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New Radiation Treatment Guidelines for Safer Radiotherapy Procedures

By MedImaging International staff writers
Posted on 01 Apr 2010

The culmination of a two-year effort to review available studies and establish new guidelines for the safe treatment of cancer with radiation has recently been published.

Several radiation oncology faculty members from the University of North Carolina at Chapel Hill (UNC; USA) participated in the process establishing the new QUANTEC (Quantitative Analysis of Normal Tissue Effects in the Clinic) guidelines. These guidelines replace standards established almost 20 years ago, before the widespread use of three-dimensional (3D) imaging technology that allows more accurate targeting of radiation to cancerous lesions.

"The new standards have resulted from a systematic review of radiation therapy dose/volume/outcome data on 16 organs. The new data were made possible by the more general use of 3D imaging during radiation planning. These new standards provide a logical framework to assess the risks of complex 3D doses that we now routinely consider,” said Lawrence B. Marks, M.D., chair of the UNC department of radiation oncology and coeditor of the QUANTEC study.

Noting the overall trend in the United States toward improved practice through evidence-based medicine, Dr. Marks added, "Our goal is to make the practice of radiation oncology more standardized and efficient, less open to interpretation and ultimately as safe and effective as it can be, using state-of-the-art technology to treat cancer.”

Teams of physicians, physicists, and statisticians/modelers reviewed the available literature for each organ to compile general dose/volume/outcome data, and make recommendations on the selection of dose/volume prescriptions. "We are pleased that UNC physician investigators played pivotal roles in this important analysis, which establishes new standards for this vital cancer treatment technology,” said Richard M. Goldberg, M.D., physician-in-chief of the NC Cancer Hospital (Chapel Hill, USA). "It is a privilege to treat patients with these outstanding experts on our multidisciplinary teams.”

David Morris, M.D., clinical associate professor of radiation oncology and member of UNC Lineberger Comprehensive Cancer Center, was part of the American Society for Radiation Oncology's Health Services Research Committee, which originally recommended a review of the standards in light of new research and clinical experience. He helped to jump-start and obtain funding for the effort.

Dr. Marks, who is also a member of UNC Lineberger, served as a coeditor and provided oversight to the entire project in addition to leading the group that established guidelines for radiation therapy to the lung.

The study was published in the March 1, 2010, issue of the International Journal of Radiation Oncology, Biology, and Physics.

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University of North Carolina at Chapel Hill

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65 (30.040740966797): select jos_facebook.link from jos_facebook where cat=10

66 (32.901763916016): select jos_google_plus.link from jos_google_plus where cat=10

67 (29.087066650391): select jos_linkedin.link from jos_linkedin where cat=10

68 (36.001205444336): SELECT fid FROM jos_deeppockets WHERE id=294728732 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=294728732 AND published='1' LIMIT 1

69 (40.054321289062): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=211 ORDER BY `ordering`

70 (369.07196044922): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (247.00164794922): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (45.7763671875): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (61.03515625): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (45.061111450195): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (31.948089599609): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (29.802322387695): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (32.901763916016): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (38.862228393555): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (!!!!! 5710.1249694824): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (108.00361633301): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (59.843063354492): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (!!!!! 1255.0354003906): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (62.942504882812): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (50.067901611328): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (41.007995605469): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (46.014785766602): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (33.140182495117): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (30.040740966797): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (!!!!! 2728.9390563965): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

105 (102.99682617188): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

106 (82.969665527344): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294728732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (528.09715270996): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294728732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

109 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

110 (48.160552978516): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294728732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (504.97055053711): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=294728732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (672.1019744873): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (570.05882263184): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (99.897384643555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

115 (57.220458984375): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

116 (55.074691772461): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

117 (42.200088500977): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

118 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

119 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

120 (75.101852416992): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

121 (51.975250244141): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

122 (465.15464782715): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 58363.914489746): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (!!!!! 1925.9452819824): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728732 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728732 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (218.15299987793): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (468.01567077637): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (190.01960754395): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (405.07316589355): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (92.029571533203): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (157.83309936523): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (75.101852416992): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (102.99682617188): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (36.954879760742): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (31.948089599609): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (618.93463134766): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (470.87669372559): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (53.882598876953): SELECT name FROM jos_deeppockets WHERE id=211

138 (41.007995605469): SELECT name FROM jos_deeppockets WHERE id=211

139 (786.06605529785): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (753.16429138184): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))211((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (941.99180603027): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

142 (85.115432739258): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

143 (!!!!! 4531.1450958252): TRUNCATE TABLE jos_trademed_module

144 (150.91896057129): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294728732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (61.988830566406): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=294728732 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (355.00526428223): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (105.14259338379): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (93.936920166016): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

149 (52.928924560547): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

150 (!!!!! 1564.9795532227): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (60.081481933594): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

152 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

153 (41.961669921875): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=294728732 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=294728732 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (32.186508178711): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

155 (28.133392333984): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=211 or channel_id is null)

156 (30.994415283203): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (156.87942504883): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

158 (67.949295043945): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=294728732 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=294728732 AND published='1' LIMIT 1

159 (76.055526733398): select jos_twitters.link from jos_twitters where cat=10

160 (40.054321289062): select jos_facebook.link from jos_facebook where cat=10

161 (38.862228393555): select jos_google_plus.link from jos_google_plus where cat=10

162 (37.193298339844): select jos_linkedin.link from jos_linkedin where cat=10

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