical trials. According to antiemetic guidelines, patients receiving T-DXd and SG are at moderate-to-high risk for NV and should routinely receive prophylaxis with an NK1 receptor antagonist (RA)-containing regimen. With limited real-world data on antiemetic efficacy in the ADC setting, a survey of international healthcare providers (HCPs) was conducted to assess their experience. At SABCS 2024, HCPs completed a brief web-based survey to assess their experiences and perceptions of ADC emetogenicity and approaches to antiemetic prophylaxis. Target participants included HCPs familiar with ADCs who manage patients with BC. Eligible participants completed the survey on computers located in the exhibit hall. Of 209 HCPs surveyed, 112 were eligible. Most were oncologists (69%) or hematologist/oncologists (21%) who spent 73% of time in patient care; nearly half were US-based (46%). Among all HCPs, 80% reported using ADCs in practice and/or in clinical trials; 99% had experience with T-DXd and 87% with SG. Among HCPs using T-DXd and SG, 78% and 83%, respectively, perceived them as either highly (32% and 28%) or moderately (46% and 55%) emetogenic. NV reported by HCPs in this survey was much lower than in the T-DXd and SG clinical trials; HCPs reported that 30%, 25% and 15% of their BC patients treated with T-DXd experience N and/or V during the acute (0-24 hours), delayed (days 2-5), and long-delayed (beyond day 5) phases, respectively. Similarly, the reported NV rates were 29%, 26% and 13%, respectively, for SG. HCPs reported that 88% of patients treated with any ADCs in an average month receive antiemetic prophylaxis; however, only 39% of HCPs report exclusively using a guideline-recommended NK1 RA regimen with T-DXd or SG. The majority of HCPs (94%) reported implementing some type of dose adjustments of ADCs due to NV. A third to nearly half of HCPs had at least sometimes implemented an ADC dose reduction or delay due to NV while a quarter reported interrupting or discontinuing ADC treatment (Table). More than half reported using rescue medication at least sometimes for delayed NV. This survey highlights a gap between evidence and HCP perceptions regarding NV with T-DXd and SG, and reveals higher-than-expected dose reductions, likely reflecting suboptimal adherence to antiemetic guidelines. As ADCs gain prominence in BC treatment, these findings underscore the need for education and guideline-implementation to optimize NV prevention. L. S. Schwartzberg, L. Licata, G. Bianchini, Y. H. Park, E. J. Roeland, M. Massagrande, F. Dato, H. Iihara, F. Scotte, K. Jordan, M. Aapro, H. S. Rugo. Examining Antiemetic Management with Antibody-Drug Conjugates (ADCs) in Patients with Breast Cancer: Healthcare Provider (HCP) Insights from a SABCS Survey [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-01-13.
