148. Changes in lateral dimensions of irradiated volume and their impact on the accuracy of dose delivery during radiotherapy for head and neck cancer

AimTo assess changes in lateral dimensions of irradiated volume during head and neck cancer radiotherapy and their impact on dose delivery accuracy.Material and methodsLateral dimensions of irradiated volumes were measured in 5 predefined points using computed tomography, simulator and manually with calipers, prior to treatment and then bi-weekly. For each measurement reference point dose was calculated and verified using in vivo dosimetry. Early radiation reactions, patient's weight changes and the need to modify radiotherapy accessories were also assessed. All these parameters were analyzed in relation to tumor site and stage, treatment field size, radiation dose and the degree of radiation reactions.ResultsThe study included 33 head and neck cancer patients (24 men and 9 women) aged 24–77 (median 56). All patients were irradiated using the parallel opposed megavoltage fields ranging from 49 to 180 cm2 (median 121 cm2) to the dose of 44 to 80 Gy (median 66 Gy). Radiation reactions included mucositis (grade 3 – 1 patient, grade 2 – 17 patients, grade 1 – 13 patients) and dysphagia (grade 2 – 12 patients, grade 1 – 16 patients). The body mass changes during radiotherapy ranged from −18 to +4 kg (median −5 kg). In 1 patient radiotherapy accessories had to be modified three times during the treatment, in 6 – twice and in 10 – once. Lateral dimensions changes >5 mm occurred in all but one patient (range −37 to +16 mm). Theoretical doses calculated for changed dimensions varied from prescribed by −2.5% to +6% (median +2%). Differences larger than 5% were present in 4.8% of calculations. In vivo dose measurements (after introduction of necessary corrections) demonstrated difference from prescribed dose larger than 5% in 7.6% of measurements.ConclusionChanges in the lateral dimensions of irradiated volume during head and neck cancer radiotherapy may lead to some inaccuracies in delivered doses. Such situations may necessitate adequate corrections of dose calculations and modification of radiotherapy accessories during the course of treatment

The perennial natural history of castration-resistant prostate cancer in the patient treated with docetaxel, cabazitaxel and abiraterone acetate

Rak gruczołu krokowego zajmuje w Polsce drugie pod względem częstości występowania miejsce wśród nowotworów złośliwych w populacji mężczyzn. Standardowymi metodami leczenia nowotworu we wczesnym i miejscowo zaawansowanym stadium pozostają chirurgia i radioterapia, zaś hormonoterapię stosuje się głównie w stadiach zaawansowanych. Wyzwaniem klinicznym w tej populacji chorych jest leczenie choroby w fazie oporności na kastrację (CRPC). Dostępne wówczas opcje terapeutyczne to chemioterapia (docetaksel, kabazytaksel) oraz nowe leki o działaniu hormonalnym (octan abirateronu, enzalutamid). W pracy przedstawiono wieloletni przebieg raka gruczołu krokowego u chorego leczonego sekwencyjnie wszystkimi dostępnymi metodami. Przez ostatnie 2 lata chory poddawany jest terapii octanem abirateronu, ze stabilizacją choroby, subiektywną poprawą jakości życia i jednocześnie bardzo dobrą kliniczną tolerancją leczenia.Prostate cancer is the second most frequently diagnosed cancer of men in Poland. There are two well-established primary therapeutic modalities to manage patients with early and locally advanced prostate cancer: surgical treatment and radiotherapy. Hormonal therapy is mainly used in advanced disease. The state of castration-resistant prostate cancer remains still the main therapeutic challenge. In this clinical scenario available therapeutic options are: chemotherapy (docetaxel, cabazitaxel) and new hormonal agents (abiraterone acetate, enzalutamid). The paper presents perennial natural history of prostate cancer in the patient treated with all above mentioned therapeutic methods. For the last two years the patient has recieved abiraterone acetate, which was well tolerated, with the effect of disease stabilization and quality of life improvement

Paliatywna radioterapia chorych na raka płuca

The main objective in the treatment of patients with advanced lung cancer is the control of symptoms related to the tumour: pain, cough, haemoptysis, dyspnoea and superior vena cava syndrome. Palliative radiotherapy is an effective and well tolerated treatment modality, resulting in improvement of chest symptoms in most patients. This treatment is most effective for palliation of haemoptysis and chest pain, whereas controlling cough and dyspnoea is less successful. In view of the limited expected survival, a short course of 1–2 large radiotherapy fractions is recommended for most patients. In selected patients who are in relatively good condition, larger irradiation doses and longer treatment schedules may be considered in the hope of achieving some survival improvement. This paper reviews existing knowledge of the efficiency and tolerability of palliative chest radiotherapy.U chorych na zaawansowanego raka płuca głównym celem leczenia jest zmniejszenie nasilenia dolegliwości związanych z postępem nowotworu, takich jak ból w klatce piersiowej, kaszel, krwioplucie, duszność i zespół żyły głównej górnej. Paliatywna radioterapia jest wartościową i dobrze tolerowaną metodą leczenia, pozwalającą u większości chorych uzyskać zmniejszenie nasilenia dolegliwości w obrębie klatki piersiowej. Jest ona szczególnie skuteczna w przypadku krwioplucia i bólu, natomiast w mniejszym stopniu w odniesieniu do kaszlu i duszności. Ze względu na przewidywany krótki czas przeżycia leczenie powinno być jak najkrótsze i najmniej obciążające. Dlatego w większości przypadków zaleca się stosowanie schematów składających się z 1–2 dużych frakcji napromieniania. Jedynie u wybranych chorych w dobrym stanie ogólnym, u których istnieje możliwość uzyskania wydłużenia całkowitego czasu przeżycia, wskazane jest rozważenie zastosowania większej dawki radioterapii. W niniejszej pracy przedstawiono obecny stan wiedzy na temat skuteczności i tolerancji paliatywnego napromieniania raka płuca

Measuring deliberate reflection in residents: validation and psychometric properties of a measurement tool

PURPOSE: Reflective capacity is the ability to understand critical analysis of knowledge and experience to achieve deeper meaning. In medicine, there is little provision for post-graduate medical education to teach deliberate reflection. The feasibility, scoring characteristics, reliability, validation, and adaptability of a modified previously validated instrument was examined for its usefulness assessing reflective capacity in residents as a step toward developing interventions for improvement. METHODS: Third-year residents and fellows from four anesthesia training programs were administered a slightly modified version of the Reflection Evaluation for Learners\u27 Enhanced Competencies Tool (REFLECT) in a prospective, observational study at the end of the 2019 academic year. Six written vignettes of imperfect anesthesia situations were created. Subjects recorded their perspectives on two randomly assigned vignettes. Responses were scored using a 5-element rubric; average scores were analyzed for psychometric properties. An independent self-report assessment method, the Cognitive Behavior Survey: Residency Level (rCBS) was used to examine construct validity. Internal consistency (ICR, Cronbach\u27s alpha) and interrater reliability (weighted kappa) were examined. Pearson correlations were used between the two measures of reflective capacity. RESULTS: 46/136 invited subjects completed 2/6 randomly assigned vignettes. Interrater agreement was high (k = 0.85). The overall average REFLECT score was 1.8 (1-4 scale) with good distribution across the range of scores. ICR for both the REFLECT score (mean 1.8, sd 0.5; α = 0.92) and the reflection scale of the rCBS (mean 4.5, sd 1.1; α = 0.94) were excellent. There was a significant correlation between REFLECT score and the rCBS reflection scale (r = .44, p \u3c 0.01). CONCLUSIONS: This study demonstrates feasibility, reliability, and sufficiently robust psychometric properties of a modified REFLECT rubric to assess graduate medical trainees\u27 reflective capacity and established construct/convergent validity to an independent measure. The instrument has the potential to assess the effectiveness of interventions intended to improve reflective capacity