National Residency Matching Program (NRMP) Results for Radiation Oncology, 2007 Update
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was 61 years. Primary sites included 21 parotid, 3 submandibular and 1 lacrimal gland. Histologies included 6 adenocarcinomas, 6 adenoid cystic, 4 acinic cell, 3 squamous cell, 3 mucoepidermoid, 2 salivary duct carcinomas and 1 basal cell carcinoma. 19 patients were treated at initial presentation, and 6 were treated for recurrent disease. 22 patients were treated adjuvantly for high risk features including close/positive margins or adverse histology. Three patients received definitive radiation for unresectable disease. Four patients had concurrent systemic therapy. Results: All patients completed the planned therapy and are alive at the time of analysis. With respect to staging, all patients who underwent a pre-treatment PET/CT scan demonstrated hypermetabolic uptake in the primary tumor (unresectable disease 3, pre- operative 3). Post-operative PET/CT imaging identified 3 patients with locally recurrent disease, 2 with regional nodal metastases, 2 with distant metastases, and 1 with synchronous colon cancer. With regards to radiation treatment planning, in the 3 patients treated definitively with radiation, PET/CT aided in the delineation of the primary tumor and targeting of involved regional lymph nodes. In the post-operative patients, PET/CT assisted in delineation of the resection bed. In addition, 10 of these patients had in- determinate PET findings, and the corresponding subvolumes were boosted to 6660 to 7200 cGy. After median follow up of 7 months (range 1–21), 16 patients are NED and 1 has stable residual disease. 8 patients have had treatment failure including 3 re- gional, 1 local, and 6 distant failures. Overall locoregional control is 84%. Recurrent disease was FDG-avid in all patients who underwent follow up PET/CT scan. Conclusions: Our experience suggests a role for FDG-PET scan in the management of patients with malignant salivary gland tu- mors. PET was useful in pre-treatment staging of the primary/regional lymph nodes and detection of occult distant metastases. Tumors appeared to be FDG-PET avid independent of primary histology. Treatment planning PET/CT assisted in delineation of the primary tumor, involved regional nodes, and post-operative tumor bed. In addition, it provides a novel strategy for focal dose escalation based on tumor biology. Follow up PET/CT was highly sensitive in the detection of disease recurrence. Based on our early experience, further studies incorporating PET/CT imaging in the management of salivary gland malignancies are warranted. Author Disclosure: J.J. Liao, None; C.E. Lominska, None; T. DeKlotz, None; K. Newkirk, None; B. Davidson, None; J. Deeken, None; K. W. Harter, None. 2490 A Standardized Nomenclature System for Head and Neck (H&N) IMRT Contouring, Planning and Quality Assurance J. J. Kim, S. L. Breen, J. N. Waldron, A. J. Bayley, B. J. Cummings, J. Ringash, L. A. Dawson, C. Liu, S. Huang, B. O’Sullivan Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada Purpose/Objective(s): A standardized system of H&N structure nomenclature, contouring and planning terminology was imple- mented in Sept. 2004 to facilitate 1) interdisciplinary communication 2) planning quality assurance review 3) the automation of planning tasks and 4) audit of outcomes. In Nov. 2006, the system was expanded to include more intensity modulated radiation therapy (IMRT)-specific planning terminology. An audit was conducted to evaluate physician compliance to our nomenclature system (NS) and to identify potential improvements to the NS. Materials/Methods: The NS conforms to ICRU 50/62 and Consensus Guidelines terminology for neck nodal levels. The NS is applicable to all H&N sites and presentations using a consistent alpha-numeric scripted language permitting unequivocal designa- tion of radiation objects necessary for the deilvery of a very large academic H&N IMRT program. Integral to this system is the delineation of separate primary site and neck target volumes. There are guidelines to handle separate, multiple or combined targets. NS terminology for normal structures, gross disease and target volumes is unique, brief, consistent and descriptive. For patients who have undergone surgery or chemotherapy, there may be no gross tumor objects and these tumor sites may be considered high-risk. Currently, there is no ICRU terminology for this principle. Terminology was developed to enable physicians to contour these high-risk regions. Seven H&N radiation oncologists are responsible for primary, gross nodal, clinical target volume (CTV) and most organ at risk (OR) contours. Planning target volumes (PTVs), planning organ at risk volumes (PRVs) and other planning volumes are planner-generated. Physician-generated contours for all H&N patients starting radiotherapy from Dec. 1, 2006 to Feb. 28, 2007 were audited. Terminology that was not consistent with NS standards and principles was considered a deviation. Termi- nology that was not addressed in the NS was categorized as non-NS. Results: 132 patients (pharynx, larynx, oral cavity, nasal cavity/paranasal sinus, unknown primary, complex skin and sarcoma/ benign tumors) treated with curative or palliative intent were included in this audit. In total, 2490 (397 gross tumor or high- risk, 625 CTV, 1283 OR, 131 reference and 54 non-NS) volumes were physician-generated. Deviations were found in 15/397 (3.8%) gross tumor/high-risk volumes, 28/625 (4.5%) CTVs and 35/1283 (2.7%) ORs. Of 273 gross nodal contours, 8 (2.9%) were assigned to the wrong nodal level in 5 patients. Deviations for gross or high-risk (primary/nodal) volumes, CTVs and ORs were found in 12/132 (9.1%), 18/132 (13.6%) and 19/132 (14.4%) patients respectively. No deviations resulted in violation of ICRU principles. Review of deviations and non-NS terminology identified the need to clarify or expand OR, bolus placement and post-operative nomenclature. Conclusions: A standardized H&N IMRT nomenclature system has been successfully adopted by radiation oncologists in a large academic centre. This system is applicable to any clinical environment. Author Disclosure: J.J. Kim, None; S.L. Breen, None; J.N. Waldron, None; A.J. Bayley, None; B.J. Cummings, None; J. Ringash, None; L.A. Dawson, None; C. Liu, None; S. Huang, None; B. O’Sullivan, None. 2491 National Residency Matching Program (NRMP) Results for Radiation Oncology, 2007 Update L. D. Wilson 1 , J. B. Yu 1 , B. G. Haffty 2 1 Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 2 Department of Radiation Oncology, UMDNJ, New Brunswick, NJ Background: Radiation oncology in now established as one of the most competitive specialties for students to gain access to for training. The National Resident Matching Program (NRMP) data for radiation oncology (2007) are presented. Proceedings of the 49th Annual ASTRO Meeting S473
Transcript of National Residency Matching Program (NRMP) Results for Radiation Oncology, 2007 Update
Proceedings of the 49th Annual ASTRO Meeting S473
was 61 years. Primary sites included 21 parotid, 3 submandibular and 1 lacrimal gland. Histologies included 6 adenocarcinomas, 6adenoid cystic, 4 acinic cell, 3 squamous cell, 3 mucoepidermoid, 2 salivary duct carcinomas and 1 basal cell carcinoma. 19 patientswere treated at initial presentation, and 6 were treated for recurrent disease. 22 patients were treated adjuvantly for high risk featuresincluding close/positive margins or adverse histology. Three patients received definitive radiation for unresectable disease. Fourpatients had concurrent systemic therapy.
Results: All patients completed the planned therapy and are alive at the time of analysis. With respect to staging, all patients whounderwent a pre-treatment PET/CT scan demonstrated hypermetabolic uptake in the primary tumor (unresectable disease 3, pre-operative 3). Post-operative PET/CT imaging identified 3 patients with locally recurrent disease, 2 with regional nodal metastases,2 with distant metastases, and 1 with synchronous colon cancer. With regards to radiation treatment planning, in the 3 patientstreated definitively with radiation, PET/CT aided in the delineation of the primary tumor and targeting of involved regional lymphnodes. In the post-operative patients, PET/CT assisted in delineation of the resection bed. In addition, 10 of these patients had in-determinate PET findings, and the corresponding subvolumes were boosted to 6660 to 7200 cGy. After median follow up of 7months (range 1–21), 16 patients are NED and 1 has stable residual disease. 8 patients have had treatment failure including 3 re-gional, 1 local, and 6 distant failures. Overall locoregional control is 84%. Recurrent disease was FDG-avid in all patients whounderwent follow up PET/CT scan.
Conclusions: Our experience suggests a role for FDG-PET scan in the management of patients with malignant salivary gland tu-mors. PET was useful in pre-treatment staging of the primary/regional lymph nodes and detection of occult distant metastases.Tumors appeared to be FDG-PET avid independent of primary histology. Treatment planning PET/CT assisted in delineationof the primary tumor, involved regional nodes, and post-operative tumor bed. In addition, it provides a novel strategy for focaldose escalation based on tumor biology. Follow up PET/CT was highly sensitive in the detection of disease recurrence. Basedon our early experience, further studies incorporating PET/CT imaging in the management of salivary gland malignancies arewarranted.
Author Disclosure: J.J. Liao, None; C.E. Lominska, None; T. DeKlotz, None; K. Newkirk, None; B. Davidson, None; J. Deeken,None; K. W. Harter, None.
2490 A Standardized Nomenclature System for Head and Neck (H&N) IMRT Contouring, Planning and Quality
AssuranceJ. J. Kim, S. L. Breen, J. N. Waldron, A. J. Bayley, B. J. Cummings, J. Ringash, L. A. Dawson, C. Liu, S. Huang, B. O’Sullivan
Radiation Medicine Program, Princess Margaret Hospital, University of Toronto, Toronto, ON, Canada
Purpose/Objective(s): A standardized system of H&N structure nomenclature, contouring and planning terminology was imple-mented in Sept. 2004 to facilitate 1) interdisciplinary communication 2) planning quality assurance review 3) the automation ofplanning tasks and 4) audit of outcomes. In Nov. 2006, the system was expanded to include more intensity modulated radiationtherapy (IMRT)-specific planning terminology. An audit was conducted to evaluate physician compliance to our nomenclaturesystem (NS) and to identify potential improvements to the NS.
Materials/Methods: The NS conforms to ICRU 50/62 and Consensus Guidelines terminology for neck nodal levels. The NS isapplicable to all H&N sites and presentations using a consistent alpha-numeric scripted language permitting unequivocal designa-tion of radiation objects necessary for the deilvery of a very large academic H&N IMRT program. Integral to this system is thedelineation of separate primary site and neck target volumes. There are guidelines to handle separate, multiple or combined targets.NS terminology for normal structures, gross disease and target volumes is unique, brief, consistent and descriptive. For patientswho have undergone surgery or chemotherapy, there may be no gross tumor objects and these tumor sites may be consideredhigh-risk. Currently, there is no ICRU terminology for this principle. Terminology was developed to enable physicians to contourthese high-risk regions. Seven H&N radiation oncologists are responsible for primary, gross nodal, clinical target volume (CTV)and most organ at risk (OR) contours. Planning target volumes (PTVs), planning organ at risk volumes (PRVs) and other planningvolumes are planner-generated. Physician-generated contours for all H&N patients starting radiotherapy from Dec. 1, 2006 to Feb.28, 2007 were audited. Terminology that was not consistent with NS standards and principles was considered a deviation. Termi-nology that was not addressed in the NS was categorized as non-NS.
Results: 132 patients (pharynx, larynx, oral cavity, nasal cavity/paranasal sinus, unknown primary, complex skin and sarcoma/benign tumors) treated with curative or palliative intent were included in this audit. In total, 2490 (397 gross tumor or high-risk, 625 CTV, 1283 OR, 131 reference and 54 non-NS) volumes were physician-generated. Deviations were found in 15/397(3.8%) gross tumor/high-risk volumes, 28/625 (4.5%) CTVs and 35/1283 (2.7%) ORs. Of 273 gross nodal contours, 8 (2.9%)were assigned to the wrong nodal level in 5 patients. Deviations for gross or high-risk (primary/nodal) volumes, CTVs andORs were found in 12/132 (9.1%), 18/132 (13.6%) and 19/132 (14.4%) patients respectively. No deviations resulted in violationof ICRU principles. Review of deviations and non-NS terminology identified the need to clarify or expand OR, bolus placementand post-operative nomenclature.
Conclusions: A standardized H&N IMRT nomenclature system has been successfully adopted by radiation oncologists in a largeacademic centre. This system is applicable to any clinical environment.
Author Disclosure: J.J. Kim, None; S.L. Breen, None; J.N. Waldron, None; A.J. Bayley, None; B.J. Cummings, None; J. Ringash,None; L.A. Dawson, None; C. Liu, None; S. Huang, None; B. O’Sullivan, None.
2491 National Residency Matching Program (NRMP) Results for Radiation Oncology, 2007 Update
L. D. Wilson1, J. B. Yu1, B. G. Haffty2
1Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, 2Department of RadiationOncology, UMDNJ, New Brunswick, NJ
Background: Radiation oncology in now established as one of the most competitive specialties for students to gain access to fortraining. The National Resident Matching Program (NRMP) data for radiation oncology (2007) are presented.
S474 I. J. Radiation Oncology d Biology d Physics Volume 69, Number 3, Supplement, 2007
Purpose/Objective(s): To provide ASTRO members, residents, students and Deans of students with the results of the 2007 NRMPradiation oncology match.
Materials/Methods: Data from the 2007 NRMP match for radiation oncology were derived from the NRMP advanced data tablesand from communication with representatives of the NRMP.
Results: A total of 202 students and 66 programs (PGY-2 positions) participated in the 2007 radiation oncology match. (The num-ber of applicants is typically much larger; .350). Some applicants do not receive interview invitations, decide against pursuinga career in radiation oncology, or accept a position outside of the NRMP process. A total of 161 candidates were US seniorsand 41 were independent applicants. The percentage of applicants who are US seniors is 80%. Radiation oncology representedthe only choice for 135 US seniors, the first choice for 17, and was not the first choice for 9 with regard to specialty. A total of24 independent applicants declared radiation oncology as their only choice of specialty in the match. Of the 135 US seniors,118 matched and hence, a total of 13% were unmatched. The only specialties offering over 100 positions to have higher unmatchedpercentages of US seniors were dermatology, orthopedic surgery, and otolaryngology with 33%, 18%, and 15% respectively. Atotal of 142 positions were available in the US. A total of 127 positions were offered as post graduate year (PGY-2) and 15were offered that included a PGY-1 year. The match/fill rate for the 15 positions inclusive of a PGY-1 position was 100% andall of those who matched were US seniors. The match/fill rate for the 127 PGY-2 positions was 94% with 8 positions not matched*.A total of 86% of the PGY-2 positions were filled with US seniors. Hence, the percentage of positions filled was 94% (134 of 142available). Of the positions filled, 93% were occupied by US seniors which is a stable compared to 2006 (Table).
Conclusions: Radiation oncology is clearly one of the most competitive specialties to gain access to with respect to training, andUS seniors appear to comprise a higher proportion of those who apply and are accepted by training programs.
*Some programs participating in the NRMP may not have actually had positions available.
Radiation Oncology NRMP Data Comparison 2003–2007
Year 2007 2006 2005 2004 2003
Radiation oncology programs
66 69 69 63 51Positions offered
142 128 137 128 117Total number of applicants (US/IA)
US-United States/IA-Independent applicant
202
185 225 200 209US seniors as a percentage of the applicant pool
80% 78% 72% 73% 75%US seniors as a percentage of those who matched
93% 93% 87% 89% 91%Percentage of positions filled
94% 98% 99% 98% 100%Ratio of applicants to positions
1.4 1.5 1.6 1.6 1.8Author Disclosure: L.D. Wilson, None; J.B. Yu, None; B.G. Haffty, None.
2492 Ontario Radiation Oncology Residents Needs in the PGY-1 Year–Residents’ Perspective Survey
E. Szumacher1, E. Warner1, L. Zhang1, G. Kane2, G. Kane2, I. Ackerman3, J. Nyhof-Young2, O. Agboola4, O. Agboola4,
C. de Metz5
1Toronto Sunnybrook Regional Cancer Ctr., Toronto, ON, Canada, 2Department of Radiation Oncology, Princess MargaretHospital, University of Toronto, Toronto, ON, Canada, 3Toronto Sunnybrook Regional Cancer Ctr, Toronto, ON, Canada,4Department of Radiation Oncology, University of Ottawa, Ottawa, ON, Canada, 5Department of Radiation Oncology, Queen’sUniversity, Kingston, Ontario, Kingston, ON, Canada
Purpose/Objective(s): This study assessed radiation oncology residents’ needs and satisfaction in the PGY-1 year in the fiveradiation oncology programs in the province of Ontario, Canada.
Methods/Materials: In 2006, 58 radiation oncology residents (of 62) who had completed their PGY-1 year in Ontario and wereeither enrolled in or had graduated in 2006, were invited to participate in a 31-item anonymous web-based survey. The web-basedquestionnaire explored PGY-1 residents’ needs and satisfaction in four domains: clinical workload, faculty/learning environment,stress level, and discrimination/harassment. The Fisher’s Exact and Wilcoxon non-parametric tests were used to determine relation-ships between covariates (e.g. age, gender, residency year, university affiliation), items and summary scores.
Results: Of 58 eligible residents, 43 (75%) responded to the survey. Although eighty four percent of residents felt that their wardand call duties were appropriate, 21% thought the workload and number of patient management problems were excessive. Over50% of respondents indicated that they often felt isolated from their radiation oncology program. Only 77% agreed that they re-ceived adequate feedback from the faculty, and only 40% felt that they had received sufficient counseling regarding career plan-ning. However, more than 93% of respondents thought that full time faculty members had contributed significantly to their learningexperience. Approximately 50% of residents experienced excessive stress or depression, and inadequate time for leisure or for read-ing the medical literature. Very few of the residents (less than 10%) indicated that they had been harassed or experienced discrim-ination related to gender, sexual orientation, race/ethnicity/culture, disability, aboriginal status or religion. Eighty-three percentagreed or strongly agreed that their PGY-1 experience had been outstanding.
Conclusions: Although most residents were satisfied with their PGY-1 training programs, more counseling by radiation oncologyfaculty members should be offered to help residents with career planning. First year residents might also benefit from more expo-sure to ‘radiation oncology’ and an introduction to stress management strategies to improve their well being during the PGY-1 year.
Author Disclosure: E. Szumacher, None; E. Warner, None; L. Zhang, None; G. Kane, None; G. Kane, None; I. Ackerman, None;J. Nyhof-Young, None; O. Agboola, None; O. Agboola, None; C. de Metz, None.
