Practical radiation oncology
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Controversy exists regarding the optimal negative margin width for ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and whole-breast irradiation. ⋯ Use of a 2-mm margin as the standard for an adequate margin in DCIS treated with whole-breast irradiation is associated with lower rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs. Clinical judgment should be used in determining the need for further surgery in patients with negative margins narrower than 2 mm.
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Adjuvant hypofractionated radiation therapy (HRT) for elderly patients with newly diagnosed glioblastoma (GBM) is a reasonable option compared with standard fractionation radiation therapy (SFRT). Outcomes in patients receiving HRT in the presence of temozolomide (TMZ) compared with SFRT with TMZ are unclear. We examined HRT for GBM with TMZ in comparison to SFRT with TMZ. ⋯ Elderly GBM patients receiving HRT and those receiving SFRT had similar OS. Subset analysis patients receiving concurrent TMZ showed no difference in OS between the HRT and SFRT groups.
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To present evidence-based guidelines for radiation therapy in treating glioblastoma not arising from the brainstem. ⋯ Radiation therapy occupies an integral role in treating glioblastoma. Whether and how radiation therapy should be applied depends on characteristics specific to tumor and patient, including age and performance status.
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Complications of anesthesia for pediatric radiation therapy are imperative for both radiation oncologists and anesthesiologists to clinically assess and manage. We performed the first systematic review to date addressing this important issue. ⋯ Rates of anesthetic complications encountered in pediatric radiation therapy are similar, if not lower, than rates reported in controlled operating room settings, implying that anesthesia for pediatric radiation therapy is safe, with low complication rates periprocedurally. Propofol infusion and oxygen delivery via nasal cannula offer the lowest immediate anesthetic complication rates and are hence most recommended for use. Though the long-term neurocognitive consequences of multiple anesthetics in pediatric patients have yet to be clearly defined, health care providers should be cognizant of the potentially serious implications.
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The purpose of this study was to investigate the incidence of and risk factors associated with femur fracture after combined modality therapy for soft tissue sarcomas (STS) of the proximal lower extremity. ⋯ Although femur fractures are rare, a component from each of the 3 therapeutic modalities contributes to the overall risk, and a multidisciplinary approach to mitigating fracture risk is needed. Although avoiding circumferential bone coverage with the 50-Gy isodose line may be a valuable dosimetric parameter, more rigorous dosimetric studies are required.