Christine Hill-Kayser

The effects of titanium mesh on passive-scattering proton dose

High-density metallic implants can introduce considerable uncertainties in proton therapy treatment planning. These uncertainties eventually translate into proton range errors, which may cause significant underdosing to the target volume or overdosing to normal tissue beyond the target. This study investigated the dosimetric impact of a 0.6xa0mm titanium (Ti) mesh implant in passive-scattering proton beam therapy through the study of the depth dose and output in water, and the dose profiles in solid water at various depths. The measurements were performed for a beam with a range of 8.5xa0cm and a modulation of 7.5xa0cm. The titanium mesh was placed at a depth of 1xa0cm below the surface of the phantom for all measurements. A range reduction of 0.5 ± 0.1xa0mm was observed for a beam perpendicular to the mesh, with no further reductions when the incident angle increased to 60°. We conclude that the dosimetric effect of a 0.6xa0mm titanium mesh implant is small for a passive scattering proton beam. With proper correction applied to metal artifacts, consistent results were observed in the phantom study in the treatment planning system.

Pencil beam scanning proton therapy for treatment of the retroperitoneum after nephrectomy for Wilms tumor: A dosimetric comparison study.

Multimodality treatment for patients with Wilms tumor has improved patient survival, but is associated with acute and long‐term toxicity, partially due to irradiation. Proton therapy using pencil beam scanning (PBS) is a promising technique to reduce dose to organs at risk (OAR). In this study, we evaluate PBS plans for postoperative irradiation in patients with Wilms tumor.

Factors associated with event reporting in the pediatric radiation oncology population using an electronic incident reporting system

PURPOSEnPediatric patients may receive complex treatment. In our department, an electronic incident reporting system (condition reporting system [CRS]) was developed and made available to all members.nnnMETHODS AND MATERIALSnThe CRS system is available on all departmental computers. Entered events are evaluated and graded by a supervisor as follows: A(dose deviation or patient harm), B (near miss), C (interruption in care process), or D (inconvenience). Data for pediatric patients for whom events were entered were reviewed retrospectively and compared to the entire treated pediatric population.nnnRESULTSnOver 2 years, 503 pediatric patients received radiation therapy (median age 10.1 years; range, 0.5-18.8 years), and 592 pediatric CRS events were entered (9.8% of 6020 total institutional CRS entries). These concerned 275 patients with an average of 2.1 entries each; 59% (348) were graded as severity D, 39% (230) as C, 2% (14) as B, and none as A. Events were most commonly related to treatment process (32%, n = 188), followed by planning/dosimetry (19%, n = 109), anesthesia (15%, n = 86), scheduling/transport (13%, n = 73), and physics (10%, n = 62). Delays associated with events were ≤1 hour for most cases (83%, n = 474). Patient and treatment factors associated with CRS entry included total duration of radiation therapy, primary brain tumor, receipt of proton therapy, and receipt of double-scattered proton therapy. No significant differences were found based on age, sex, race, treatment intent (curative vs palliative), type of photon treatment (conformal vs intensity modulated radiation therapy vs arc), use of total body irradiation, or use of pencil beam scanning proton therapy.nnnCONCLUSIONSnAn incident reporting system is a widely used part of the safety culture at our institution, which treats one of the largest pediatric patient volumes in North America. Most pediatric CRS-reported events are of minor severity. Longer treatment course and use of new and complex technologies appear to increase the likelihood of a CRS event within the pediatric population, which supports the need for increased safety processes when new techniques are initiated.

Proton therapy for pediatric head and neck malignancies

Pediatric head and neck malignancies are managed with intensive multimodality therapy. Proton beam therapy (PBT) may reduce toxicity by limiting exposure of normal tissue to radiation. In this study, we report acute toxicities and early outcomes following PBT for pediatric head and neck malignancies.

Patient-reported survivorship care practices and late effects after treatment of Hodgkin (HL) and non-Hodgkin lymphoma (NHL).

PURPOSEnMultimodal treatment of Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) yields excellent outcomes; however, survivors are at risk of developing myriad late and long-term effects.nnnMETHODSnFrom a convenience sample of 964 survivors of HL (37%) and NHL (63%) using a publicly available Internet-based survivorship care plan (SCP) tool between 2011 and 2016, we examined patient-reported cancer care, toxicities, and survivorship care data.nnnRESULTSnOf all survivors, 67% were female and 84% were white and 88% were free of cancer. Median age of diagnosis was 28 years for survivors of HL and 49 years for NHL. Many survivors reported treatment with chemotherapy (92%), surgery (52%), and/or radiation (41%), with most radiation delivered to chest/mantle fields (81%). Survivors reported a diversity of radiation- and chemotherapy-related sequelae, including thyroid dysfunction, speaking and/or swallowing changes, pulmonary fibrosis/pneumonitis, heart disease, chronic fatigue, neurocognitive decline, neuropathy, sexual changes, and secondary breast cancers. Few reported receipt of previous survivorship information. Most reported management/comanagement by an oncology specialist after active treatment; however, a shift to management by primary care provider alone was observed as a trend over time in follow-up. Sixty-six percent of users who responded to a follow-up survey reported that they intend to share the SCP with their health care team.nnnCONCLUSIONnSurvivors of lymphoma, many of whom are free of disease, report a substantial burden of late and long-term adverse effects, suboptimal delivery of survivorship information, and transitions of care in follow-up in which fragmented systems and/or poor communication may contribute to unmet survivor needs. Multiple opportunities thus exist for which SCPs may be used to improve awareness regarding survivorship and associated adverse effects in addition to communicating follow-up care plans between survivors and treatment teams.

First report of cancer survivor utilization of comprehensive internet-based survivorship care plans

20547 Background: Over the past three decades, the number of cancer survivors in the US has more than tripled (MMWR 2004), and these patients remain at risk for late effects resulting from cancer t...