J.C. Greenwalt

Outcomes of Definitive Radiation Therapy for Primary Vaginal Carcinoma.

Objective(s):The aim of this study was to review treatment and outcomes of patients with primary vaginal cancer treated with definitive radiotherapy. Materials and Methods:We retrospectively reviewed medical records of 71 patients with primary vaginal adenocarcinoma or squamous cell carcinoma treated with definitive radiotherapy with at least 2 years of follow-up (median follow-up, 6.24 y). Results:Ninety-three percent of patients were treated with external-beam radiotherapy plus brachytherapy (median dose, 7540 cGy); 4 patients with stage I disease and 1 patient with stage II disease were treated with brachytherapy alone (median dose, 6000 cGy). The cause-specific 5- and 10-year survival rates, respectively, were 96% and 96% for stage I patients, 75% and 68% for stage II patients, 69% and 64% for stage III patients, and 53% and 53% for stage IVA patients. The 5- and 10-year local-regional control rates for all patients were 79% and 75%, respectively. The 5- and 10-year distant metastasis-free survival rates for all patients were 87% and 85%, respectively. Sixteen patients had tumors involving the distal one third of the vagina. Of the 7 who received elective inguinal node irradiation, 0 failed in the inguinal nodes. Of the 9 who did not receive elective inguinal node irradiation, 2 failed in the inguinal nodes. Severe complications (grades 3 to 4) occurred in 16 patients (23%). Conclusions:Radiotherapy provides excellent results as definitive treatment for primary vaginal cancer, although the risk of severe complications is high. Generally, treatment should consist of both external-beam radiation therapy and brachytherapy. Inguinal nodes should be irradiated electively when the primary tumor involves the distal one third of the vagina.

A framework for quality improvement and patient safety education in radiation oncology residency programs

In training future radiation oncologists, we must begin to focus on training future QI specialists. Our patients are demanding better quality and safer care, and accrediting bodies are requiring it. We must equip radiation oncology trainees to be leaders in this new world. To that end, a QI/PS educational program should contain 2 components: a didactic portion focused on teaching basic QI tools as well as an overview of the quality and safety goals of the institution, and an experiential component, ideally a resident-led QI project mentored by an expert faculty member and that is linked to the departments and institutions goals.

The cure for the cynical physician: Gratitude and global health

Why did I choose my career in medicine? For me, it’s simple. Most of us, I think, in our medical school or residency applications, shared the same vision: to help people. So we chose a profession that would allow us to put others before ourselves. Often now, however, our profession can seem full of cynicism driven by increased work hours and insurance hoops. Some—perhaps many—physicians are burning out. A recent online CBS News article titled, “

Pregnancy testing in patients undergoing radiation therapy

1 million mistake: Becoming a doctor,”1 describes a 2013 survey showing that, if given the opportunity to choose a career again, fewer than 50% of physicians would pursue medicine. When did insurance companies and electronic charting distance us from our core values? Simply stated, I believewe physicians need to return to our vision, our “first love.” That belief comes from faith. When a person has strayed from faith, a return to “first love” can mean—at least in my case—remembering the passion of discovering God’s unconditional love. I call on all physicians to return to our first love in medicine: helping people. To do so, for me, has required putting aside cynicism and doing something vastly different from the contemporary physician’s normal day. For me, a return to my first love in medicine has come from serving global health. I know what you are thinking: why am I, a radiation oncology resident, writing about global health? Doesn’t radiation oncology require millions of dollars for equipment and extensive technical expertise? Or maybe you wonder why, with a passion for global health, why didn’t I choose primary care, infectious disease, or obstetrics and gynecology? My answer is that my calling is to help patients through their cancer journeys while pursuing my passions for research, technology, and physics. In fact, my involvement with

Long-term Outcomes Following Radiotherapy for Adolescent Patients With Nonmetastatic WHO Type III Nasopharyngeal Carcinoma.

Radiation therapy (RT) can be lethal to a developing fetus; therefore, determining pregnancy status before RT is essential. We here sought to determine how many women treated with RT at our institution for over one year were at risk for pregnancy when starting RT. We retrospectively reviewed the medical records of all female patients 12–55 years old treated with radiation, i.e. 1 October 2012 to 31 September 2013. Patients were categorised as ‘at risk’ if they had a uterus and ‘no risk’ if they had a hysterectomy. Documented birth control, pregnancy test status, and timing of the pregnancy test in relation to the radiation start date were recorded. We included 131 female patients with a median age of 48 years (range 14–55 years). Breast cancer was the most prevalent disease site (18%) followed by head/neck and central nervous system (both 11%). Of the 131 patients, 35 were deemed ‘no risk’ and 95 (72%) were ‘at risk’. Pregnancy testing of the ‘at risk’ population was done in 47%, but only 17% of the pregnancy testing was performed accurately, which we defined as a test performed within 14 days before starting RT. Over one year, 66% (63/95) of ‘at risk’ women were not tested appropriately before starting RT. Most (66%) women of child-bearing age with an intact uterus receiving RT at our institution were not appropriately tested for pregnancy before the initiation of RT. These data laid the foundation for our formal pregnancy testing policies for women undergoing RT.

Cervical cancer with a rare umbilical metastases in prior surgical site.

Objectives:To report long-term results of primary radiotherapy for nasopharyngeal cancer (NPC) presenting in the adolescent group. Methods:Ten adolescent patients with World Health Organization (WHO) type III NPC were treated with primary radiotherapy at our institution between 1969 and 2007. Median age was 16.5 years (range, 11 to 21). Median radiotherapy dose to the primary target volume was 67.5 Gy (range, 60 to 74.8). The bilateral neck received 51.1 Gy (range, 50 to 60 Gy). Five patients were treated with once-daily radiotherapy and 5 received twice-daily radiotherapy. Three patients received neoadjuvant cisplatin and 5FU, and 1 patient received adjuvant maintenance cisplatin and 5FU. Results:Median follow-up time was 9.5 years (range, 1.94 to 34.74). Fifteen-year overall survival, cause-specific survival, and progression-free survival rates were all 70%. Fifteen-year local and regional control rates were 100% and 90%. One patient recurred regionally and distantly simultaneously, and 2 patients developed distant metastases alone. All 3 died of their disease within 3 years. One patient died from multiple radiation-induced secondary meningiomas 34 years after radiotherapy. Five patients developed hypothyroidism, 3 developed sensorineural hearing loss, and 4 developed dental complications. The overall rates of CTCAE grade 3, 4, and 5 toxicity were 40%, 10%, and 10%, respectively. Despite high-radiation doses to the skull base, none of the patients in this study developed grade 3+ cognitive or vision toxicity. Conclusions:Radiotherapy achieves excellent local control in adolescent patients with unresectable WHO type III NPC. Our data support current protocols to systematically tailor treatment volumes and deescalate radiation doses to reduce treatment toxicity.

Implementing an Electronic Event-Reporting System in a Radiation Oncology Department: The Effect on Safety Culture and Near-Miss Prevention

Highlights • We describe the case of an unusual port-site cervical cancer metastasis.• We perform a review of the current published literature of port-site metastases.• We demonstrate that our patient’s case is unlike others previously described.