M.R. Waddle

Performance/outcomes data and physician process challenges for practical big data efforts in radiation oncology

It is an exciting time for big data efforts in radiation oncology. The use of big data to help aid both outcomes and decision-making research is becoming a reality. However, there are true challenges that exist in the space of gathering and utilizing performance and outcomes data. Here, we summarize the current state of big data in radiation oncology with respect to outcomes and discuss some of the efforts and challenges in radiation oncology big data.

Post-operative radiation therapy in locally advanced non-small cell lung cancer and the impact of sequential versus concurrent chemotherapy

Lung cancer is the second most common cancer and the leading cause of death from cancer in the United States (1). Despite the adoption of lung cancer screening, most patients present with locally advanced or advanced disease which is associated with poor survival (1).

Google Search Trends in Oncology and the Impact of Celebrity Cancer Awareness

Introduction There is widespread public interest when celebrities are diagnosed with cancer. We sought to assess how this interest impacts awareness of prevalent cancers.

Short-course Versus Long-course Neoadjuvant Therapy for Non-metastatic Rectal Cancer: Patterns of Care and Outcomes From the National Cancer Database

Micro‐Abstract The current United States practice trend for neoadjuvant radiation for rectal cancer is unknown. In this study, 28,193 patients within the National Cancer Database treated with neoadjuvant radiation were identified and analyzed. Although long‐course neoadjuvant chemoradiation was strongly preferred over short‐course radiation, no difference in outcomes was identified. Introduction The purpose of this study was to compare the utilization, pathologic response, and overall survival (OS) between long‐course neoadjuvant chemoradiation (LC‐CRT) and short‐course neoadjuvant radiation (SC‐RT) in the treatment of non‐metastatic rectal cancer. Methods and Materials Retrospective data was obtained from the National Cancer Database (NCDB) for patients diagnosed with clinical stage II or III (limited to T3, any N or T1‐2, N1‐2) rectal cancer between 2004 and 2014 (28,193 patients). Univariate and multivariate analyses were performed to investigate factors associated with receipt of SC‐RT, pathologic complete response (pCR) rate, and OS. Patients were compared based on the neoadjuvant therapy they received prior to tumor resection. SC‐RT was defined as 25 Gy given over 1 week prior to surgery (with or without chemotherapy as part of their treatment course). LC‐CRT was defined as 45 to 60 Gy given over 5 to 6 weeks (with chemotherapy) prior to surgery. Results A total of 27,988 (99%) of patients received LC‐CRT, and 205 (1%) patients received SC‐RT. Receipt of SC‐RT was associated with older age, more comorbidities, and treatment at an academic facility (P < .001 for each). Additional days from radiation completion to surgery was associated with a higher pCR rate (P < .001 for both). LC‐CRT did not lead to increased OS compared with SC‐RT (P = .517). Conclusions In this United States database study, there was no improvement in OS for patients receiving LC‐CRT compared with SC‐RT; however, a longer interval between radiation therapy and surgery led to a higher pCR rate. Academic facilities were more likely to utilize SC‐RT compared with other facilities.

Implementation of patient pagers in radiation oncology waiting rooms for patient privacy and satisfaction

ObjectiveIn order to improve privacy, quality, and coordination of care, a patient pager system was introduced to notify patients of daily treatment in the Department of Radiation Oncology. One hundred patients undergoing daily radiation therapy prospectively participated in a six-question survey addressing the paging service, privacy prior to pager use, and demographics. Twelve radiation therapists also participated in a survey addressing privacy and workflow.ResultsSurvey results from all patient participants revealed that convenience, privacy, ease of use, desire for use for consults and return visits were highly rated as very good to excellent. The top three categories were “ease of use,” “convenience” and “privacy.” Nineteen patients had the experience of our waiting room prior to introduction of the patient pagers and highly rated “privacy,” “efficiency,” and “satisfaction.” Twelve radiation therapists participated and rated workflow related categories fair to good. Only patient privacy was rated as very good to excellent. Thus, patients and staff highly rated the paging system for privacy protection and satisfaction. However, it did not change overall workflow. Our study shows clinics should prioritize privacy in the waiting room to address the emotional needs of patients and improve satisfaction.

Analysis of MRI volumetric changes after hypofractionated stereotactic radiation therapy for benign intracranial neoplasms

Purpose To quantitatively assess volumetric changes after hypofractionated stereotactic radiation therapy (HFSRT) in patients treated for vestibular schwannomas and meningiomas. Methods and materials We retrospectively reviewed records of patients treated with HFSRT at our institution from 2002 to 2014. Patients received a median dose of 25 Gy in 5 fractions. After treatment, they underwent clinical and radiologic follow-up with magnetic resonance imaging (MRI) at 3- to 12-month intervals. Gross tumor volume was outlined on each thin slice of contrast-enhanced T1 series before and on each scan after HFSRT. Volumetric changes were calculated and compared with neuroradiologist interpretations. Results Forty-three patients underwent 182 MRI scans. Tumor types included vestibular schwannoma (n = 34) and meningioma (n = 9). Median follow-up time was 29 months. Median gross tumor volume was 3.1 cm3. Local control was 81.4% for the entire cohort at the time of last follow-up. Transient volume expansion was noted in 17 patients (50%) with vestibular schwannoma and 2 (22%) with meningioma. For all patients, transient volume expansion and subsequent regression occurred at a median time of 5.5 and 12 months, respectively. Neuroradiologist agreement with regard to tumor regression, progression, or stability occurred in 155 of 182 total reports (85%). The largest discordance identified was a stable finding on the MRI interpretation when the measured volumetric change exceeded 20% (n = 24 [13%]). Conclusions HFSRT is associated with excellent local control and a low incidence of toxicity. With volumetric MRI measurement, transient volume expansion was a common finding and was associated with temporary adverse effects. Although the neuroradiologist’s interpretation generally agreed with the volumetric MRI measurement, the overall 15% discordance rate emphasizes the potential benefit of considering volumetric measurements, which may help clinicians correlate posttreatment symptoms with MRI findings.