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Program Director and Chief Resident Perspectives on the Educational Environment of U.S. Radiation Oncology Programs
Poster Viewing Session E381
Volume 93 Number 3S Supplement 2015 asked them to delineate CTV again in accordance with the protocol. Clinical target volumes of the GI leader and participants were contoured for geometrical analysis (total volume, antero-posterior, latero-lateral and cranio-caudal diameters) and to calculate the mean Dice Similarity Index (mDSI). Results: The mDSI value before using the protocol was 0.70 (range 0.39-0.84), and it was increased to 0.82 (range 0.72-0.91; PZ.03) when CTV was based on the protocol. Significantly bigger craniocaudal diameter of CTV was delineated after observers used the protocol book 11.8cm (range 9.5-14.2) versus 13. cm (range 12.514.6); PZ.006. Conclusion: Use of a GI multi-institutional evidence based medicine handbook protocol significantly decreases interobserver variations of CTV delineation in external beam radiation therapy of pancreatic cancer. Further studies and strategies to evaluate and reduce intra-observer variability in CTV delineation need to be established. Author Disclosure: G. Marosevic: None. E. Butler: None. D. Mileusnic: None. D. Stricic: None. O. Arsovski: None. B. Vujosevic: None. S. Maric: None. D. Trokic: None. P. Banovic: None. S. Spasojevic: None. B. Strbac: None. A. Kostovski: None. R. Pino: None. N. Jacobs: None. R. Mills: None. C.A. Connolly: None.
2949 Phase 2 Study of Intensity Modulated Radiation With Concurrent Chemotherapy as Definitive Treatment for Esophageal Squamous Cell Cancer M. Xu and J. Li; Shan Dong Cancer Hospital, Jinan, China Purpose/Objective(s): To explore the feasibility and therapeutic effect of simultaneous integrated boost intensity modulated radiation (SIB-IMRT) and concurrent systemic chemotherapy as definitive treatment for esophageal squamous cell cancer. Materials/Methods: From May 2009 through December 2011, 22 patients with histologically proven esophageal squamous cell cancer who were treated with intensity modulated radiation therapy were analyzed (4 cervical esophageal cancer, 11 upper thoracic esophageal cancer, 7 in the middle). The tumor lengths in long axis measured in barium esophagogram were from 2.5cm to 10cm (median: 5cm). Six patients presented with stagedisease, nine patients with stage II disease, and seven patients with stage III disease. The esophageal tumor visible in CT image and positive regional lymph nodes (LN) were contoured as the gross target volume (GTV) for each patient. Three cm longitudinal and 1.0cm radial margins were added to the esophagus GTV and LN region with positive LN to form the clinical target volume (CTV). Then two planning target volumes were formed: FPTV was GTV+0.5cm; PTV-c was CTV+0.5cm. The prescribed dose was 60-66 Gy/28-30f to PTV and 50.4 -54Gy/28-30f to PTV-c. Concurrent systemic therapy was scheduled with DP regimen (Docetaxel 75mg/kg d1 and cisplatin 60mg d1, 2) in all patients from the beginning of the radiation therapy. Locoregional control and overall survival as well as acute and late toxicities were evaluated. Results: A radiation therapy plan was completed for all patients except 1. Short-term effects were: 7 patients getting CR (33.3%), 10 patients getting PR (47.6%), 4 patients getting SD (19%). Effective rate was 66.7%. The median overall survival was 26 months. The actuarial 1, 2, 3, and 5-year overall survival rates were 95.2%, 52.4%, 23.8% and 9.5%, respectively. For the patients getting CR, the median survival was 31 months, 2-year, and 3-year survival rates were 85.7% and 57.1%, respectively. For the patients getting PR, the median survival was 19 months, 2-year, and 3-year survival rates were 40% and 10%, respectively. For the patients getting SD, the median survival was 14 months, 2-year, and 3-year survival rates were 25% and 0, respectively. Six patients (28.6%) suffered from acute CTC grade 3/4 toxicity of hematological side
effects, and 4 patients (19%) suffered from acute CTC grade 3/4 toxicity of radiation-induced esophagus. No severe side effects to lung, heart, and skin were observed. Esophagus fistula occurred in 3 patients within one year after treatment and the occurrence rate was 14.3%. Conclusion: Intensity modulated RT with an integrated boost to gross tumor with concurrent systemic chemotherapy is feasible and effective in the definitive treatment for esophageal cancer. Acute toxicities could be tolerated and accepted by the patients. Author Disclosure: M. Xu: None. J. Li: None.
2950 Program Director and Chief Resident Perspectives on the Educational Environment of U.S. Radiation Oncology Programs C.A. Berriochoa, M.A. Weller, D. Berry, C.A. Reddy, S. Koyfman, and R.D. Tendulkar; Cleveland Clinic, Cleveland, OH Purpose/Objective(s): Our goals were to examine the educational approaches utilized at radiation oncology residency programs nationwide and to evaluate program director (PD) and chief resident (CR) perceptions of their educational environment. Materials/Methods: We distributed a 21 question survey regarding curricular structure and culture via email to all identified program directors and chief residents of U.S. radiation oncology residency programs. Pearson’s chi-squared test was used to evaluate whether statistically significant differences existed between answers provided by the two study populations. Results: The survey was disseminated to 200 individuals in 85 U.S. residency programs as some programs identified more than one CR; 44/ 85 PDs (52%) and 71/115 (62%) CRs responded. There were no significant differences between the two groups of respondents in terms of program size or description (community, tertiary care, university-based). More than half of PDs and CRs report that attending physicians discussed evidence-based management, treatment plans, and reviewed contours with residents at least 75% of the time. The majority of PDs (75%) and CRs (54%) reported that at least half of the faculty conducted mock oral board exams with the residents. Over 60% of programs dedicate at least 5 hours per week for scheduled teaching conferences. The majority of PDs (84%) and CRs (59%) responded that protected educational time is “never” or “infrequently” compromised by clinical duties (PZ.005). At nearly 50% of programs, the majority of teaching conferences utilized a lecture-based approach, while only 20% had the majority of conferences implemented in a Socratic manner; however, both PDs (59%) and CRs (49%) believed that Socratic teaching is more effective than didactic lectures (16% and 20%, respectively), with the remainder responding that they are equally effective. Teaching sessions were reported to be resident-led >75% of the time by 49% of CRs versus 18% of PDs (PZ.002); 62% of CRs versus 20% of PDs felt that faculty-led teaching conferences were more effective, while 6% of CRs and 20% of PDs felt that resident-led conferences were more effective, with the remainder responding that they were equally effective (P<.001). Conclusion: This survey highlights the considerable variability in the perceived structure and effectiveness of resident education in U.S. radiation oncology residency programs. While there is strong agreement regarding the perceived efficacy of Socratic teaching methods, only a minority of programs utilize this approach on a consistent basis; PDs and CRs differ in their perceptions of the efficacy and frequency of resident-led academic conferences. This heterogeneity represents an opportunity for improvement in radiation oncology residency training. Author Disclosure: C.A. Berriochoa: None. M.A. Weller: None. D. Berry: None. C.A. Reddy: None. S. Koyfman: None. R.D. Tendulkar: None.
Volume 93 Number 3S Supplement 2015 asked them to delineate CTV again in accordance with the protocol. Clinical target volumes of the GI leader and participants were contoured for geometrical analysis (total volume, antero-posterior, latero-lateral and cranio-caudal diameters) and to calculate the mean Dice Similarity Index (mDSI). Results: The mDSI value before using the protocol was 0.70 (range 0.39-0.84), and it was increased to 0.82 (range 0.72-0.91; PZ.03) when CTV was based on the protocol. Significantly bigger craniocaudal diameter of CTV was delineated after observers used the protocol book 11.8cm (range 9.5-14.2) versus 13. cm (range 12.514.6); PZ.006. Conclusion: Use of a GI multi-institutional evidence based medicine handbook protocol significantly decreases interobserver variations of CTV delineation in external beam radiation therapy of pancreatic cancer. Further studies and strategies to evaluate and reduce intra-observer variability in CTV delineation need to be established. Author Disclosure: G. Marosevic: None. E. Butler: None. D. Mileusnic: None. D. Stricic: None. O. Arsovski: None. B. Vujosevic: None. S. Maric: None. D. Trokic: None. P. Banovic: None. S. Spasojevic: None. B. Strbac: None. A. Kostovski: None. R. Pino: None. N. Jacobs: None. R. Mills: None. C.A. Connolly: None.
2949 Phase 2 Study of Intensity Modulated Radiation With Concurrent Chemotherapy as Definitive Treatment for Esophageal Squamous Cell Cancer M. Xu and J. Li; Shan Dong Cancer Hospital, Jinan, China Purpose/Objective(s): To explore the feasibility and therapeutic effect of simultaneous integrated boost intensity modulated radiation (SIB-IMRT) and concurrent systemic chemotherapy as definitive treatment for esophageal squamous cell cancer. Materials/Methods: From May 2009 through December 2011, 22 patients with histologically proven esophageal squamous cell cancer who were treated with intensity modulated radiation therapy were analyzed (4 cervical esophageal cancer, 11 upper thoracic esophageal cancer, 7 in the middle). The tumor lengths in long axis measured in barium esophagogram were from 2.5cm to 10cm (median: 5cm). Six patients presented with stagedisease, nine patients with stage II disease, and seven patients with stage III disease. The esophageal tumor visible in CT image and positive regional lymph nodes (LN) were contoured as the gross target volume (GTV) for each patient. Three cm longitudinal and 1.0cm radial margins were added to the esophagus GTV and LN region with positive LN to form the clinical target volume (CTV). Then two planning target volumes were formed: FPTV was GTV+0.5cm; PTV-c was CTV+0.5cm. The prescribed dose was 60-66 Gy/28-30f to PTV and 50.4 -54Gy/28-30f to PTV-c. Concurrent systemic therapy was scheduled with DP regimen (Docetaxel 75mg/kg d1 and cisplatin 60mg d1, 2) in all patients from the beginning of the radiation therapy. Locoregional control and overall survival as well as acute and late toxicities were evaluated. Results: A radiation therapy plan was completed for all patients except 1. Short-term effects were: 7 patients getting CR (33.3%), 10 patients getting PR (47.6%), 4 patients getting SD (19%). Effective rate was 66.7%. The median overall survival was 26 months. The actuarial 1, 2, 3, and 5-year overall survival rates were 95.2%, 52.4%, 23.8% and 9.5%, respectively. For the patients getting CR, the median survival was 31 months, 2-year, and 3-year survival rates were 85.7% and 57.1%, respectively. For the patients getting PR, the median survival was 19 months, 2-year, and 3-year survival rates were 40% and 10%, respectively. For the patients getting SD, the median survival was 14 months, 2-year, and 3-year survival rates were 25% and 0, respectively. Six patients (28.6%) suffered from acute CTC grade 3/4 toxicity of hematological side
effects, and 4 patients (19%) suffered from acute CTC grade 3/4 toxicity of radiation-induced esophagus. No severe side effects to lung, heart, and skin were observed. Esophagus fistula occurred in 3 patients within one year after treatment and the occurrence rate was 14.3%. Conclusion: Intensity modulated RT with an integrated boost to gross tumor with concurrent systemic chemotherapy is feasible and effective in the definitive treatment for esophageal cancer. Acute toxicities could be tolerated and accepted by the patients. Author Disclosure: M. Xu: None. J. Li: None.
2950 Program Director and Chief Resident Perspectives on the Educational Environment of U.S. Radiation Oncology Programs C.A. Berriochoa, M.A. Weller, D. Berry, C.A. Reddy, S. Koyfman, and R.D. Tendulkar; Cleveland Clinic, Cleveland, OH Purpose/Objective(s): Our goals were to examine the educational approaches utilized at radiation oncology residency programs nationwide and to evaluate program director (PD) and chief resident (CR) perceptions of their educational environment. Materials/Methods: We distributed a 21 question survey regarding curricular structure and culture via email to all identified program directors and chief residents of U.S. radiation oncology residency programs. Pearson’s chi-squared test was used to evaluate whether statistically significant differences existed between answers provided by the two study populations. Results: The survey was disseminated to 200 individuals in 85 U.S. residency programs as some programs identified more than one CR; 44/ 85 PDs (52%) and 71/115 (62%) CRs responded. There were no significant differences between the two groups of respondents in terms of program size or description (community, tertiary care, university-based). More than half of PDs and CRs report that attending physicians discussed evidence-based management, treatment plans, and reviewed contours with residents at least 75% of the time. The majority of PDs (75%) and CRs (54%) reported that at least half of the faculty conducted mock oral board exams with the residents. Over 60% of programs dedicate at least 5 hours per week for scheduled teaching conferences. The majority of PDs (84%) and CRs (59%) responded that protected educational time is “never” or “infrequently” compromised by clinical duties (PZ.005). At nearly 50% of programs, the majority of teaching conferences utilized a lecture-based approach, while only 20% had the majority of conferences implemented in a Socratic manner; however, both PDs (59%) and CRs (49%) believed that Socratic teaching is more effective than didactic lectures (16% and 20%, respectively), with the remainder responding that they are equally effective. Teaching sessions were reported to be resident-led >75% of the time by 49% of CRs versus 18% of PDs (PZ.002); 62% of CRs versus 20% of PDs felt that faculty-led teaching conferences were more effective, while 6% of CRs and 20% of PDs felt that resident-led conferences were more effective, with the remainder responding that they were equally effective (P<.001). Conclusion: This survey highlights the considerable variability in the perceived structure and effectiveness of resident education in U.S. radiation oncology residency programs. While there is strong agreement regarding the perceived efficacy of Socratic teaching methods, only a minority of programs utilize this approach on a consistent basis; PDs and CRs differ in their perceptions of the efficacy and frequency of resident-led academic conferences. This heterogeneity represents an opportunity for improvement in radiation oncology residency training. Author Disclosure: C.A. Berriochoa: None. M.A. Weller: None. D. Berry: None. C.A. Reddy: None. S. Koyfman: None. R.D. Tendulkar: None.