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MR-guided high dose rate (HDR) brachytherapy for focal GTV boost in prostate cancer radiotherapy is an established technique. However, this is resource-intense, invasive and may be contraindicated in some patients. Linear accelerators with integrated MRI allow visualization of the GTV within the prostate, facilitating the use of External Beam Radiation Therapy (EBRT) to deliver GTV boost. This study compared patient-reported quality of life for the first 20 patients treated with these two techniques. Twenty intermediate risk prostate cancer patients who were enrolled and treated between May 2022 and August 2023 in prospective clinical trials were included in this study. Patients were stratified based on patient preference; 10 patients received GTV boost fraction using HDR brachytherapy and 10 patients were treated with EBRT using a 1.5T MR-Linac. For HDR treatment patients were positioned supine under general anesthesia while transperineal catheters were inserted under MRI guidance. For EBRT treatment patients were positioned supine with minimal immobilization and an empty bladder. All patients received 1 × 15 Gy to the GTV followed within 1 week by 5 × 6 Gy (alternate days) to the whole prostate. Both groups received their subsequent whole gland prostate treatment on the MR-Linac. Patient-reported quality of life was captured using The Expanded Prostate Cancer Index Composite (EPIC) survey. The questionnaire was administered at baseline and at one month follow-up. Results were analyzed using descriptive statistics. All patients completed treatment as planned and had minimum follow up of 1 month (range 1-6). The mean score and standard deviation collected from EPIC for bladder and bowel subscales at 1-month follow up were similar between those who received HDR and EBRT with 81.1(29.7) and 94.1 (13.9) vs 85.2(23.1) and 93.9(15.0) respectively. There were also no statistically significant differences when looking further at additional subsets, urinary function was 87.7(13.1) vs 89.8(8.3), p=1.0 for HDR and EBRT and urinary bother 74.2(21.8) vs 81.63(11.0), p=0.71. Bowel function was 94.3(6.2) vs 92.9(8.3), p=1.0 for HDR and EBRT and bowel bother 93.9(7.5) vs 94.8(8.8), p=0.62. The mean change in score from baseline assessment was –5.7 for urinary incontinence and –6.1 urinary irritative/obstructive and 0.8 in rectal subscales for HDR patients compared to 1.0, -1.9 and 0.0 for EBRT patients. These changes from baseline only exceeded the minimally important difference (MID) reported in literature for the urinary irritative/obstructive subscale and only in HDR patients. MRL focal boost to GTV region of the prostate was found to have a similar patient-reported quality of life compared to HDR focal boost at 1 month following completion of treatment, although patients receiving HDR reported a MID from baseline in urinary irritative/obstructive symptoms. A larger sample size may confirm these preliminary findings translate into differences in QOL. [ABSTRACT FROM AUTHOR]

Delivery of a focal boost to the intraprostatic gross tumour volume (GTV) for prostate cancer patients has shown to improve biochemical disease-free survival and has been done via brachytherapy at our institution. However, brachytherapy has contraindications and patients may not want to undergo an invasive procedure. Onboard MR imaging enables visualization of gross disease and can guide treatment on a linear accelerator (linac). The purpose of this study was to describe the initial experience of delivering a focal boost to intraprostatic GTV(s) using MR-guidance on a 1.5T MR-Linac and determining the relevance of bladder preparation for this adaptive radiotherapy technique, because bladder filling may contribute to intrafraction motion. Between March 2023 and January 2024, 20 patients with prostate cancer were enrolled onto a prospective study involving the delivery of a 15 Gy in 1 focal boost to their GTV(s), followed by 30 Gy in 5 to the whole gland. GTV(s) were required to be less than 1/3 of the total prostate volume. Patients were treated using the 1.5T MR-Linac (Unity, Elekta). All patients were asked to empty their bladder prior to the treatment session. The first 10 patients were treated without additional hydration (no-prep), while the latter 10 were given 300mL of water to drink 10 minutes prior to entering the treatment room (prep). The margin expansion used to generate the planning target volume was 3mm in the left-right direction, and 4mm in all other directions from the contoured GTV volume. Daily online adaptive procedure used the full adapt-to-shape (ATS) workflow, including online recontouring and full inverse-replanning on the initial 3D T2-weighted localization image. Additional ATS or adapt-to-position (ATP) virtual-couch-shift procedures, and additional verification imaging were done when large intra-fraction motion was exhibited by the patient. If further large intra-fraction motion was observed after additional ATS or ATP procedure, the session would be aborted, and the patient rescheduled for treatment on a subsequent day. Treatment time, bladder volumes and frequency of additional adaption and aborting treatment were collected, and the student t-test was used for mean comparison. Delivery of the focal boost was completed for all 20 patients. Average treatment time was 55 minutes (sd = 9.8minutes). Bladder dose constraint D0.05cc<1800cGy was met for all patients. Mean bladder volumes on the initial localization scans were not statistically different between the two groups (no-prep: mean=87.4cc, SD=50.7cc vs prep: mean=134.8cc, SD=64.7cc, p = 0.0855). Of the 10 no-prep patients, additional adaptation was required for 4 patients and treatment was aborted for 3 due to large intrafraction motion that could not be rectified with a second adaptation. Although additional adaptation was performed for more patients treated with prep (n=6), all patients received treatment on the scheduled day. Whilst bladder volume between patients with and without prep were not statistically significantly different, based on the current data, bladder prep is still relevant to increase the likelihood of successful treatment delivery. Further investigation is required to understand what other factors may have contributed to the large intrafraction motion observed that led to treatments being aborted. [ABSTRACT FROM AUTHOR]

Bladder cancer treatment involving whole-bladder irradiation and a simultaneous integrated boost (SIB) to the bladder tumor or the post-surgical tumor bed is currently being investigated. To improve precision, our institution has adopted the patient-specific planning target volume (PS-PTV) strategy, which requires manual delineation of bladder and post-surgical tumor bed on the first 4 Conebeam-CTs (CBCT). This process is time-consuming and increases workload. However, autosegmentation based on deformable image registration (DIR) between CBCT and CT may improve efficiency and reduce interobserver variability. This study aimed to assess the accuracy of DIR-propagated SIB volume for bladder cancer radiotherapy. The Institutional Quality Improvement Committee approved access to imaging data from 29 patients with bladder cancer who received treatment to the whole bladder (45-50Gy/20) and SIB to the post-surgical tumor bed (55Gy/20). Of the 29 patients, 23 were male and 6 were female, and all were treated with a comfortably full bladder. For each patient, two DIR-propagated SIBs were generated on each of the 4 CBCTs. The SIB_Intensity was generated based on DIR using image intensity alone, while the SIB_Bladder was created based on DIR with the inclusion of both image intensity and anatomical information from the manually delineated bladder as input. The DIR-propagated SIBs were compared to the corresponding manually delineated SIBs using the Dice Similarity Coefficient (DSC) and Mean Distance to Agreement (MDA). A DSC of < 0.8 and an MDA of > 2mm were considered unacceptable for the PS-PTV strategy. A two-tailed paired t-test was performed to compare the mean DSC and MDA of the SIB_Intensity and SIB_Bladder with the manually delineated SIB, with statistical significance defined as p < 0.05. The location of each SIB was categorized into 3 regions (Bladder dome, Lateral/Central wall and Trigone) to assess its association with DSC and MDA. A total of 113 CBCTs were available to generate the DIR-propagated SIBs. The geometry of SIB_Intensity was significantly different from the manually delineated SIB, with a mean DSC of 0.71 (Range: 0.42 – 0.88), and 49% of MDA was >2mm. On the other hand, SIB_Bladder was more similar to the manually delineated SIB, achieving a significantly higher mean DSC of 0.83 (Range: 0.74 – 0.91, p < 0.05), with only 13% of MDA being >2mm. Out of 113 volumes, 78 SIB_Intensity volumes and 39 SIB_Bladder volumes had a DSC of <0.8. Performance of deformable contour propagation was worse when either the entire or a portion of SIB was located in the bladder dome, with a higher frequency of DSC < 0.8 and MDA > 2mm. However, the difference between the manually delineated and either SIB_Intensity or SIB_Bladder was not significant for SIB located in the trigone region of the bladder, with DSC ranging from 0.82 – 0.91 and MDA ranging from 0.7 – 1.8mm. The inclusion of additional anatomical information such as bladder could improve the performance of DIR in generating the SIB on CBCT for bladder radiotherapy, particularly for SIBs located in the bladder dome region. Deformable contour propagation of the bladder and the SIB could be applied in an online CBCT-guided adaptive workflow to improve the efficiency of the process, making the adaptive processes more feasible for bladder radiotherapy. [ABSTRACT FROM AUTHOR]

An integrated linear accelerator and magnetic resonance scanner (MR-linac) was implemented with a multidisciplinary model-of-care for daily online adaptive radiation therapy (ART). A potential disadvantage of this technique is the long patient treatment times within the enclosed MR-linac bore. This study evaluated patient-reported experiences with their overall hospital care as well as treatment in the MR-linac environment Patients pre-screened for MR-eligibility and claustrophobia were referred to simulation on a 1.5T MR-linac (Unity, Elekta AB). MR-linac simulation included assessment to determine suitability of MR-guided ART. Daily MR-guided ART procedure included patient set up, MR imaging, target and organ at risk contouring, treatment plan re-optimization and review by the team (3 Therapists, 1 Physicist, 1 Oncologist). All patients were approached for a single-institution, prospective, observational study to evaluate clinical outcomes, patient experiences and collect technical data for MR-linac research. Patient-reported experience measures were captured using two validated surveys. The 15-item MR-anxiety questionnaire (MR-AQ) was administered immediately after the first treatment to rate MR-related anxiety and relaxation as "not at all", "somewhat", "moderately" or "very much so". The 40-item satisfaction with cancer care questionnaire (EORTC PATSAT-C33 plus OUT-PATSAT7) was administered immediately after the last treatment using five-point Likert responses, with "very good" or "excellent" responses considered positive. Results were analyzed using descriptive statistics One hundred and forty patients consented to the study and completed questionnaires from 114 patients were included in this analysis. The median age was 70 (range 27-91). Treatments were 1-7 fractions (median 6) with an average patient time on the MR-linac couch of 50 minutes (range 31-114) per fraction. Treated sites were prostate (n=76), pancreas (n=14), liver (n=12), kidney (n=4) and other (n=8). All patients were positioned supine with arms by side or on chest and 29% had abdominal compression to limit breathing motion. Following MR-linac simulation, no patient discontinued treatment on MR-linac due to MR-related comfort or anxiety reasons. Patients rated MR-related anxiety scores as 86% "not at all", 12% "somewhat", 2% "moderately" and 0% as "very much so". Positive satisfaction responses ranged from 79-100% (median 95%) across all items. All of the MR-linac radiation therapist-specific items were rated as 97-100% including provision of information on treatment and symptoms, providing physical comfort and emotional support. The five lowest rated items (range 79-84%) were related to general provision of information and coordination by the team on supportive services, post-treatment care planning, communication with the team from home, and hospital access (e.g. parking, transportation). Overall hospital care was rated positively as 99% Despite lengthy treatments for ART, MR-linac treatment was well tolerated with the majority of patients reporting low MR-related anxiety and completing their treatment as planned. Overall, patients were highly satisfied with their MR-linac radiation therapy and cancer care [ABSTRACT FROM AUTHOR]

Patients undergoing radiation therapy for prostate cancer are often required to have a full bladder for their CT-simulation (CTsim) and daily treatment. At our institution bladder fullness was considered acceptable when the bladder dome is 1-4cm above the femoral heads. However, this resulted in >50% of patients requiring a CTsim rescan to meet this criterion. A full dosimetric review of bladder filling during treatment suggested that 0.5-2.5cm above the femoral heads was a better representation of bladder filling on treatment. Herein we report our experiences after the clinical implementation of the modified bladder acceptance criterion (MBAC). The MBAC was implemented in September 2022 for all patients receiving treatment for prostate cancer. To assess its effect on the CT-simulation rescan rate, the total number of prostate patients CT-simulated between September and November 2022, the number of repeated CT-imaging in this cohort, along with the reason documented by the CTsim Therapists were collected from the Radiation Therapy Electronic Medical Record system (MosaiQ). These were compared against a similar cohort CT-simulated prior to the implementation of the MBAC, between September and November 2021. Descriptive statistics were used to analyze the data. There were 105 prostate patients CT-simulated using the MBAC. In the comparison cohort, 97 prostate patients were CT-simulated using the previous bladder filling acceptance criterion. The overall rescan rate was 45% (47 patients) for the MBAC cohort, and 48% (47 patients) for the comparison cohort. There were no statistical differences between the average number of scans per patient between the two cohorts (MBAC 1.66 scans, comparison 1.70 scans; p 0.74). In the MBAC cohort, 32% (34 patients) had one rescan, 8% (8 patients) had two rescans, 3% (3 patients) had three rescans and 2% (2 patients) had four or more rescans. In the comparison cohort 33% (32 patients) had one rescan, 11% (11 patients) had two rescans, 2% (2 patients) had three rescans, and 2% (2 patients) had four or more rescans. Using a chi-square test, no significant differences were found between the two cohorts (p=0.865). In 36% (17 patients) of the rescans, the documented reason was not meeting the MBAC. However, in the comparison cohort, failure to meet the previous bladder criterion accounted for 28% (13 patients) of the rescans. From the information documented by CTsim Therapists, two patients from the comparision cohort could not meet the previous acceptance criteria and required penile clamps, whereas post-MBAC implementation, no comments related to penile clamp use were documented. According to the data collected thus far, the implementation of a more lenient bladder filling criterion that could be considered more achievable by the patient did not decrease CTsimulation rescan rates. We continue to look for clinical factors that influence the dosimetric acceptance of CTsimulation scans for prostate radiation therapy. [ABSTRACT FROM AUTHOR]

Prostate cancer patients are commonly instructed to achieve a 'comfortably full' bladder at the time of CT simulation and throughout the course of radiotherapy. At our institution, bladder status is considered acceptable when the dome is between 10-40mm above the superior aspect of the femoral head. Despite explicit drinking instructions, repeated CT imaging is common due to failure to achieve an acceptable bladder status. There is operational value in re-assessing the validity of the assessment criteria for bladder by comparing the quality of two plans optimized based on either an 'Accepted' or 'Rejected' bladder status. Twenty prostate patients with repeated CTsimulation imaging due to suboptimal bladder filling were identified. These were treated with various dose/fractionation schemes. For each patient, a VMAT plan using the 'Rejected' bladder was created to evaluate if the 'rejected' bladder filling could have resulted in clinically acceptable dose-volume metrics. Delivered dose to bladder was estimated using ≥4 CBCTs to measure number of fractions with major bladder dose violation (>5% difference) for both plans. Bladder heights of fractions without major bladder dose violations were compared to those with a violation to determine a threshold height for bladder filling acceptability. The height of the 'Rejected' bladder was significantly shorter than the 'Accepted' bladder (mean 24mm vs 45mm, p < 0.05). Despite a shorter/smaller bladder, the plan was clinically acceptable in 17/20 patients. Using the 'Accepted' bladder plans for treatment resulted in 30/175 fractions with major dose violations. These 30 bladders were significantly shorter than those without major violation (mean 28mm vs 43mm, p < 0.05). The 'Rejected' bladder plans delivered a lower dose to the bladder by ≥5% than the 'Accepted' bladder plans in 59% of fractions, and the number of fractions with major dose violations was 17. Using a shorter bladder for plan optimization resulted in better bladder sparing during treatment and improved compliance to protocol specific bladder dose constraints. A bladder height range of 20-40mm measured between the bladder dome and the superior aspect of the symphysis pubis is recommended at time of CTsimulation for this clinical scenario. [ABSTRACT FROM AUTHOR]

Psychographics data were collected from three global consumer studies for phytonutrient supplements products. The objective of this paper was to explore the usage of the psychographics and other consumer data for sensory causal inference, i.e., cause-and-effect inference, rather than conventional statistical associational inference. In this work, three case studies are presented for different key measures from each study with different resulting outcomes. For each case study, propensity score analysis (PSA) was applied to account for consumer covariates after down-selection of the many scales included in each study to those of relevant importance. Causal effects are shown to be not significant in two of the three case studies, but larger than the associational effects; and importantly, one of these studies shows direction of the effects changed. The third case study shares a situation where the associational effect is not significant, however significant causal effects were found. These findings suggest accounting for consumer psychographic and other covariates is prudent for researchers to consider, especially for observational studies where many important covariates exist that may confound results and interpretations. Results show the PSA methodology using psychographics and other data for causal inference provides useful insights that may lead to implications for business decision-making. [ABSTRACT FROM AUTHOR]

• General self-efficacy measures are collected from Japanese consumers. • Agglomerative hierarchical clustering is applied for consumer segmentation. • Clusters formed from general self-efficacy ratings are reviewed. • Clusters are compared/contrasted with selected psychographics and hedonics. • The implications of general self-efficacy cluster differences are discussed. Segmentation based on psychographics data is a relatively new topic and one of the current trends of consumer research within the sensory and consumer research fields. In this paper, Japanese consumer segmentation was conducted based on General self-efficacy (GSE) self-assessment collected in a phytonutrient supplement study. The aim of this study was to understand the influence of GSE on self-reported health behaviors, well-being, and product involvement and liking. The product tested was a 3-tablet phytonutrient supplement, 2 of each to be taken twice daily for 5 days; n = 206 vitamin mineral supplement (VMS) users participated in the study. The agglomerative hierarchical clustering method was used in the segmentation. Two clusters were identified that distinguished those with higher vs lower GSE. Results indicate those with higher GSE have a higher overall sense of well-being , are more actively looking for products and services that help them live a healthy lifestyle and are more involved with the product (phytonutrient tablets). Those with higher GSE also tend to rate the product more favorably on Overall Liking. These findings extend our understanding of GSE and the influential role of psychographics on responses for the phytonutrient supplement category. Further, these results suggest future efforts to increase GSE may help increase involvement and engagement with the category toward quality-of-life improvement. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to determine the practice patterns and outcomes of intracranial germ cell tumors (IGCT) in adolescents and young adults according to different therapeutic approaches.Methods and Materials: One-hundred twelve patients with IGCT aged 15 to 39 years were managed at either XX or the XY center from 1975 to 2015. The charts were retrospectively reviewed and data collected.Results: Median duration of follow-up was 8.3 years. Ninety-four patients had germinomas, and 18 had nongerminomatous germ cell tumors (NGGCT). The primary disease sites were pineal gland (37 of 94 germinoma, 14 of 18 NGGCT) and suprasellar region (23 of 94 germinoma, 2 of 18 NGGCT). Eleven patients with germinoma (12%) and 2 patients with NGGCT (11%) had radiographic spinal metastases or positive lumbar cerebrospinal fluid cytology. Event-free survival (EFS) was 84% and overall survival (OS) was 90% at 10 years for germinoma; EFS was 71% and OS was 86% at 10 years for NGGCT. For patients with germinoma, 10-year EFS was 100% after craniospinal radiation therapy (CSRT) with chemotherapy (N = 10); 100% after whole-ventricular radiation therapy (WVRT), whole-brain radiation therapy (WBRT), or focal radiation therapy (FRT) with chemotherapy (N = 22); 90% after CSRT alone (N = 46); and 41% after WVRT, WBRT, or FRT alone (N = 16) (P < .0005). Ten-year OS was 100%, 100%, 90%, and 72%, respectively (P = .032). For patients with NGGCT, 10-year EFS was 80% after CSRT, WBRT, or WVRT plus chemotherapy (N = 10) versus 58% after FRT plus chemotherapy (N = 8) (P = .31); 10-year OS was 90% versus 58%, respectively (P = .16).Conclusions: We report excellent overall outcomes according to treatment approach in the largest study of IGCT in adolescents and young adults to our knowledge. EFS and OS were inferior after non-CSRT without chemotherapy in germinoma. [ABSTRACT FROM AUTHOR]

An abstract of the article "Establishing Community Wellness Teams" by Jennifer Dang is presented.

• Functional data analysis (FDA) for Rating Scale (RS) Time-Intensity (T-I) data. • The mean RS functional curves and their 1st and 2nd derivative curves. • The index of efficiency (A.RS) based on area under curve for percentage (%) relief. • Functional analysis of variance (FANOVA) for detection of group effects. A longitudinal study was undertaken recently in the USA to investigate the perceptual efficacy of a supplement tablet. Efficacy was assessed using an 11-attribute 5-point Rating Scale (RS). The RS diary time-intensity data were analyzed using functional data analysis (FDA). The mean RS functional curves and their 1st and 2nd derivative curves are produced. Attribute intensities (symptom relief) are compared to baseline measures. Two indices of efficacy were used to measure reduction in symptom severity. Results show symptoms decreased over the 12-week study with use of the tablet. The focus of this paper is on applied use of FDA and the new index A.RS which shows advantages by providing examination of the full range of longitudinal data (0–84 days) and a percentage efficacy index versus a traditional efficacy index that is based on the difference between just two time points (day 0 and day 84). The analytic methods in this paper have relevancy for sensory and consumer time-intensity research and longitudinal study. [ABSTRACT FROM AUTHOR]