Importance Patients with interstitial lung disease (ILD) and early-stage non-small cell lung cancer (NSCLC) have been reported to be at high risk of toxic effects after stereotactic ablative radiotherapy (SABR), but for many patients, there are limited alternative treatment options. Objective To prospectively assess the benefits and toxic effects of SABR in this patient population. Design, Setting, and Participants This prospective cohort study was conducted at 6 academic radiation oncology institutions, 5 in Canada and 1 in Scotland, with accrual between March 7, 2019, and January 12, 2022. Patients aged 18 years or older with fibrotic ILD and a diagnosis of T1-2N0 NSCLC who were not candidates for surgical resection were enrolled. Intervention Patients were treated with SABR to a dose of 50 Gy in 5 fractions every other day. Main Outcomes and Measures The study prespecified that SABR would be considered worthwhile if median overall survival-the primary end point-was longer than 1 year, with a grade 3 to 4 risk of toxic effects less than 35% and a grade 5 risk of toxic effects less than 15%. Secondary end points included toxic effects, progression-free survival (PFS), local control (LC), quality-of-life outcomes, and changes in pulmonary function. Intention-to-treat analysis was conducted. Results Thirty-nine patients enrolled and received SABR. Median age was 78 (IQR, 67-83) years and 59% (n = 23) were male. At baseline, 70% (26 of 37) of patients reported dyspnea, median forced expiratory volume in first second of expiration was 80% (IQR, 66%-90%) predicted, median forced vital capacity was 84% (IQR, 69%-94%) predicted, and median diffusion capacity of the lung for carbon monoxide was 49% (IQR, 38%-61%) predicted. Median follow-up was 19 (IQR, 14-25) months. Overall survival at 1 year was 79% (95%, CI 62%-89%; P < .001 vs the unacceptable rate), and median overall survival was 25 months (95% CI, 14 months to not reached). Median PFS was 19 months (95% CI, 13-28 months), and 2-year LC was 92% (95% CI, 69%-98%). Adverse event rates (highest grade per patient) were grade 1 to 2: n = 12 (31%), grade 3: n = 4 (10%), grade 4: n = 0, and grade 5: n = 3 (7.7%, all due to respiratory deterioration). Conclusions and Relevance In this trial, use of SABR in patients with fibrotic ILD met the prespecified acceptability thresholds for both toxicity and efficacy, supporting the use of SABR for curative-intent treatment after a careful discussion of risks and benefits.

PURPOSE:This trial examined if patients with ≤5 sites of oligoprogression benefit from the addition of SABR to standard of care (SOC) systemic therapy. METHODS AND MATERIALS:We enrolled patients with 1 to 5 metastases progressing on systemic therapy, and after stratifying by type of systemic therapy (cytotoxic vs noncytotoxic), randomized 1:2 between continued SOC treatment versus SABR to all progressing lesions plus SOC. The trial was initially limited to non-small cell lung cancer but was expanded to include all nonhematologic malignancies to meet accrual goals. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), lesional control, quality of life, adverse events, and duration of systemic therapy postrandomization. RESULTS:Ninety patients with 127 oligoprogressive metastases were enrolled across 8 Canadian institutions, with 59 randomized to SABR and 31 to SOC. The median age was 67 years, and 39 (43%) were women. The most common primary sites were lung (44%), genitourinary (23%), and breast (13%). Protocol adherence in the SOC arm was suboptimal, with 11 patients (35%) either receiving high-dose/ablative therapies (conflicting with trial protocol) or withdrawing from the study. The median follow-up was 31 months. There was no difference in PFS between arms (median PFS 8.4 months in the SABR arm vs 4.3 months in the SOC arm, but curves cross and 2-year PFS was 9% vs 24%, respectively; P = .91). The median OS was 31.2 months versus 27.4 months, respectively (P = .22). Lesional control was superior with SABR (70% vs 38%, respectively; P = .0015). There were 2 (3.4%) grade 3 and no grade 4/5 adverse events attributable to SABR. CONCLUSIONS:SABR was well-tolerated with superior lesional control but did not improve PFS or OS. Accrual to this study was difficult, and the results may have been impacted by an unwillingness to forgo ablative treatments on the SOC arm. (NCT02756793).

Effective documentation serves as a cornerstone for communication and patient care, especially in radiation oncology (RO). Studies have shown room for improvement in documentation practices, and although documentation guidelines exist, it is uncertain if RO physicians are aware of or adhere to them. We aimed to assess RO resident physicians’ medicolegal knowledge and the impact of an educational intervention on documentation practices. Grading rubrics for consultation and progress notes were created using guidelines, comprising of a fundamental score and total score. Residents from two institutions attended a didactic seminar on medicolegal documentation. Pre- and post-seminar, an electronic anonymous survey was used to assess resident knowledge and perspectives and random resident consultation and progress notes were scored. Mean documentation and survey item scores from pre- and post-seminar were compared. Fourteen resident physicians participated and completed surveys, and 48 consultation notes and 40 progress notes were analyzed. No participant had prior education specific to RO documentation, nor were any aware of available resources. Post-seminar, participants’ medicolegal documentation knowledge significantly increased (86.61

Artificial intelligence and natural language processing tools have shown promise in oncology by assisting with medical literature retrieval and providing patient support. The potential for these technologies to generate inaccurate yet seemingly correct information poses significant challenges. This study evaluates the effectiveness, benefits, and limitations of ChatGPT for clinical use in conducting literature reviews of radiation oncology treatments. This cross-sectional study used ChatGPT version 3.5 to generate literature searches on radiotherapy options for seven tumor sites, with prompts issued five times per site to generate up to 50 publications per tumor type. The publications were verified using the Scopus database and categorized as correct, irrelevant, or non-existent. Statistical analysis with one-way ANOVA compared the impact factors and citation counts across different tumor sites. Among the 350 publications generated, there were 44 correct, 298 non-existent, and 8 irrelevant papers. The average publication year of all generated papers was 2011, compared to 2009 for the correct papers. The average impact factor of all generated papers was 38.8, compared to 113.8 for the correct papers. There were significant differences in the publication year, impact factor, and citation counts between tumor sites for both correct and non-existent papers. Our study highlights both the potential utility and significant limitations of using AI, specifically ChatGPT 3.5, in radiation oncology literature reviews. The findings emphasize the need for verification of AI outputs, development of standardized quality assurance protocols, and continued research into AI biases to ensure reliable integration into clinical practice.

High-fidelity simulation (HFS) training is suited to high-stakes, uncommon situations such as malignant spinal cord compression (MSCC), allowing for rare hands-on practice. This pilot study was created as the first of its kind to examine educational outcomes of a radiation therapist (RTT)-led multidisciplinary radiation oncology (RO) emergency simulation course. A multidisciplinary course design team composed of RO residents, radiation oncologists, RTT course instructors, and medical physicists created a high-fidelity MSCC simulation course using collaboratively developed learning goals. Fifteen learners including RO residents, senior RTT students, and a medical physics (MP) resident participated in a live, RTT-facilitated simulation. Participants completed anonymized pre- and post-simulation standard interdisciplinary education perception (IEP) scales and a course evaluation assessing educational outcomes. Standard IEP questionnaire results showed highly favorable perceptions of respondents' own specialty and other allied specialties, with mean total pre-simulation scores of 91.76 and post-simulation scores of 94.23. The course evaluation assessed 10 learning objective domains, with significant improvements seen in self-rated post-course knowledge in 9 domains. Pre-course evaluations showed that 6/15 participants agreed or strongly agreed that they felt comfortable in their knowledge of all included domains; after course completion, 14/15 participants agreed or strongly agreed they felt comfortable in all domains. Collaboratively designed and led HFS courses are not only viable but can be an effective means of improving learning outcomes for RO residents, RTT students, and MP residents.

Background Canadian medical student (MS) interest in Radiation Oncology (RO) residency training has varied over the last decade. Concerns related to post-training job availability, employment location flexibility, and extended fellowship training may have affected MS perceptions of RO, potentially deterring past applicants. With recent job market improvements, there has been increased MS interest in the specialty. However, despite recent years showing no gender differences in successfully matching to first-choice overall nonsurgical disciplines, the number of women entering RO residency remains low. This study examines 10 years of resident match data to assess trends in gender-specific interest and match characteristics in RO. Methods Publicly available Canadian Resident Matching Service (CaRMS) data from 2012 to 2021 were compiled. Gender-based analysis focused on Canadian medical graduates (CMGs) ranking RO as their first-choice discipline in the match's first iteration. No applicant gender data were available for the 1 to 8 first-year residency positions carried over to the second iteration that occurred in 7 out of 10 matches over the study period. Pearson's chi-square test was used to evaluate whether the number of female applicants differed significantly from what could be expected if RO applicant gender breakdown reflected Canadian CaRMS participant demographics. Results Numbers of applicants ranking RO as their first-choice discipline have recently increased. 2018-2021 saw 23-28 RO-preferring applicants, while 2012-2017 saw 9-18. Total applicants ranged from 24-51 per year over the study period. Numbers of female RO-preferring applicants have remained largely unchanged, with a 10-year average of 7 women per year, ranging from 2/15 (13%) in 2016 to 12/27 (44%) RO-preferring applicants in 2018. Overall, 190 CMG applicants ranked RO as their first choice over the last 10 years, comprising 73 females (38%) and 117 males (62%). During this period, 56% (17696/31618) of CMG applicants who participated in the CaRMS match were female. ​​Rates of female applicants to RO were significantly lower compared to rates of female applicants to all specialties combined (p < 0.01). Discussion While recent years have had more RO-preferring applicants overall, numbers of RO-preferring female applicants have remained low, and disproportionately less than rates of female CaRMS participants. Findings highlight the need for greater understanding of the factors influencing female medical students' career selection and CaRMS ranking decisions to develop strategies to improve female representation in RO.

Radiotherapy is an important component of the treatment for primary and metastatic brain tumors. Due to the close proximity of critical structures and normal brain parenchyma, Central Nervous System (CNS) radiotherapy is associated with adverse effects such as neurocognitive deficits, which must be weighed against the benefit of improved tumor control. Advanced radiotherapy technology may help to mitigate toxicity risks, although there is a paucity of high-level evidence to support its use. Recent advances have been made in the treatment for gliomas, meningiomas, benign tumors, and metastases, although outcomes remain poor for many high grade tumors. This review highlights recent developments in CNS radiotherapy, discusses common treatment toxicities, critically reviews advanced radiotherapy technologies, and highlights promising treatment strategies to improve clinical outcomes in the future.

With the goal of improving the quality of sexual health care provision at our tertiary cancer centre, we developed, implemented, and assessed a multidisciplinary sexuality in an oncology program, to identify patient needs and apply interventions that could be effective in a broader oncology care context. The establishment of our institution’s first oncology-focused sexual health program is described within a quality improvement framework. A complementary retrospective chart review was performed to evaluate clinicodemographic data, including responses to validated sexual health questionnaires, from a 2-year clinical pilot. A sexual health program was introduced for cancer patients identified by health care providers or self-referred, receiving 130 referrals and conducting 64 consultation and 75 follow-up visits within a 2-year pilot period. Patients attending the program were 75% female, of mean age 52 years, and had most often breast (33%) or hematologic (30%) malignancies. Most (84%) had completed curative-intent treatment, with no evidence of disease, with 34% on ongoing endocrine therapy. The most frequent reasons for referral were sexual pain (38%), decreased libido (35%), and vaginal dryness (35% of females). All female patients demonstrated sexual dysfunction on the Female Sexual Function Index, and 80% of male patients demonstrated moderate to severe erectile dysfunction on the Sexual Health Inventory for Men. Patients waited a median of 63 days (SD 107, range 3–516) from referral to consultation, suggesting that demand for multidisciplinary sexual health care overwhelmed existing resources. We have demonstrated unmet sexual health needs across a diverse oncology patient population and have presented a framework for addressing these issues, highlighting the challenges encountered and proposing improvements. Insights emerging from a quality improvement perspective included the role of group-based sexual health support to improve accessibility and the need for staff education to encourage proactive intervention before referral for specialized care is needed.

BACKGROUND AND PURPOSE:We prospectively assessed the contributions of PET to initial staging, early detection of treatment failures, and prognostication in patients with anal squamous cell carcinoma (ASCC). MATERIALS AND METHODS:Consecutive patients with ASCC referred for radical chemoradiotherapy (CRT) consented to undergo FDG-PET imaging pre-treatment and at 3 and 6 months post-treatment. Clinicopathologic data were collected and CT and PET imaging reviewed for contribution to staging and recurrence detection. Maximum standardized uptake value (SUVmax), peak standardized uptake value (SUVpeak), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were assessed for association with progression-free survival (PFS), cause-specific survival (CSS), and overall survival (OS) using the Kaplan-Meier and Cox regression models. RESULTS:Between 2009 and 2016, 73 patients with clinical stages I-IIIB ASCC completed curative-intent CRT. Median follow-up was 48 months. 14 patients died and 18 patients experienced disease progression. 4-year PFS, CSS, and OS were 73%, 87%, and 84%, respectively. A pre-treatment MTV >35 cm3 predicted for worse PFS (p = 0.011) and CSS (p = 0.024) on univariate and multivariate analyses, employing an MTV definition of voxels ≥25% of SUVmax. Higher 6-month post-treatment SUVmax and SUVpeak predicted for worse PFS and OS (p ≤ 0.011). Pre-treatment SUVmax, SUVpeak, and TLG, and 3-month post-treatment SUVmax and SUVpeak did not significantly correlate with survival outcomes. CONCLUSIONS:Our findings support that pre-treatment MTV provides meaningful prognostic information, with suggestion that an MTV delineation threshold of voxels ≥25% of SUVmax is appropriate in the anal region. Post treatment, the combination of clinical examination and PET effectively detected all treatment failures. Higher 6-month post-treatment SUVmax and SUVpeak predicted worse PFS and OS; however, the optimal timing of post-treatment PET imaging remains unclear.

two highest impact factor RO journals: The International Journal of Radiation Oncology, Biology, Physics (IJROBP) and Radiotherapy and Oncology (R&O).From each journal, 20 articles per year were chosen at random.Data abstracted included the total number of authors, percent female authors, and gender of the first, second, and last authors.'Collaborating authors' were defined as those not in the first, second, or last position.We created the Female Author Impact Ratio (FAIR), a new metric representing the average percentage of female first and last authors.[FAIR = (% female first authors + % female last authors)/2*100].FAIR values range as a percentage from 0-100, with higher numbers reflecting a higher proportion of females in the first and last authorship positions.Time trend analyses were performed by year, journal, and fiveyear time period (2007-2011; 2012-2016).Chi-square, Fisher's Exact, two-sample T-test or Wilcoxon rank sum tests were used as appropriate.Results: Across 400 articles, the mean percentage of female authors was 30.9% (SD ± 22.0).34.8% of first, 36.7% of second, and 25.4% of last authors were female.The median number of authors per article was seven (interquartile range (IQR): 5, 10) with a median of two female authors per article (IQR: 1, 4).The percentage of female authors per year increased from 2007 to 2016 (p=0.005),but there were no significant increases in the percentage of first (p=0.25),second (p=0.06), or last (p=0.21)female authors.However, the percentage of female collaborating authors increased significantly (p<0.001).The mean FAIR score across all 10 years was 30%, with no significant increase in FAIR scores over time (p=0.09).After the introduction of double-blind peer review in the IJROBP, an increase in the mean percentage of female authors was observed (2012-2016: 34.0%; versus 2007-2011: 27.4%; p=0.012), corresponding to a rise in the proportion of female second (p=0.018) and collaborating (p=0.02)authors only. Conclusions:Although the percentage of female authors in RO has increased over the past decade, this did not correspond to a higher representation of women in high-profile authorship positions.The FAIR score, measuring the proportion of female first and last authors, did not increase over time.Introduction of double-blind peer review was associated with a rise in female authorship, suggesting that all journals should establish this practice to help mitigate gender bias throughout the publication process.

Oncology is a medical branch devoted to the study, diagnosis, treatment, and prevention of cancer. Cancer prevalence is increasing. By 2030, the global cancer burden is expected to grow to 21.7 million new cases and 13 million deaths. Developing as well as developed nations have cancer burden, but there is a gap. Ideally, cancer management involves a multidisciplinary team composed of qualified individuals from different specialties collaborating to optimize the care. This team must follow evidence-based medicine principles, considering three questions: What is the problem? How can we manage it? And why are we selecting this pathway? To fill the gaps in care, we present 10 questions that can help those who are managing patients with cancer globally. We concluded that although there is no “one-size-fits-all” approach, adhering to basic principles can help guide provision of evidence-based patient-centered care and fill some of the gaps in oncology.

Purpose Many patients with advanced cancer receive primary supports from informal caregivers (IC). As patient health deteriorates, IC assume increasing responsibility, often accompanied by distress. We investigated the quality of life (QOL) of IC of patients referred to a palliative radiotherapy (PRT) program. Methods IC accompanying patients to a dedicated PRT clinic completed a survey based on the validated Caregiver Quality of Life Index-Cancer (CQOLC). Demographics, burden, and engagement in support services were evaluated. Summary statistics were calculated, and parameters were assessed for association with CQOLC scores by a generalized linear model. Results Two hundred one surveys were analyzed representing 197 unique patients. The mean age was 68.3 years, with predominantly lung (25.0%) and prostate (19.3%) malignancies. 24.4% had been in hospital/long-term care within the previous 7 days. IC were 60.8% female, and 60.6% were the patient's spouse. 69.5% lived with the patient and 38.3% were additionally employed. IC spent a daily mean of 6.6 h (SD 7) assisting with instrumental (72.5%) and basic (37.5%) activities of daily living. Mean CQOLC score was 82.1/140 (SD 20). 63.8% of IC had previously accessed support service(s), most commonly home care (37.2%) and pharmacy (29.1%). 55.9% indicated interest in services not yet accessed. Multivariate analysis revealed additional employment, cohabitation, poor patient performance status, and interest in accessing more support services significantly correlated with higher IC burden. Conclusions Employing the CQOLC to screen IC of patients referred to a PRT program permits early identification of vulnerable IC to facilitate linkage with appropriate supports.

Stereotactic body radiotherapy (SBRT) has not been widely employed in the treatment of limited-stage (LS) small-cell lung cancer (SCLC), although SBRT finds particular utility in patients medically unfit to undergo surgical resection or radiotherapy with conventional fields. The authors present the case of a 61-year-old female smoker with severe chronic obstructive pulmonary disease (COPD), diagnosed incidentally with LS-SCLC. Concurrent chemoradiotherapy was contraindicated by her poor pulmonary function, and she was treated radically with four cycles of cisplatin and etoposide chemotherapy. This was followed by prophylactic cranial irradiation and consolidative SBRT (48 Gy in 4 fractions) to the residual tumour, which achieved a complete clinical response. Fifteen months following the patient's initial diagnosis, a metachronous Stage IA contralateral non-small cell lung cancer (NSCLC) was incidentally diagnosed and was treated with SBRT (48 Gy in 4 fractions). Although studies have established that the incidence of a second lung cancer is higher in patients with previous SCLC, this case is unique in that both primaries were treated with SBRT.