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At least 19 recordsLinked to original sources
PubMed1999

Molecular biology in radiation oncology. Radiation oncology perspective of BRCA1 and BRCA2.

The breast cancer susceptibility genes, BRCA1 and BRCA2, are used to illustrate the application of molecular biology to clinical radiation oncology. Identified by linkage analysis and cloned, the structure of the genes and the numerous mutations are determined by molecular biology techniques that examine the structure of the DNA and the proteins made by the normal and mutant alleles. Mutations in the non-transcribed portion of the gene will not be found in protein structure assays and may be important in gene function. In addition to potential deleterious mutations, normal polymorphisms of the gene will also be detected, therefore not all differences in gene sequence may represent important mutations, a finding that complicates genetic screening and counseling. The localization of the protein in the nucleus, the expression in relation to cell cycle and the association with RAD51 led to the discovery that the two BRCA genes may be involved in transcriptional regulation and DNA repair. The defect in DNA repair can increase radiosensitivity which might improve local control using breast-conserving treatment in a tumor which is homozygous for the loss of the gene (i.e., BRCA1 and BRCA2 are tumor suppressor genes). This is supported by the early reports of a high rate of local control with breast-conserving therapy. Nonetheless, this radiosensitivity theoretically may also lead to increased susceptibility to carcinogenic effects in surviving cells, a finding that might not be observed for decades. The susceptibility to radiation-induced DNA damage appears also to make the cells more sensitive to chemotherapy. Understanding the role of the normal BRCA genes in DNA repair might help define a novel mechanism for radiation sensitization by interfering with the normal gene function using a variety of molecular or biochemical therapies.

BRCA2 Protein↗
PubMed1991

Issues in gynecologic radiation oncology.

Radiation therapy has a number of established roles in the curative, adjuvant, and palliative management of gynecologic malignancies. Specific indications for use of radiation therapy, concepts of integration of radiation therapy with other modalities, and techniques of radiation therapy, however, continue to evolve. Rather than discuss the use of radiation therapy in specific diseases, this paper reviews recent studies dealing with current issues in gynecologic radiation oncology.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2003

Molecular markers in clinical radiation oncology.

Radiation therapy plays a critical role in the management of a majority of patients diagnosed with cancer. Identification of factors that help predict which patients are at risk for relapse within the irradiated field remains an active area of investigation. Although conventional clinical and pathologic factors have been helpful in identifying risk and guiding clinical decision-making for both local and systemic management, there is clearly a need to identify additional prognostic markers, which can aid in refining our treatment strategies and improving outcomes. A substantial amount of research efforts have been devoted to identifying molecular markers for prognostic and therapeutic strategies. The recent emergence of a powerful armamentarium of molecular tools has resulted in rapid expansion of our fund of knowledge and understanding of the molecular biology underlying tumor behavior and response. While a majority of these efforts have been focused on risk factors for metastatic disease and survival, there is a rapidly growing body of literature focused on molecular factors associated with radiation resistance and locoregional failure. In this review, we summarize recent advances and the available literature evaluating molecular markers as they relate to radiation sensitivity of solid tumors. Literature regarding the potential application of expression of genes related to apoptosis, angiogenesis, cell cycle, DNA repair and growth factors will be reviewed. Some of the basic biology and laboratory evidence demonstrating how the marker relates to radiation response and available correlative clinical studies employing these markers as prognostic tools are presented. The majority of molecular markers that have potential clinical significance with respect to radiation sensitivity and local control will be highlighted.

Animals↗
PubMed1995

Therapeutic principles and options in radiation oncology.

Radiation therapy is used increasingly as a definitive or adjunctive treatment for cancer. Definitive irradiation allows functional preservation of structures critical to function. Adjunctive irradiation following surgical resection of the primary lesion treats regional lymph nodes and/or sites of primary extension at high risk for microscopic involvement. Specialized techniques can be applied to deliver higher total doses of irradiation and minimize late normal tissue effects to adjacent normal tissues. Local-regional tumor control combined with functional preservation represents the specific goals of radiation therapy applied alone or in conjunction with surgical resection.

Brachytherapy↗
PubMed1997

Advances in gynecologic radiation oncology.

Radiation therapy is an important modality in the curative and palliative management of patients with gynecologic malignancies. However, the specific roles of radiation therapy continue to evolve in terms of specific indications, volumes treated, techniques, and integration with other modalities. Retrospective assessments of outcome and prospective clinical trials are necessary to answer questions, generate additional hypotheses, and guide further refinements in the application of radiation therapy. This article focuses on recent literature and ongoing clinical trials in this disease group.

Antineoplastic Agents↗
PubMed1980

Radiation oncology.

Radiation may be used for the treatment of neoplastic lesions, either as a palliative measure or in an attempt at cure. Particulate or electromagnetic radiation can be obtained from a variety of machines and isotopes. Radiation therapy is the treatment of choice for certain malignancies and may be an acceptable alternative to surgery in others. Pre- or postoperative radiation is increasingly used to improve local control and survival. As with any therapeutic tool, acute and chronic complications may occur.

Female↗
PubMed1999

Radiation oncology training in the United States: report from the Radiation Oncology Resident Training Working Group organized by the Society of Chairman of Academic Radiation Oncology Programs (SCAROP).

PURPOSE: In response to the major changes occurring in healthcare, medical education, and cancer research, SCAROP addressed issues related to post-graduate education that could enhance existing programs and complement the present system. METHODS AND MATERIALS: SCAROP brought together a Working Group with a broad range of representatives organized in subcommittees to address: training, curriculum, and model building. RESULTS: The Working Group emphasized the importance of training physicians with the necessary clinical, scientific, and analytical skills, and the need to provide expert radiation oncology services to patients throughout the United States. Opportunities currently exist for graduates in academic medicine, although there may be limited time and financial resources available to support academic pursuits. CONCLUSIONS: In the face of diminishing resources for training and education and the increased scope of knowledge required, a number of models for resident training are considered that can provide flexibility to complement the present system. This report is intended to initiate dialogue among the organizations responsible for radiation oncology resident education so that resident training can continually evolve to meet the needs of cancer patients and take advantage of opportunities for progress through innovative cancer care and research.

Curriculum↗
PubMed2005

Radiation oncology practice accreditation: the American College of Radiation Oncology, Practice Accreditation Program, guidelines and standards.

The American College of Radiation Oncology Practice Accreditation Program (ACRO PAP) is a process by which a medical practice is evaluated through an in depth external review to ascertain whether or not key components of the practice comply with existing regulations, rules, laws, practice guidelines and professional practice standards. In radiation oncology, like other fields, it is driven by the need or desire to demonstrate an identified level of patient care. The accreditation process adopted by the American College of Radiation Oncology (ACRO) is based on the parameters of quality care assessment outlined by the National Academy of Science's Institute of Medicine. Those practices that meet these criteria are eligible for recognition and accreditation by ACRO.

Accreditation↗
PubMed1992

The structure for a radiation oncology protocol. The Committee of Radiation Oncology Group Chairmen.

Multi-institutional Cooperative Group clinical trials involving radiotherapy require unambiguous therapeutic guidelines, so that patients entered from each of the participating institutions will receive essentially uniform treatment. The technical guidelines for a Radiation Oncology Protocol presented in this report represents a consensus of the Radiotherapy Committees in the major NCI funded Cooperative Groups and is derived from over a decade of experience. Although they have been written for external beam therapy, they are applicable to brachytherapy with appropriate technical considerations. It is anticipated that further evolution will occur with the introduction of new technologies such as 3-D treatment planning and delivery, multi-leaf collimation and small field irradiation.

Clinical Protocols↗
PubMed2006

[Evaluation of flat-rate payment in radiation oncology. German experience with disease-related groups for inpatient funding in radiation oncology].

PURPOSE: In Germany a new casemix-related reimbursement system with "diagnosis related groups" (DRGs) for inpatient treatment was started in 2003. The first German system G-DRG 1.0 was developed on the basis of the Australian AR-DRG version 4.1. German inpatient treatment in radiation oncology was not specifically represented in this system due to the very different health care systems. As the DRG system was planned as a pricing system with severe effects on the funding of radiation oncology departments, an adjustment was urgently needed. For the modification, national data about pattern of care and economic relevance were needed. METHODS: For 3,689 cases treated in radiation oncology departments from eleven hospitals data were collected prospectively concerning diagnosis, length of stay, procedures and high-cost drugs and treatments. The DRGs were analyzed for homogeneity in length of stay and costs. Readmission frequency and interval were analyzed and the relevance of existing reimbursement regulations for this situation was evaluated. RESULTS: It could be shown, that radiation therapy implicated additional expenses for oncologic inpatients. These additional costs were not represented in the G-DRG 1.0 reimbursement system. Chemotherapy was an additional cause for economically inhomogeneous oncologic DRGs. The complex sequence of cases for the same patient could be shown, and that the rules for reimbursement of readmissions have to take these sequential treatments into account. Based on these data, modifications of the reimbursement system were suggested. In the following G-DRG version for the year 2004, 21 DRGs were designed for patients receiving radiation therapy. The regulations concerning the readmission of oncologic patients were modified. The correlation between the number of radiation therapy fractions and the total expense was acknowledged in the following year (G-DRG system 2005) and resulted in 35 DRGs. The version for 2006 showed the solidity of these solutions with almost unchanged definitions of these DRGs. CONCLUSION: This evaluation revealed the deficits in the G-DRG system 1.0 (and the AR-DRG system 4.1) related to the inpatient treatment in radiation oncology departments. Modifications could be proposed for following years. In 2004-2006, the regulatory boards adopted several implications of these data for the improvement of the German casemix-based hospital-financing system.

Diagnosis-Related Groups↗