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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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OBJECTIVE To investigate the effect of smoking on the outcome in a cohort of men treated for localized prostate cancer at one institution with a uniform protocol of radical external beam radiotherapy (EBRT). PATIENTS AND METHODS The study was a retrospective review of 434 patients with cT1-T4 N0m0 prostate cancer treated with curative intent with EBRT (66 Gy in 33 fractions) between 1990 and 1999. Univariate and multivariate Cox regression analyses were used to estimate the risk associated with smoking on biochemical failure (American Society for Therapeutic Radiology and Oncology definition), local failure, distant failure, overall and disease-specific survival. RESULTS The median follow-up was 70.3 months. A smoking history was obtained in 96% of cases; 16.8% were current smokers, 54.4% previous smokers and 28.8% non-smokers. Current smokers presented at a younger median age, by 3.6 years ( P = 0.06). There were no differences in clinical T stage, Gleason score or prostate-specific antigen level amongst the three patient groups. Smoking conferred a higher risk of developing metastatic disease in both current smokers (hazard ratio 5.24; 95% confidence interval 1.75–15.72) and previous smokers (2.90, 1.09–7.67). There were also increases in risk, although not quite significant, for biochemical failure (1.49, 0.88–2.40) and overall survival (1.72, 0.94–3.15). CONCLUSIONS After curative treatment with EBRT, a history of smoking was associated with a greater risk of developing metastatic disease. Smoking status was not associated with worse disease on presentation. [ABSTRACT FROM AUTHOR]