Practical radiation oncology
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Radiation therapy is one of the mainstays of treatment for painful bone metastases; however, the optimal fractionation and dosing of radiation for a given patient and disease characteristics are still subject to debate. ⋯ Our data demonstrate that selection of radiation fractionation schedules should take into account primary tumor type, KPS, and age, and we have generated an RPA model including these factors to help guide decision making. We also found that shorter fractionation schedules are as effective as longer fractionation schedules for pain control, regardless of primary tumor type.
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Radiation therapy (RT) for gastric mucosa-associated lymphoid tissue (MALT) lymphoma is challenging because of variation in the stomach's position, size, and shape. We investigated the interfractional changes in stomach location, consequent dosimetric effects, and impact of daily computed tomography image guidance RT (CT-IGRT). ⋯ Substantial interfractional variation in stomach volume was observed, despite treatment with breath-hold and restriction of oral intake. Daily CT-IGRT improved target coverage, enabling excellent coverage despite the use of small PTV margins.
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This guideline presents evidence-based recommendations for stereotactic body radiation therapy (SBRT) in challenging clinical scenarios in early-stage non-small cell lung cancer (NSCLC). ⋯ SBRT has an important role to play in treating early-stage NSCLC, particularly for medically inoperable patients with limited other treatment options. Shared decision-making with patients should be performed in all cases to ensure the patient understands the risks related to SBRT, the side effects, and the alternative treatments available.
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The purpose of this study was to assess the state of palliative and supportive care (PSC) and palliative radiation therapy (RT) educational curricula in radiation oncology residency programs in the United States. ⋯ Residency program directors believe that PSC and palliative RT are important competencies for their trainees and support increasing education in these 2 educational domains. Many residency programs have structured curricula on PSC and palliative radiation education, but room for improvement exists in management of fatigue, assessing role of spirituality, and discussion regarding advance care planning.