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With the increasing prevalence and complexity of re-irradiation cases, there is a need for comprehensive policies and procedures to ensure optimal patient outcomes and minimize risk. A critical incident involving re-irradiation was reported to Ontario Health-Cancer Care Ontario (OH-CCO) which prompted a review of re-irradiation practices across radiation treatment facilities. The aim of the OH-CCO Re-Irradiation Symposium Webinar was to explore re-irradiation incidents and lessons learned and current re-irradiation practices and processes across the province with the goal of knowledge transfer exchange and best practice sharing. In the context of this webinar, re-irradiation was defined as delivery of a new course of radiation therapy to a previously irradiated volume where there is overlap or potential overlap between the two plans. Prior to the webinar, a pre-meeting survey was circulated to the radiation therapy managers at each of Ontario's radiation treatment facilities. The managers were asked to coordinate one submission per centre in collaboration with the inter-professional team. The survey included questions on re-irradiation policy, gathering radiation treatment history and combining previous and current plans. A 100% response rate (n=15) was achieved. The OH-CCO Re-Irradiation Symposium webinar was held in June 2023. The webinar included an overview of the epidemiology of re-irradiation, a review of the pre-meeting survey results, a summary of the Radiation Incident Safety Committee (RISC) analysis of re-irradiation incidents reported to the National System for Incident Reporting-Radiation Treatment (NSIR-RT), a presentation of a critical incident involving re-irradiation and the resulting quality care review recommendations, and a showcase of re-irradiation processes and learnings from three radiation treatment facilities. The webinar also included four discussion periods where participants could ask questions and share their experiences and challenges with re-irradiation processes. A showing of the recorded webinar was hosted in November 2023 for those unable to attend the live event. The benefits of the webinar included bringing representatives from all radiation treatment facilities to participate in knowledge transfer exchange and best practice sharing, as well as increasing awareness of variation in current re-irradiation processes and challenges with creating or updating these processes. 93% of radiation treatment facilities indicated during the pre-meeting survey that they would be interested in sharing their re-irradiation policy/process with other facilities highlighting an appetite for continued collaboration amongst facilities. The main challenge of the webinar was the size of the group and the virtual setting, which made participation in discussion more difficult and limited the interaction among attendees. Over 180 participants attended the live webinar and/or the showing of the recording. There was representation from each of Ontario's radiation treatment facilities including participants from multiple areas of the multidisciplinary team (i.e. radiation oncologists, medical physicists, clinical specialist radiation therapists, radiation therapists, dosimetrists, clinical educators, radiation nurses, management, students etc.). Opportunities for continued collaboration and best practice sharing have stemmed from this webinar. Suggestions for future symposia topics were raised by the participants; these will be explored by the OH-CCO team. Work is underway to collect re-irradiation policies/processes from each of Ontario's radiation treatment facilities with the goal of developing a recommendation document to support creating or updating these processes to improve their effectiveness. There has also been interest in forming a provincial re-irradiation working group to establish provincial guidelines and promote consensus on re-irradiation practices both clinically and logistically. [ABSTRACT FROM AUTHOR]

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Abstract: Purpose: To standardize upper abdominal normal organ contouring guidelines for Radiation Therapy Oncology Group (RTOG) trials. Methods and Materials: Twelve expert radiation oncologists contoured the liver, esophagus, gastroesophageal junction (GEJ), stomach, duodenum, and common bile duct (CBD), and reviewed and edited 33 additional normal organ and blood vessel contours on an anonymized patient computed tomography (CT) dataset. Contours were overlaid and compared for agreement using MATLAB (MathWorks, Natick, MA). S95 contours, defined as the binomial distribution to generate 95% group consensus contours, and normal organ contouring definitions were generated and reviewed by the panel. Results: There was excellent consistency and agreement of the liver, duodenal, and stomach contours, with substantial consistency for the esophagus contour, and moderate consistency for the GEJ and CBD contours using a Kappa statistic. Consensus definitions, detailed normal organ contouring recommendations and high-resolution images were developed. Conclusions: Consensus contouring guidelines and a CT image atlas should improve contouring uniformity in radiation oncology clinical planning and RTOG trials. [Copyright &y& Elsevier]

Background: Neoadjuvant chemoradiation followed by surgery (NeoCRT) has been advocated as standard therapy for resectable esophageal cancer. Our objective was to compare oncologic outcomes between NeoCRT and upfront surgical resection (SURG). Methods: We conducted a single-institution, retrospective review of all potentially resectable esophageal cancer patients treated with NeoCRT or SURG. Results: From 2003 to 2010, 151 patients had NeoCRT (n = 48; 31.8%) or SURG (n = 103; 68.1%). Histology was mostly adenocarcinoma (77.5%) or squamous carcinoma (19.2%). Mean radiation dose was 44 ± 0.1 Gy, and 80.8% received platinum-based doublet chemotherapy. There were more women in the SURG group (23.3% vs 4.2%; p < 0.01) and more cardiovascular comorbidity in the NeoCRT group (39.6% vs 21.4%; p = 0.027). There was no difference in age, histology, R0 resection rate, and treatment-related mortality (NeoCRT = 4.2%; SURG = 3.9%; p = 0.15). Failure to undergo resection after NeoCRT (n = 11; 22.9%) was mainly due to disease progression (n = 6) or treatment-related mortality (n = 4). Resection could not be performed in 4 SURG patients (3.9%; p < 0.001; unresectable = 2; occult metastases = 2). NeoCRT did not improve median survival (NeoCRT = 29 ± 6; SURG = 26 ± 3 months; p = 0.376) or recurrence-free interval (NeoCRT = 25.8 ± 5; SURG = 19.4 ± 2 months; p = 0.19). Complete pathologic response (n = 8; 21.6%) was not associated with improved survival. If we exclude from analysis NeoCRT patients who did not undergo surgery, survival was significantly improved after NeoCRT (NeoCRT = 41 ± 15; SURG = 24 ± 8 months; p = 0.0082). Conclusions: Patient selection and early assessment of treatment response may be key factors in identifying the best candidates for trimodality therapy. [ABSTRACT FROM AUTHOR]