Common error pathways seen in the RO-ILS data that demonstrate opportunities for improving treatment safety

Purpose

The Radiation Oncology Incident Learning System (RO-ILS) receives event reports from facilities across the country. This effort extracted common error pathways seen in the data. These pathways, expressed as fault trees, demonstrate the need for, and opportunities for, preventing these errors and/or limiting their propagation to treatment.

Carbon Fiducial Image Guidance Increases the Accuracy of Lumpectomy Cavity Localization in Radiation Therapy for Breast Cancer

Purpose

We investigated the feasibility and accuracy of using carbon fiducials to localize the lumpectomy cavity with 2-dimensional kV imaging for early stage breast cancer radiation therapy.

Phantom Verification of AAA and Acuros Dose Calculations for Lung Cancer: Do Tumor Size and Regression Matter?

Purpose

This study aimed to evaluate dose calculation accuracy for the Eclipse Analytical Anisotropic Algorithm (AAA) and Acuros XB algorithm for various lung tumor sizes and to investigate dosimetric changes associated with treatment of regressing tumors.

Prostate cancer–specific PET radiotracers: A review on the clinical utility in recurrent disease

Prostate cancer–specific positron emission tomography (pcPET) has been shown to detect sites of disease recurrence at serum prostate-specific antigen (PSA) levels that are lower than those levels detected by conventional imaging. Commonly used pcPET radiotracers in the setting of biochemical recurrence are reviewed including carbon 11/fludeoxyglucose 18 (F-18) choline, gallium 68/F-18 prostate-specific membrane antigen (PSMA), and F-18 fluciclovine. Review of the literature generally favors PSMA-based agents for the detection of recurrence as a function of low PSA levels. Positive gallium 68/F-18 PSMA positron emission tomography/computed tomography scans detected potential sites of recurrence in a median 51.5% of patients when PSA level is <1.0 ng/mL, 74% of patients when PSA level is 1.0 to 2.0 ng/mL, and 90.5% of patients when PSA level is >2.0 ng/mL. Review of carbon 11/fludeoxyglucose 18 (F-18) choline and F-18 fluciclovine data commonly demonstrated lower detection rates for each respective PSA cohort, although with some important caveats, despite having similar operational characteristics to PSMA-based imaging. Sensitive pcPET imaging has provided new insight into the early patterns of disease spread, which has prompted judicious reconsideration of additional local therapy after either prostatectomy, definitive radiation therapy, or postprostatectomy radiation therapy. This review discusses the literature, clinical utility, availability, and fundamental understanding of pcPET imaging needed to improve clinical practice.     

Small-cell Lung Cancer in Very Elderly (≥ 80 Years) Patients

BackgroundThis analysis was performed to describe the outcome of very elderly (≥ 80 years) patients with small-cell lung cancer (SCLC) as there is no published data regarding these patients.Materials and MethodsOne hundred forty-six very elderly patients with SCLC were identified from the Institutional Lung Cancer Database ranging in age from 80 to 92 years (median, 82 years). Of these, 47 (32%) patients had limited-stage SCLC (L-SCLC), and 99 (68%) had extensive-stage SCLC (E-SCLC). All were Caucasian, and the majority (64%) were female. Sixty-seven (46%) patients had Zubrod performance status (PS) of 0 to 1.ResultsOf the 146 patients, 44 (30%) received no therapy, 65 (45%) received chemotherapy alone, 27 (19%) received chemotherapy plus local therapy (thoracic radiotherapy [TRT] or surgery), and 10 (7%) received local therapy alone. The median survival was 5.4 months. On univariable analysis, age (P = .019), stage (L-SCLC vs. E-SCLC; P = .0002), PS (P < .0001), and treatment option (P < .0001) were associated with survival. On multivariable analysis, stage (P = .011), PS (P = .029), and treatment option (P < .0001) maintained significance. For entire cohort, the median survival was 1.3 months without active therapy, 6 months with local therapy alone, 7.2 months with chemotherapy alone, and 14.4 months with chemotherapy plus local therapy (P < .0001, univariable and multivariable). Similar survival findings in response to treatment were found when the L-SCLC and E-SCLC cohorts were separately analyzed.ConclusionsThe survival of very elderly patients with SCLC was associated with stage (L-SCLC vs. E-SCLC), PS, and treatment option. Very elderly patients with SCLC often have limited functional reserve required to tolerate aggressive multimodality therapy but appeared to benefit from it. Geriatric assessments, careful monitoring, and extra support are warranted in elderly patients. Care should be individualized based on the desires and needs of each patient.     

Association of a 97 kilodalton glycoprotein with human ovarian carcinoma

The association of a 97 kilodalton glycoprotein (97k-GP) with human ovarian epithelial tumors is reported. The 97k-GP has been found to be present in elevated levels in all the 8 serous cystadenocarcinoma specimens tested. This glycoprotein is present in small amounts in endometrial tumors and either absent or present in trace amounts in control ovaries. Subcellular localization of this glycoprotein indicates that it is a component of plasma membrane.     

Fungal prosthetic valve endocarditis: Mayo Clinic experience with a clinicopathological analysis

Fungal prosthetic valve endocarditis is a rare but devastating disease. To better characterise this syndrome, we retrospectively reviewed 21 cases of fungal prosthetic valve endocarditis seen at Mayo Clinic over the past 40 years. The average patient age was 65 years with a 2 : 1 male predominance. Twelve of 21 cases (57%) occurred within 1 year of prosthetic valve placement. The aortic valve was most commonly affected, and the most common aetiological agent was Candida species, followed by Histoplasma capsulatum. Although 20 of 21 patients (95%) were immunocompetent, they had other risk factors for fungal infection. Patients typically presented with systemic signs and symptoms of infection, and cardiac imaging was abnormal in 68% of cases. Pathological evaluation of valve material was of high yield, with organisms identified in 92% of cases who underwent valve replacement surgery or had an autopsy performed. Prosthetic valve fungal endocarditis was associated with a high morbidity and mortality, with 67% of patients experiencing complications and 57% of patients dying of infection‐related disease. Hopefully, with the prompt institution of early medical therapy, surgical intervention and lifelong oral antifungal suppressive therapy, cure rates will continue to improve.     

Modeling excess lung cancer risk among screened arm participants in the Mayo Lung Project

BACKGROUND:

The Mayo Lung Project (MLP) was a randomized clinical trial designed to test whether periodic screening by chest x‐ray reduced lung cancer (LC) mortality in men who were high‐risk smokers. Among MLP participants, there were more deaths from LC in the screening arm both at the trial's end and after long‐term follow‐up. Overdiagnosis was cited widely as an explanation for the MLP results, whereas a role for excess LC risk attributable to undergoing numerous chest x‐ray screenings largely was unexamined. The authors of this report examined the consistency of the MLP data with a modified 2‐stage clonal expansion (TSCE) model of excess LC risk.

METHODS:

By using a simulation model calibrated to the initial MLP data, the authors examined the expected statistical variance of LC incidence and mortality between the screening and control arms. A Bayesian estimation framework using a modified version of the TSCE model to evaluate the role of excess LC risk attributable to chest x‐ray screening was derived and applied to the MLP data.

RESULTS:

Simulation experiments indicated that the overall difference in LC deaths and incidence between the study arm and the control arm was unlikely (P = .0424 and P = .0104, respectively) assuming no excess risk of LC. The authors estimated that the 10‐year excess LC risk for a man aged 60 years who smoked and who received 10 chest x‐ray screenings was 0.574% (P = .0021).

CONCLUSIONS:

The excess LC risk observed among screening arm participants was found to be statistically significant with respect to the TSCE model framework in part because of the incorporation of key risk correlates of age and screen frequency into the estimation framework. Cancer 2010. Published 2010 American Cancer Society     

Phase II Study of Systemic High-dose Methotrexate and Intrathecal Liposomal Cytarabine for Treatment of Leptomeningeal Carcinomatosis From Breast Cancer

Metastatic breast cancer frequently leads to brain metastases and, less commonly, leptomeningeal carcinomatosis (LC). Once cerebrospinal fluid involvement occurs, the prognosis is poor. There are limited treatment options available, but none offer significant survival benefit. Methotrexate, given systemically at high doses (3.5-8 gm/m²), achieves cytotoxic concentrations in the CSF and has been shown to prolong survival in patients with LC. Intrathecal liposomal cytarabine has been shown to increase time to neurologic progression in patients with breast cancer and LC. The combination of these 2 agents in LC has not been studied extensively. Here, we present the results of the phase II study with this combination showing promising efficacy and very good tolerability.