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Objectives Increasing diversity in radiation oncology with respect to sex, under-represented minorities (URMs), and people of color is a major objective of our profession. The purpose of this project is to plot diversity percentages in our residency program over the past 52 years and explain major causes for change when identified. Materials and methods Plots of the percent of residents in our program each year between 1967 and 2020 in the following categories: White male, female, URM, and people of color. Results Between 1967 and 1992 diversity percentage in our program changed little with ∼90% of residents representing White males. Between 1992 and 1995, overall diversity increased by 40 percentage points, a change maintained from 1995 to 2020. Approximate annual percentages over the past 25 years were: female, 35%; URM, 10%; and people of color, 25%.The main reason for increased diversity starting in 1992 was new leadership seeking to promote diversity. Tools that helped promote diversity were measuring our diversity profile and setting target goals. Conclusions Our experience provides a model to measure diversity and track performance over time in residency programs, departments, or practice groups. The priority to place on diversity, and specific performance goals, vary by group. For those seeking to increase diversity, our experience shows it is possible to achieve substantial diversity in all categories, but change requires leadership making diversity a priority.

OBJECTIVES Increasing the percentage of academic faculty who are female and/or an under-represented minority (URM) is a goal in radiation oncology. When studying diversity changes in our University Radiation Oncology Department, we found that increases in resident diversity preceded changes in faculty diversity in every major category. To illustrate these findings, we plotted resident versus faculty diversity each year over the 52-year history of our program. MATERIALS AND METHODS Plots were generated of the percent of residents versus faculty in our program each year between 1967 and 2020 in the following categories: female, URM, and people of color. RESULTS By 1995, substantial levels of diversity were present among both residents and faculty with approximate median annual values between 1995 and 2020 of 30% female for both residents and faculty, 15% URM for both residents and faculty, and 30% persons of color for residents and 15% for faculty. In all analyses, increase in resident diversity preceded an increase in faculty diversity and, in the great majority of years, resident diversity was greater than faculty diversity. CONCLUSION Our experience suggests that it may be easier to increase resident than faculty diversity and that increases in resident diversity may facilitate increasing faculty diversity.

Pain management during radiotherapy helps assess quality of care. By establishing an intervention to address pain during on-treatment visits (OTVs), we aim to lower patient-reported pain scores.A total of 171 patients were included in the analysis: 58 were retrospectively reviewed to provide a control and 113 were prospectively enrolled and evaluated after the intervention. The intervention included (1) a pain management in-service performed with the resident physician and nurses, (2) distribution of pain management educational materials, and (3) nurse consultation for patients with a pain score ≥5 within 2 days of the in-service. Study aims were to reduce the number of pain scores ≥5 by 30% and increase the number of pain scores documented during every OTV to90%.Median patient age was 65 years. Before the intervention, the average DVPRS score at initial consultation was 2 (range, 0 to 9) and 98% of patients had scores documented during OTVs. Overall, 26% (44/171) of OTV scores measured ≥5. Following the intervention, average DVPRS score at initial consultation was 2 (range, 0 to 10) and 99% of scores were documented during OTVs. About 14% (49/341) of patient-reported scores were ≥5, representing an ~50% relative reduction (P=0.023). The number of patients with 2+ pain scores ≥5 was reduced from 21% (12/58) before the intervention to 11% (12/109) after the intervention (P=0.1068).Involving nursing staff in the education and follow-up of patients with uncontrolled pain during radiotherapy led to an ~50% relative reduction in patient-reported DVPRS scores of 5+ during weekly OTVs.

The aim of this study was to review treatment and outcomes of patients with primary vaginal cancer treated with definitive radiotherapy.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).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%).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.

Purpose To determine the residual setup errors of several image guidance scenarios, using cone-beam computed tomography (CBCT) in conventionally fractionated radiotherapy for lung tumors. Methods Thirteen lung cancer patients were treated with conventionally fractionated radiotherapy, using daily image guidance with CBCT, resulting in 389 CBCT scans which were registered to the planning scan using automated soft-tissue registration. Using the resulting daily alignment data, 4 imaging frequency scenarios were analyzed: (A) no imaging; (B) weekly imaging with a 3-mm threshold; (C) first 5 fractions imaged, then weekly imaging with a patient-specific threshold; and (D) imaging every other day. Results The systematic setup error (Sigma) was reduced with increasing frequency of imaging from 3.4 mm for no imaging to 1.0 mm for imaging every other day. Random setup error (sigma), however, varied little regardless of the frequency of imaging: 2.9, 3.0, 3.4, and 3.2 mm for scenarios A, B, C, and D, respectively. The setup margins required to account for the residual error of each imaging scenario were 1 to 1.6 cm for scenario A, 4 to 6 mm for scenarios B and C, and 4 to 5 mm for scenario D. As the residual error of daily CBCT was not included in this analysis, these margins compare with a margin of zero for daily CBCT. Conclusions Daily image guidance is ideal as the setup margin can be reduced by about 5 mm versus a nondaily imaging scenario. However, if daily image guidance is not possible, there is little benefit in imaging more often than once a week.

Objective: Report the long-term outcome of patients who received postoperative radiotherapy for incidentally discovered cervix cancer following simple hysterectomy. Methods: We recorded tumor status, treatment complications, and survival of 25 patients treated at our institution from 1961 to 2004 with postoperative RT for invasive cervix cancer discovered following simple hysterectomy (median follow-up, 17 years). All patients had stage IA2-II squamous cell carcinoma (76%) or adenocarcinoma (24%) of the cervix. Results: One patient had an isolated vaginal-cuff recurrence and was cured long-term with salvage surgery. No patient died of cervix cancer. The actuarial rate of tumor control and relapse-free survival at 5, 10, and 20 years was 96%. One patient died of a treatment-related complication. Cause-specific survival was 100% at 5 and 10 years, but 92% at 20 years. Overall survival was 100% at 5 years, 95% at 10 years, and 62% at 20 years. The complications rate from therapy was surprising. The overall grade 2 to 5 complications rate was 36% (9 of 25). Twenty percent (5 of 25) of patients experienced grade 4 or 5 complications. Conclusions: This series demonstrates the price we pay for adding comprehensive radiotherapy to simple hysterectomy for early-stage cervix cancer. The findings support 2 recommendations: (1) Avoid postoperative radiotherapy by aggressively screening patients for invasive disease before performing simple hysterectomy. (2) Raise the threshold for delivering pelvic radiotherapy following simple hysterectomy with an incidental diagnosis of invasive cervix cancer. We recommend vaginal brachytherapy alone in patients with negative postoperative imaging, negative surgical margins, and < 10 mm tumor invasion.