In breast cancer (BC) care, radiotherapy is considered an efficient treatment, prescribed both for controlling localized tumors or as a therapeutic option in case of inoperable, incompletely resected or recurrent tumors. However, approximately 90% of BC-related deaths are due to the metastatic tumor progression. Then, it is strongly desirable to improve tumor radiosensitivity using molecules with synergistic action. The main aim of this study is to develop curcumin-loaded solid nanoparticles (Cur-SLN) in order to increase curcumin bioavailability and to evaluate their radiosensitizing ability in comparison to free curcumin (free-Cur), by using an in vitro approach on BC cell lines. In addition, transcriptomic and metabolomic profiles, induced by Cur-SLN treatments, highlighted networks involved in this radiosensitization ability. The non tumorigenic MCF10A and the tumorigenic MCF7 and MDA-MB-231 BC cell lines were used. Curcumin-loaded solid nanoparticles were prepared using ethanolic precipitation and the loading capacity was evaluated by UV spectrophotometer analysis. Cell survival after treatments was evaluated by clonogenic assay. Dose–response curves were generated testing three concentrations of free-Cur and Cur-SLN in combination with increasing doses of IR (2–9 Gy). IC50 value and Dose Modifying Factor (DMF) was measured to quantify the sensitivity to curcumin and to combined treatments. A multi-“omic” approach was used to explain the Cur-SLN radiosensitizer effect by microarray and metobolomic analysis. We have shown the efficacy of the Cur-SLN formulation as radiosensitizer on three BC cell lines. The DMFs values, calculated at the isoeffect of SF = 50%, showed that the Luminal A MCF7 resulted sensitive to the combined treatments using increasing concentration of vehicled curcumin Cur-SLN (DMF: 1,78 with 10 µM Cur-SLN.) Instead, triple negative MDA-MB-231 cells were more sensitive to free-Cur, although these cells also receive a radiosensitization effect by combination with Cur-SLN (DMF: 1.38 with 10 µM Cur-SLN). The Cur-SLN radiosensitizing function, evaluated by transcriptomic and metabolomic approach, revealed anti-oxidant and anti-tumor effects. Curcumin loaded- SLN can be suggested in future preclinical and clinical studies to test its concomitant use during radiotherapy treatments with the double implications of being a radiosensitizing molecule against cancer cells, with a protective role against IR side effects.

Radiosensitizing effect of curcumin-loaded lipid nanoparticles in breast cancer cells

Quality Indicators, based on clinical practice guidelines, have been used in medicine and within oncology to measure quality of care for over twenty years. However, radiation oncology quality indicators are sparse. This article describes the background to the development of current national and international, general and tumour site‐specific radiation oncology quality indicators in use. We explore challenges and opportunities to expand their routine prospective collection and feedback to help drive improvements in the quality of care received by people undergoing radiation therapy.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1111/1754-9485.13373

Quality indicators for radiation oncology

Oncologic specialty societies and multidisciplinary collaborative groups have dedicated considerable effort to developing evidence-based quality indicators (QIs) to facilitate quality improvement, accreditation, benchmarking, reimbursement, maintenance of certification, and regulatory reporting. In particular, the field of radiation oncology has a long history of organized quality assessment efforts and continues to work toward developing consensus quality standards in the face of continually evolving technologies and standards of care. This report provides a comprehensive review of the current state of quality assessment in radiation oncology. Specifically, this report highlights implications of the healthcare quality movement for radiation oncology and reviews existing efforts to define and measure quality in the field, with focus on dimensions of quality specific to radiation oncology within the "big picture" of oncologic quality assessment efforts.

Quality indicators in radiation oncology.

External beam radiotherapy (EBRT), with or without androgen deprivation therapy (ADT), is an established treatment option for nonmetastatic prostate cancer Despite high-level evidence from several randomized trials, risk group stratification and treatment recommendations vary due to contradictory or inconclusive data, particularly with regard to EBRT dose prescription and ADT duration Our aim was to investigate current patterns of practice in primary EBRT for prostate cancer in Switzerland Treatment recommendations on EBRT and ADT for localized and locally advanced prostate cancer were collected from 23 Swiss radiation oncology centers Written recommendations were converted into center-specific decision trees, and analyzed for consensus and differences using a dedicated software tool Additionally, specific radiotherapy planning and delivery techniques from the participating centers were assessed The most commonly prescribed radiation dose was 78 Gy (range 70–80 Gy) across all risk groups ADT was recommended for intermediate-risk patients for 6 months in over 80 % of the centers, and for high-risk patients for 2 or 3 years in over 90 % of centers For recommendations on combined EBRT and ADT treatment, consensus levels did not exceed 39 % in any clinical scenario Arc-based intensity-modulated radiotherapy (IMRT) is implemented for routine prostate cancer radiotherapy by 96 % of the centers Among Swiss radiation oncology centers, considerable ranges of radiotherapy dose and ADT duration are routinely offered for localized and locally advanced prostate cancer In the vast majority of cases, doses and durations are within the range of those described in current evidence-based guidelines

Consensus and differences in primary radiotherapy for localized and locally advanced prostate cancer in Switzerland: A survey on patterns of practice.

Purpose We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year. Methods and Materials State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy. Results Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined. Conclusions The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.

VA-Radiation Oncology Quality Surveillance Program

Purpose The purpose of this survey was to test the feasibility of using proposed quality indicators to assess radiotherapy quality in prostate cancer management based on a 2007 stratified random survey of treating academic and nonacademic US institutions. Methods and Materials A total of 414 patients with clinically localized prostate cancer treated with external beam radiotherapy (EBRT) or brachytherapy were selected from 45 institutions. Indicators used as specific measurable clinical performance measures to represent surrogates for quality of radiotherapy delivery included established measures such as the use of prescription doses ≥ 75 Gy for intermediate- and high-risk EBRT patients and androgen-deprivation therapy (ADT) in conjunction with EBRT for patients with high-risk disease, and emerging measures, including daily target localization (image-guidance) to correct for organ motion for EBRT patients. Results Among the 354 patients treated with EBRT, the beam energy was recorded in 353 patients. One hundred sixty-seven patients (47%) were treated with 6 MV photons, 31 (9%) were treated with 10 MV, 65 (18%) received 15 MV, and the remaining 90 (26%) 16-23 MV. For intermediate- plus high-risk patients (n = 181), 78% were treated to ≥75 Gy. Among favorable-risk patients, 72% were treated to ≥75 Gy. Among high-risk EBRT patients, 60 (87%) were treated with ADT in conjunction with EBRT and 13% (n = 9) with radiotherapy alone. Among low- and intermediate-risk patients, 10% and 42%, respectively, were treated with ADT plus EBRT. For 24% of EBRT patients (85 of 354), weekly electronic portal imaging was obtained as verification films without daily target localization, and the remaining 76% were treated with daily localization of the target using various methods. Conclusions Adherence to defined quality indicators was observed in a majority of patients. Approximately 90% of high-risk patients were treated with ADT plus EBRT and ≈80% of intermediate- and high-risk patients received prescription doses ≥75 Gy, consistent with the published results of randomized trials.

https://www.practicalradonc.org/article/S1879-8500(12)00008-2/pdf

Evaluation of Adherence to Quality Measures for Prostate Cancer Radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey.

Since Practical Radiation Oncology (PRO) published its first issue in January 2011, we have been humbled by the response we have received from inside the radiation oncology community and from our multidisciplinary colleagues. Like the effects of radiation therapy in humans, it takes many years to see the full impact of a new journal and the articles published therein as the typical metrics for measuring journal success take many years to mature. One common way that a journal measures its success is through the Impact Factor (IF), initially described by Eugene Garfield, PhD, in 1955.1 The IF is calculated as the number of citations in the current year compared with items published during the previous 2 years.2 PRO has applied for an IF and will likely receive our first IF in 2014. We will have more to say about the IF when we receive one, including the problems with using the metric and how some journals are gaming the system. Given that it is too early to calculate the IF for PRO, we have been busy looking at other measures of success. In our view, the early results are very good. PRO is not yet indexed by PubMed, but it is clear to us that our colleagues are reading/downloading the articles that we publish, and investigators from across the globe are citing them in their own work. Figure 1 shows a few examples of highly-cited articles from 2011. The breadth of journals is very gratifying. Citations can be found in our sister journal, the International Journal of Radiation Oncology, Biology, Physics; a result that we can reasonably expect but we are humbled nonetheless. We are particularly excited to see citations in journals whose scope is outside of radiation

https://www.practicalradonc.org/article/S1879-8500(13)00254-3/pdf

An Editorial Note: The Long Arm of Practical Radiation Oncology

Welcome to the second issue in the third volume of Practical Radiation Oncology (PRO). PRO began accepting manuscripts in July of 2010, and since that time more than 700 manuscripts have been received. I would like to again thank the reviewers, editors, and the professional staff of PRO for their continued commitment to this new journal. In this brief note, I want to bring 3 things to your attention: the importance of patient safety, the international scope of PRO, and an increase in scientific misconduct observed in the peer-reviewed literature. From the beginning of PRO, the journal has been committed to publishing papers focusing on patient safety. Indeed our first paper published in PRO described the challenges of maximizing safety in radiation oncology.1 This paper is one of the most highly cited papers from PRO. This commitment to publishing material that emphasizes patient safety continues in this issue. Rangaraj et al. describe a robust, reliable, and efficient QA process to detect errors.2 I encourage physicists especially to read this paper. The second point is to highlight that PRO has become an international journal. In this issue, there are excellent papers fromCanada, Australia, and France.3–5 The number of submitted manuscripts from outside of the United States has been increasing and to date, approximately 15% of published papers originated from Australia, Belgium, Canada, China, France, India, Italy, Japan, Netherlands, Turkey, and the United Kingdom. I hope that this number continues to increase with time. I especially look forward to publishing papers from developing countries. Finally, some bad news. A recent report found that the percentage of scientific articles retracted has increased markedly over the past 3 decades.6 To make matters worse, it appears that the majority of retractions are attributable to scientific misconduct, not error. Scientific misconduct can include fraud, plagiarism, or duplicate publication. I am acutely sensitive to this issue as a paper

https://www.practicalradonc.org/article/S1879-8500(13)00125-2/pdf

Editor's Note: The importance of understanding patient safety, international scope, and scientific misconduct.

Purpose In the last 2 decades, guidelines have been developed to improve quality of patient care. A recent editorial of guideline development procedures suggested the process has significant limitations that affect their scientific validity. 1 This prompted us to review oncology treatment guidelines to determine if such limitations are widespread. Methods and Materials We performed a review of oncology treatment guidelines registered at the National Guidelines Clearinghouse (www.guideline.gov). Each guideline was independently reviewed by 2 authors and the following criteria were assessed: coordinating organization, guideline panel composition, reporting conflict of interest, peer review, dissent, expiration date, PubMed citation, and evidence-based scoring and grading of recommendations. Disagreements were resolved by consensus in subsequent discussions. Results Sixty-four guidelines were reviewed (39 [61%] were developed by a medical specialty society and 25 [39%] were developed by government agencies). Fifty (78%) guideline panels were multidisciplinary and 44 (69%) included individuals with epidemiologic and health services research expertise. Potential conflicts of interest were disclosed in 43 (67%) guidelines. Sixty (94%) guidelines underwent peer review, with external review in 31 (48%). Seventeen (27%) guidelines are indexed by PubMed. Fifty-one (80%) guidelines included evidence-based methodologies and 46 (72%) used evidence-based scoring of recommendations. Significant differences were observed according to coordinating organization (eg, disclosure of conflict of interest in 46% of guidelines developed by medical specialty societies versus 100% authored by government agencies [ P Conclusions The majority of oncology-related treatment guidelines registered at the National Guidelines Clearinghouse satisfy most of the criteria for sound guideline development. Significant differences in these criteria were observed according to the coordinating organization that developed the guideline.

The development of oncology treatment guidelines: an analysis of the National Guidelines Clearinghouse.

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Papers

Evaluation of Adherence to Quality Measures for Prostate Cancer Radiotherapy in the United States: Results from the Quality Research in Radiation Oncology (QRRO) Survey.

An Editorial Note: The Long Arm of Practical Radiation Oncology

Editor's Note: The importance of understanding patient safety, international scope, and scientific misconduct.

The development of oncology treatment guidelines: an analysis of the National Guidelines Clearinghouse.