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Purpose: The GammaPod is a novel device for stereotactic breast treatments that employs 25 rotating Co‐60 sources while the patient is continuously translated in three axes to deliver a highly conformal dose to the target. There is no commercial software available for independent second calculations. The purpose of this study is to determine an efficient way to estimate GammaPod treatment times based on target volume and use it as a second calculation for patient‐specific quality assurance. Methods: Fifty‐nine GammaPod (Xcision Medical Systems, LLC.) breast cancer patient treatments were used as the fitting dataset for this study. Similar to the Curie‐seconds concept in brachytherapy, we considered dose‐rate × time/(prescribed dose) as a function of target volumes. Using a MATLAB (Mathworks, Natick, MA, USA) script, we generated linear (with 95% confidence interval (CI)) and quadratic fits and tested the resulting equations on an additional set of 30 patients. Results: We found a strong correlation between the dose‐rate × time/(prescribed dose) and patients' target volumes for both the linear and quadratic models. The linear fit was selected for use and using the polyval function in MATLAB, a 95% CI graph was created to depict the accuracy of the prediction for treatment times. Testing the model on 30 additional patients with target volumes ranging from 20 to 188 cc yielded treatment times from 10 to 25 min that in all cases were within the predicted CI. The average absolute difference between the predicted and actual treatment times was 1.0 min (range 0–3.3 min). The average percent difference was 5.8% (range 0%–18.4%). Conclusion: This work has resulted in a viable independent calculation for GammaPod treatment times. This method has been implemented as a spreadsheet that is ready for clinical use to predict and verify the accuracy of breast cancer treatment times. [ABSTRACT FROM AUTHOR]

Patient selection For boost treatments: Patients undergoing a lumpectomy as part of breast-conserving therapy can be eligible for a GammaPod boost treatment. This workflow consists of patient selection, daily quality assurance (QA), breast cup fitting, CT imaging, treatment planning, and treatment. [Extracted from the article]

Purpose Intrathoracic recurrence of non-small cell lung cancer (NSCLC) after initial treatment remains a dominant cause of death. We report our experience using proton beam therapy and intensity modulated radiation therapy for reirradiation in such cases, focusing on patterns of failure, criteria for patient selection, and predictors of toxicity. Methods and Materials A total of 102 patients underwent reirradiation for intrathoracic recurrent NSCLC at a single institution. All doses were recalculated to an equivalent dose in 2-Gy fractions (EQD2). All patients had received radiation therapy for NSCLC (median initial dose of 70 EQD2 Gy), with median interval to reirradiation of 17 months and median reirradiation dose of 60.48 EQD2 Gy. Median follow-up time was 6.5 months (range, 0-72 months). Results Ninety-nine patients (97%) completed reirradiation. Median local failure-free survival, distant metastasis-free survival (DMFS), and overall survival times were 11.43 months (range, 8.6-22.66 months), 11.43 months (range, 6.83-23.84 months), and 14.71 (range, 10.34-20.56 months), respectively. Toxicity was acceptable, with rates of grade ≥3 esophageal toxicity of 7% and grade ≥3 pulmonary toxicity of 10%. Of the patients who developed local failure after reirradiation, 88% had failure in either the original or the reirradiation field. Poor local control was associated with T4 disease, squamous histology, and Eastern Cooperative Oncology Group performance status score >1. Concurrent chemotherapy improved DMFS, but T4 disease was associated with poor DMFS. Higher T status, Eastern Cooperative Oncology Group performance status ≥1, squamous histology, and larger reirradiation target volumes led to worse overall survival; receipt of concurrent chemotherapy and higher EQD2 were associated with improved OS. Conclusions Intensity modulated radiation therapy and proton beam therapy are options for treating recurrent non-small cell lung cancer. However, rates of locoregional recurrence and distant metastasis are high, and patients should be selected carefully to maximize the benefit of additional aggressive local therapy while minimizing the risk of adverse side effects. [ABSTRACT FROM AUTHOR]

Cell cycle checkpoints are essential for maintaining genomic integrity. Human topoisomerase II binding protein 1 (TopBP1) shares sequence similarity with budding yeast Dpb11, fission yeast Rad4/Cut5, and Xenopus Cut5, all of which are required for DNA replication and cell cycle checkpoints. Indeed, we have shown that human TopBP1 participates in the activation of replication checkpoint and DNA damage checkpoints, following hydroxyurea treatment and ionizing radiation. In this study, we address the physiological function of TopBP1 in S phase by using small interfering RNA. In the absence of exogenous DNA damage, TopBP1 is recruited to replicating chromatin. However, TopBP1 does not appear to be essential for DNA replication. TopBP1-deficient ceils have increased H2AX phosphorylation and ATM-Chk 2 activation, suggesting the accumulation of DNA double-strand breaks in the absence of TopBP1. This leads to formation of gaps and breaks at fragile sites, 4N accumulation, and aberrant cell division. We propose that the cellular function of TopBP1 is to monitor ongoing DNA replication. By ensuring proper DNA replication, TopBP1 plays a critical role in the maintenance of genomic stability during normal S phase as well as following genotoxic stress. [ABSTRACT FROM AUTHOR]

Patients' understanding of radiation therapy (RT) and data regarding optimal approaches to patient education (PE) within radiation oncology (RO) are limited. We aimed to evaluate PE practices of radiation oncologists and interprofessional RT care team members to inform recommendations for delivering inclusive and accessible PE. An anonymous survey was administered to all Radiation Oncology Education Collaborative Study Group members (10/5/22-11/23/22). Respondent demographics, individual practices/preferences, and institutional practices were collected. Qualitative items explored strategies, challenges, and desired resources for PE. Descriptive statistics summarized survey responses. The Fisher exact test compared PE practices by respondent role and PE timing. Thematic analysis was used for qualitative responses. One hundred thirteen Radiation Oncology Education Collaborative Study Group members completed the survey (28.2% response rate); RO attendings comprised 68.1% of respondents. Most practiced in an academic setting (85.8%) in North America (80.5%). Institution-specific materials were the most common PE resource used by radiation oncologists (67.6%). Almost half (40.2%) reported that their PE practices differed based on clinical encounter type, with paper handouts commonly used for in-person and multimedia for telehealth visits. Only 57.7% reported access to non-English PE materials. PE practices among radiation oncologists differed according to RT clinical workflow timing (consultation versus simulation versus first RT, respectively): one-on-one teaching: 88.5% versus 49.4% versus 56.3%, P <.01, and paper handouts: 69.0% versus 28.7% versus 16.1%, P <.01. Identified challenges for PE delivery included limited time, administrative barriers to the development or implementation of new materials or practices, and a lack of customized resources for tailored PE. Effective strategies for PE included utilization of visual diagrams, multimedia, and innovative education techniques to personalize PE delivery/resources for a diverse patient population, as well as fostering interprofessional collaboration to reinforce educational content. Radiation oncologists and interprofessional RO team members engage in PE, with most using institution-specific materials often available only in English. PE practices differ according to clinical encounter type and RT workflow timing. Increased adoption of multimedia materials and partnerships with patients to tailor PE resources are needed to foster high-quality, patient-centered PE delivery. [ABSTRACT FROM AUTHOR]

Black women with breast cancer often present with more aggressive disease compared with other races, contributing to an increased risk of cancer mortality. Despite this inequity, Black women remain severely underrepresented in breast cancer clinical trials. We aim to characterize factors that influence a woman's decision to enroll in a clinical trial, with the goal of identifying clinical interventions to aid in the recruitment of vulnerable groups. A cross-sectional, descriptive study was conducted using a questionnaire adapted from 2 prevalidated surveys investigating factors influencing clinical trial enrollment. The survey was administered to women with curable breast cancer during a single follow-up visit at 4 different sites within a university medical system where all patients are screened for clinical trial eligibility. Chi-square tests and Mann-Whitney U tests were used to assess associations or differences between the populations. One hundred ninety-four out of 209 women completed the survey, giving a compliance rate of 93%. Twenty-six percent of women self-identified as Black, most women were located at community sites (67.1%), most women had diagnoses of early-stage disease (I: 57.7%, II: 29.4%), and 81% of women had some collegiate-level education. Black women were younger at diagnosis (P =.005) and less likely to be married (P =.012) but more often lived with family members (P =.003) and had a lower median income (P <.001). According to the survey, Black women were less likely to trust their care team (P =.032), more likely to believe that research ultimately harms minorities (P <.001), and had a stronger belief in God's will determining illness and wellness (P <.001). Recurring themes of trust in the health care team, patient education, and advancement of cancer treatments were discussed in the focus groups. Failure to offer clinical trials and mistrust in research institutions may pose the greatest hindrances to the enrollment of Black women in clinical trials. Empowering women through education and fostering trustworthy relationships can encourage greater clinical trial participation. [ABSTRACT FROM AUTHOR]

The American Association of Physicists in Medicine Radiation Oncology Medical Physics Education Subcommittee (ROMPES) has updated the radiation oncology physics core curriculum for medical residents in the radiation oncology specialty. Thirteen physicists from the United States and Canada involved in radiation oncology resident education were recruited to ROMPES. The group included doctorates and master's of physicists with a range of clinical or academic roles. Radiation oncology physician and resident representatives were also consulted in the development of this curriculum. In addition to modernizing the material to include new technology, the updated curriculum is consistent with the format of the American Board of Radiology Physics Study Guide Working Group to promote concordance between current resident educational guidelines and examination preparation guidelines. The revised core curriculum recommends 56 hours of didactic education like the 2015 curriculum but was restructured to provide resident education that facilitates best clinical practice and scientific advancement in radiation oncology. The reference list, glossary, and practical modules were reviewed and updated to include recent literature and clinical practice examples. ROMPES has updated the core physics curriculum for radiation oncology residents. In addition to providing a comprehensive curriculum to promote best practice for radiation oncology practitioners, the updated curriculum aligns with recommendations from the American Board of Radiology Physics Study Guide Working Group. New technology has been integrated into the curriculum. The updated curriculum provides a framework to appropriately cover the educational topics for radiation oncology residents in preparation for their subsequent career development. [ABSTRACT FROM AUTHOR]

Purpose: Although supported by most men and women, paternity leave is heavily underused across industries owing in part to external pressures and inconsistent availability. The goal of this study was to assess the use of paternity leave in radiation oncology (RO) practices and identify any associated barriers.Methods and Materials: A 36-item survey was distributed via e-mail to 536 male domestic RO attending and resident physicians. Questions assessed paternity leave policies, use, and departmental support. Data were collected using Research Electronic Data Capture from January to February 2021. Descriptive statistics were obtained for analysis, and logistic regression was performed to analyze the association between practice type and presence of policy.Results: The survey response rate was 20% (n = 108), with 98% of participants completing all applicable questions. Respondents included 63 attending physicians (58%) and 45 resident physicians (42%). The median age of all respondents was 35 years. Among all participants, 51 (47%) stated their practice had a formal paternity leave policy. The median time allowed for leave was 4 weeks (range, 0.5 weeks to unlimited), whereas the median time taken was 2 weeks (range, 0.5-12 weeks). Sixteen men felt pressure to take less leave than what was allowed by their policy, and 46% of men stated that in retrospect, they would have taken more time off for paternity leave.Conclusions: To the authors' knowledge, this is the first study to investigate the use of paternity leave in RO practices in the United States. Integrating expanded family leave policies, including specifically allowing for paternity leave and accompanying these policies with cultural changes acknowledging the importance of family leave, would be beneficial to improving quality of life and work-life balance for parents. [ABSTRACT FROM AUTHOR]

Patient understanding of the radiation treatment process, including anticipated logistics, side effects, and outcomes of treatment, is often limited. We lack data on optimal radiation oncology provider approaches to patient education. Our objective was to assess patient education practices and preferences of interdisciplinary radiation oncology providers to inform recommendations for providers and institutions. An anonymous, web-based survey was developed in collaboration with the Radiation Oncology Education Collaborative Study Group (ROECSG) Patient Education Working Group and distributed to all members of the ROECSG listserv via Qualtrics in October 2022. The survey contained 17 items: 13 multiple choice and 4 open-ended. Descriptive statistics summarized survey responses. Thematic analysis was used to analyze qualitative responses. 123 ROECSG members completed the survey (31% response rate). Most respondents were radiation oncology attendings (64%), worked in an academic/university affiliated setting (86%), and were in North America (82%). Aside from verbal communication, the most common educational approaches used were institution-specific materials (61%) and electronic health system-generated materials (38%). 41% of respondents highlighted that their patient education practices differed according to whether assessments were in-person or virtual; printed handouts versus Internet images/videos were used most often for in-person versus virtual visits, respectively. A majority (86%) stated that their institution utilized disease site-specific patient education materials. Over half (58%) reported that their institution had non-English materials available. Review of patient education materials by staff (53%) was the most common assessment method, though 19% reported no assessment of materials at their institution. Among institutions with an assessment process, respondents were largely "unsure" (56%) of the assessment frequency. On qualitative analysis, a central theme surrounding challenges for providing patient education was lack of time for providers to deliver and patients to review materials provided. Respondents also identified administrative roadblocks such as inadequate leadership support, training, and funding for developing education materials. Key strategies for successful patient education included using visual/multimedia materials, personalizing content for patients/caregivers (e.g., based on their learning styles, preferences, and language), reiterating information at multiple timepoints by multiple team members, and utilizing active education (e.g., teach-back method, encouraging notetaking, involving caregivers). Many radiation oncology providers use institution-specific and disease site-specific materials to provide patient education, with personalization of content for patients differing for in-person versus virtual environments. Increased adoption of visual/multimedia materials and partnerships with organizational leadership may facilitate access to and contribute towards the development of high-quality, tailored patient education resources. [ABSTRACT FROM AUTHOR]