Survey: "breast cancer: applicability and limits of international guidelines" (French)

Enquête: "cancer du sein: applicabilité et limites des guidelines internationales".

Quel que soit notre lieu d’exercice, nous connaissons, lisons et utilisons tous les mêmes recommandations internationales. Afin de faire le point sur l'applicabilité et les limites des guidelines internationales concernant la pratique de la radiothérapie mammaire, nous vous remercions de prendre quelques instants pour répondre à ce questionnaire. Ce questionnaire n’est probablement pas exhaustif, n’hésitez pas à amender vos réponses de commentaires dont nous ne manquerons pas de tenir compte lors de l'analyse.

Questionnaire.

Cette étude est menée conjointement entre la société marocaine de cancérologie (SMC) et la SFRO. Nous vous remercions de prendre quelques minutes afin de répondre à cette enquête avant le 30 aout 2023 ainsi que de la diffuser largement autour de vous.

SFRO

Société Française de Radiothérapie Oncologique (French) (French Society of Radiation Oncologists).

Survey: "Applicability of international recommendations in the management of cervical cancer" (French)

Enquête: "Applicabilité des recommandations internationales dans la prise en charge du cancer du col utérin": link.

Cette étude est menée conjointement entre la Société Marocaine de Cancérologie (SMC) et la Société Française de Radiothérapie Oncologique (SFRO). Nous vous remercions de prendre quelques minute afin de répondre à cette enquête avant le 15 aout 2023 ainsi que de la diffuser largement autour de vous.

SDX introduction - Zero in on a moving target

ABGT, Lda.; SDX® Respiratory Gating System, DYN’R, SAS, a spirometry-based system.

Stability

It is «a measure of how the accuracy and precision of the system perform over time [1].»

[1]

«Stability deals with the degree to which sensor characteristics remain constant over time. Changes in stability, also known as drift, can be due to components aging, decrease in sensitivity of components, and/or a change in the signal to noise ratio, etc [2].»

Bibliographic references:

[1] Reliawiki. 2017. Measurement System Analysis. [online] Available at: <https://reliawiki.org/index.php/Measurement_System_Analysis> [Accessed 20 February 2022].

[2] Apogeeinstruments.com. 2022. Uniformity, Repeatability, Stability, and Accuracy. [online] Available at: <https://www.apogeeinstruments.com/uniformity-repeatability-stability-and-accuracy/> [Accessed 20 February 2022].

SPO (Sociedade Portuguesa de Oncologia)

SPO (Sociedade Portuguesa de Oncologia [Portuguese Society of Oncology]).

Reference: SPO. n.d. Sociedade Portuguesa Oncologia. [online] Available at: <https://www.sponcologia.pt/pt/> [Accessed 28 April 2020].

SEOR

Sociedad Española de Oncología Radioterápica (SEOR) (Spanish Society of Radiation Oncology).

Bibliographic reference: SEOR. n.d. Inicio - SEOR. [online] Available at: <http://www.seor.es/> [Accessed 26 April 2020].

Siewert classification

AC = anatomical cardia

Source: Ulla M, et al. Esophageal cancer characterization with pneumo-64-MDCT. Abdom Imaging. 2012 Aug;37(4):501-11. Available at: https://doi.org/10.1007/s00261-011-9784-z.

«The Siewert-Stein classification is a system of anatomical classification used for adenocarcinomas of the esophagogastric junction.»

Bibliographic reference: En.wikipedia.org. (2019). Siewert classification. [online] Available at: https://en.wikipedia.org/wiki/Siewert_classification [Accessed 28 Mar. 2019].

Stomach parts

«This drawing shows the parts of the anterior surface of the stomach. The body of the stomach is separated from the pyloric part by an oblique line that extends from the angular notch (incisura angularis) on the lesser curvature to the greater curvature.»

Source: Uptodate.com. (2019). UpToDate. [online] Available at: https://www.uptodate.com [Accessed 28 Mar. 2019].

Spinal cord end

«In humans, the spinal cord stops growing in infancy and the end of the spinal cord is about the level of the third lumbar vertebra, or L3, at birth. Because the bones of the vertebral column continue to grow, by about 12 months of age, the end of the cord reaches its permanent position at the level of L1 or L2 (closer to the head). However, due to normal anatomical variations, the final cord end position may occur anywhere from the twelfth thoracic vertebra (T12) to L3.»

Source: Spine and Pelvis [Internet]. Musculoskeletal Key. 2016 [cited 2019 Jul 7]. Available from: https://musculoskeletalkey.com/spine-and-pelvis-3/.

Bibliographic reference: En.m.wikipedia.org. (n.d.). Cauda equina. [online] Available at: https://en.m.wikipedia.org/wiki/Cauda_equina [Accessed 27 Mar. 2019].

Statistics

«The statistics studies how to collect data (How many? In what way?) and how to analyze them to obtain the information that allows answering the questions that we put. It is about producing knowledge through observation and analysis of reality, in an intelligent and objective way. It is the essence of the scientific method.»
«To summarize a set of information from a large dataset, certain quantities are selected which concentrate the most possible information, and through them - can be 5 or 6 points - we can get a fairly accurate idea of the behavior of the data in general. These amounts are normally divided into three groups: tendency (center), scale (or dispersion), and location.»

Bibliographic reference: Grima P. Os segredos da estatística - a certeza absoluta e outras ficções. National Geographic - Edição Especial Matemática. 2018:15.

SABR (stereotactic ablative radiotherapy)

It is a stereotactic radiotherapy with dose by a fraction greater than 8 Gy, that allows stopping both cellular division and cellular function, overwhelms tumor repair, and is more likely to cause «late» effects.

Bibliographic reference: Timmerman RD. An overview of hypofractionation and introduction to this issue of seminars in radiation oncology. Semin Radiat Oncol. 2008 Oct;18(4):215-22. Available at: https://doi.org/10.1016/j.semradonc.2008.04.001.

Single brain metastases

It «is only one brain lesion in addition to other sites of disease.»
Bibliographic reference: Kehrer JD, Stall B. 87 - Brain Metastases. In: Hristov B, Lin S, Christodouleas J. Radiation Oncology. 2nd ed. Philadelphia, USA: Wolters Klumer Health; 2015:567.

Solitary brain metastases

It «is only one brain lesion and the only site of disease.»
Bibliographic reference: Kehrer JD, Stall B. 87 - Brain Metastases. In: Hristov B, Lin S, Christodouleas J. Radiation Oncology. 2nd ed. Philadelphia, USA: Wolters Klumer Health; 2015:567.

SPECT (single photon emission computed tomography)

SPECT, or less commonly, SPET [3], is a medical imaging technique that is based on conventional nuclear medicine imaging, using gamma rays, and tomographic reconstruction methods. It is «performed by using a gamma camera to acquire multiple two-dimensional (2D) images from multiple angles» [4]. «The images reflect functional information about patients similar to that obtained with positron emission tomography (PET). Both SPECT and PET (...) give information based on the spatial concentration of injected radiopharmaceuticals» [1]. It «is a type of nuclear imaging test that shows how blood flows to tissues and organs» [2]. It is very similar to conventional nuclear medicine planar imaging using a gamma camera (that is, scintigraphy), but, it is able to provide true three-dimensional (3D) information [3]. A computer is used to apply a tomographic reconstruction algorithm to the multiple 2D projections, yielding a 3D dataset. «This dataset may then be manipulated to show thin slices along any chosen axis of the body» [4]. SPECT can be used to complement any gamma imaging study, where a true 3D representation can be helpful, (e.g., tumor imaging, infection (leukocyte) imaging, thyroid imaging or bone scintigraphy). Because SPECT permits accurate localization in 3D space, it can be used to provide information about the localized function in internal organs, such as functional cardiac or brain imaging [3].

Bibliographic references:

[1] National Research Council (US) and Institute of Medicine (US) Committee on the Mathematics and Physics of Emerging Dynamic Biomedical Imaging. Mathematics and Physics of Emerging Biomedical Imaging. Washington (DC): National Academies Press (US); 1996. Chapter 5, Single Photon Emission Computed Tomography. Available at: https://www.ncbi.nlm.nih.gov/books/NBK232492/. Accessed October 15, 2017.

[2] SPECT (single photon emission computed tomography) scan. Mayfield Brain & Spine. 2016. Available at: https://www.mayfieldclinic.com/PE-SPECT.htm. Accessed October 15, 2017.

[3] Single-photon emission computed tomography. Enwikipediaorg. 2017. Available at: https://en.wikipedia.org/wiki/Single-photon_emission_computed_tomography. Accessed October 15, 2017.
[4] Hricak H, Akin O, Vargas HA. (2013). C. In: L. Brady and T. Yaeger, ed., Encyclopedia of Radiation Oncology, 1st ed. Springer-Verlag Berlin Heidelberg, pp.790.

Standard error (SE)

«These are the SEs for the descriptive statistics. The SE gives some idea about the variability possible in the statistic [1].» It «(...) is a measure of the variability of a statistic. It is an estimate of the standard deviation of a sampling distribution [2].» It «(...) is the standard deviation of the sampling distribution of a statistic, (...) (Everitt BS, 2003, cited in [3]). «The SE of the mean [SEM] (...) is the theoretical standard deviation of all sample means of size n drawn from a population and depends on both the population variance (sigma) and the sample size (n) (...) [4].» «The SEM can be seen to depict the relationship between the dispersion of individual observations around the population mean (the standard deviation), and the dispersion of sample means around the population mean (the SE). Different samples drawn from that same population would in general have different values of the sample mean, so there is a distribution of sampled means (with its own mean and variance). (...) As the sample size increases, the dispersion of the sample means clusters more closely around the population mean and the SE decreases [3].» «The SE depends on three factors: the number of observations in the population (N), the number of observations in the sample (n), and the way that the random sample is chosen. If the population size is much larger than the sample size, then the sampling distribution has roughly the same SE, whether we sample with or without replacement . On the other hand, if the sample represents a significant fraction (say, 1/20) of the population size, the SE will be noticeably smaller, when we sample without replacement [2].» «The SE of the proportion (...) is the standard deviation of the distribution of the sample proportion over repeated samples [4].»

Source: Steve's Favorites. Pinterest. Available at: https://www.pinterest.pt/pin/419819996504206121/. Accessed November 3, 2017.

Bibliographic references:

[1] Annotated SPSS Output: Descriptive statistics [Internet]. Ats.ucla.edu. 2016 [cited 20 November 2016]. Available from: http://www.ats.ucla.edu/stat/spss/output/descriptives.htm.

[2] Statistics Dictionary [Internet]. Stattrek.com. 2016 [cited 20 November 2016]. Available from: http://stattrek.com/statistics/dictionary.aspx.

[3] Standard error [Internet]. En.wikipedia.org. 2016 [cited 20 November 2016]. Available from: https://en.wikipedia.org/wiki/Standard_error#cite_note-1.

[4] Statistics Glossary: S [Internet]. Statsoft.com. 2016 [cited 20 November 2016]. Available from: http://www.statsoft.com/textbook/statistics-glossary/s#Standard.

Standard deviation (σ or s)

«The standard deviation of a population is denoted by σ and the standard deviation of a sample, by s [1].» It is a measure of dispersion or absolute variability [2,3] in original units (unit of measurement equal to that of the mean). It is the positive square root of the variance (σ² or s² or Var[X]). It «is useful as a measure of variation within a given set of data» [4]. «A small value of the standard deviation indicates that most values are close to the sample mean. A large value of the standard deviation indicates many values are far from the sample mean. Other words which are used to convey the concept of the standard deviation are “spread” and “scale.”» It is «the “typical” spread of observations about the sample mean [2].» It «is a numerical value used to indicate how widely individuals in a group vary. If individual observations vary greatly from the group mean, the standard deviation is big; and vice versa [1].»

Bibliographic references:
[1] Stattrek.com. (2016). Statistics Dictionary. [online] Available at: http://stattrek.com/statistics/dictionary.aspx [Accessed 13 Nov. 2016].
[2] Supino, P. and Borer, J. (2012). Principles of research methodology. 1st ed. New York, NY: Springer.
[3] Doi, S. and Williams, G. (2013). Methods of clinical epidemiology. 1st ed. Berlin: Springer.

[4] Daniel, W. and Cross, C. (2013). Biostatistics: a foundation for analysis in the health sciences. 10th ed. Danvers, Massachusetts, USA: John Wiley & Sons, Inc.

Systematic review

It answers a defined research question by collecting and summarising all empirical evidence that fits pre-specified eligibility criteria [1]. It is a thorough, comprehensive, and explicit way of interrogating the medical literature. It typically involves several steps, including asking an answerable question, identifying one or more databases to search, developing an explicit search strategy, selecting titles, abstracts, and manuscripts based on explicit inclusion and exclusion criteria, and abstracting data in a standardized format [2]. They often, but not always, use statistical techniques (meta-analysis) to combine results of eligible studies, or at least use scoring of the levels of evidence depending on the methodology used. While many systematic reviews are based on an explicit quantitative meta-analysis of available data, there are also qualitative systematic reviews which adhere to standards for gathering, analyzing and reporting evidence. A review of existing studies is often quicker and cheaper than embarking on a new study. Systematic reviews of randomized controlled trials are key in the practice of evidence-based medicine [3].

Bibliographic references:

[1] Ccace.ed.ac.uk. (2013). Systematic reviews and meta-analyses: a step-by-step guide | www.ccace.ed.ac.uk. [online] Available at: http://www.ccace.ed.ac.uk/research/software-resources/systematic-reviews-and-meta-analyses [Accessed 21 Jun. 2016].

[2] Researchcore.org. (2016). ResearchCore.org - What is the difference between a "systematic review" and a "meta-analysis"?. [online] Available at: http://www.researchcore.org/faq/answers.php?recID=5 [Accessed 21 Jun. 2016].

[3] Wikipedia. (2016). Systematic review. [online] Available at: https://en.wikipedia.org/wiki/Systematic_review [Accessed 21 Jun. 2016].

Shaving or shave biopsy

It is a biopsy of a skin lesion by excising it with a cut parallel to the surface of the surrounding skin.

Bibliographic reference: TheFreeDictionary.com. (2012). shave biopsy. [online] Available at: http://medical-dictionary.thefreedictionary.com/shave+biopsy [Accessed 5 Jun. 2016].

Split course

It is a set of fractions planned and prescribed as a whole with a period of no treatment during them [1]. Split-course radiation therapy is an altered fractionation regimen originally designed to diminish radiation morbidity by splitting the total dose into at least two separate courses with an interruption of 10 to 14 days [2]. It allows  the body recovers while the cancer shrinks [3]. It may be disadvantageous compared with continuous treatment because the decreased radiation morbidity of normal tissues will also result in lower anti-tumour efficiency and reduced local control rates. There is also concern about repopulation during the rest period [4]. There are at least three regimens of split-course radiotherapy [5]:

1. Standard total treatment dose at 1.8 to 2.0 Gy fraction size, but with different total treatment time and an interruption interval of one to two weeks;
2. Standard total treatment dose but different fraction size to maintain the same overall treatment time including the interruption interval of one to two weeks;
3. Different total treatment dose, fraction size, overall treatment time and interruption interval.

Bibliographic references:
[1] Datadictionary.nhs.uk. (2016). Supporting Information: Radiotherapy Treatment Course. [online] Available at: http://www.datadictionary.nhs.uk/data_dictionary/nhs_business_definitions/r/radiotherapy_treatment_course_de.asp?shownav=1 [Accessed 2 Jun. 2016].

[2] Scanlon TW. Split dose radiotherapy: the original premise. Int J Radiat Oncol Biol Phys 1980;6:527-8. Available at: http://dx.doi.org/10.1016/0360-3016(80)90072-3.

[3] Cancer.org. (2015). External radiation therapy. [online] Available at: http://www.cancer.org/treatment/treatmentsandsideeffects/treatmenttypes/radiation/understandingradiationtherapyaguideforpatientsandfamilies/understanding-radiation-therapy-external-radiation-therapy [Accessed 2 Jun. 2016].

[4] Parsons JT, Bova FJ, Million RR. A re-evaluation of split-course technique for squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 1980;6:1645-52. Available at: http://dx.doi.org/10.1016/0360-3016(80)90246-1.

[5] Members of the Lung Cancer Disease Site Group. Altered fractionation of radical radiation therapy in the management of unresectable non-small cell lung cancer. Toronto (ON): Cancer Care Ontario; 2002 Sep [Endorsed 2012 Nov]. Program in Evidencebased Care Practice Guideline Report No.: 7-12 Version 2. Available at: https://www.cancercare.on.ca/common/pages/UserFile.aspx?fileId=14170 [Accessed 2 Jun. 2016].