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a b s t r a c t: Objective: To study the impact of target volume changes in brain metastases during fractionated stereotactic radiosurgery (fSRS) and identify patients that benefit from MRI guidance. Material and methods: For 15 patients (18 lesions) receiving fSRS only (fSRSonly) and 19 patients (20 lesions) receiving fSRS postoperatively (fSRSpostop), a treatment planning MRI (MR0) and repeated MRI during treatment (MR1) were acquired. The impact of target volume changes on the target coverage was analyzed by evaluating the planned dose distribution (based on MR0) on the planning target volume (PTV) during treatment as defined on MR1. The predictive value of target volume changes before treatment (using the diagnostic MRI (MRD)) was studied to identify patients that experienced the largest changes during treatment. Results: Target volume changes during fSRS did result in large declines of the PTV dose coverage up to 34.8% (median = 3.2%) for fSRSonly patients. For fSRSpostop the variation and declines were smaller (median PTV dose coverage change = 0.5% (4.5% to 1.9%)). Target volumes changes did also impact the minimum dose in the PTV (fSRSonly; 2.7 Gy (16.5 to 2.3 Gy), fSRSpostop; 0.4 Gy (4.2 to 2.5 Gy)). Changes in target volume before treatment (i.e. seen between the MRD and MR0) predicted which patients experienced the largest dose coverage declines during treatment. Conclusion: Target volume changes in brain metastases during fSRS can result in worsening of the target dose coverage. Patients benefiting the most from a repeated MRI during treatment could be identified before treatment.
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Stereotactische radiotherapie van wervelmetastasen vereist een hoge precisie in alle stappen van de behandeling. Deze techniek werd in het VU medisch centrum in 2009 geïntroduceerd. Data met betrekking tot de behandeling van de eerste 17 klinische patiënten is geëvalueerd. Deze patiënten werden behandeld op een Novalis Tx versneller die beschikt over zowel een kilovolt (kV) cone beam CT (CBCT) scan als het ExacTrac® kV röntgensysteem. De gebruikte methode van de verschillende beeldmodaliteiten voor positionering en verificatie, de behandelingstijd en de intrafractie beweging worden in dit artikel beschreven.
PurposeThis study investigates patients’ experiences of interaction with their healthcare professionals (HCPs) during cancer treatment and identifies elements that HCPs can utilize to improve cancer care provision.MethodsPubMed, CINAHL, PsycINFO, SCOPUS, and Embase were systematically searched for relevant studies published from January 2010 until February 2022. Qualitative studies investigating adult patients’ perspectives on their interaction with HCPs during cancer treatment were included. Studies conducted during the diagnosis or end-of-life treatment phase were excluded. Duplicate removal, screening, and quality appraisal were independently performed by four reviewers using Covidence.org. We performed a thematic meta-synthesis of qualitative data extracted from studies meeting the quality criteria in three stages: excerpts coding, codes categorization, and theme identification by merging similar categories.ResultsEighty-eight studies were included for quality appraisal, of which 50 papers met the quality inclusion criteria. Three themes were identified as essential to positively perceived patient-HCP interaction: “Support, respect and agency”, “Quantity, timing, and clarity of information”, and “Confidence, honesty, and expertise”. Overall, patients experienced positive interaction with HCPs when the approach was person-centered and when HCPs possessed strong interpersonal skills. However, patients expressed negative experiences when their preferences regarding communication and the type of personal support needed were ignored.ConclusionsThis meta-synthesis emphasizes the importance for HCPs to recognize all patients’ needs, including communication and personal support preferences, to provide high-quality care. Consequently, healthcare professionals should continuously train their verbal and non-verbal communication, empathy, active listening, and collaboration skills during their undergraduate and continuing education.
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