2
Pediatric craniospinal irradiation: proton beam and medical ethics Johnstone et al and Wolden Proton beam, because of its cost and complexity, raises a host of challenging ethical and societal issues. There is, however, widespread agreement that its strongest justification is in the treatment of pediatric malignancies. In a special point-counterpoint feature this month, two distinguished radia- tion oncologists debate a particular pediatric scenario: craniospinal radiation for medullo- blastoma. Peter Johnstone et al thoughtfully argue that proton beam is the only ethical approach and that every effort should be made to ensure that every child has the opportunity to be treated this way. Suzanne Wolden takes the contrary stance arguing that without better data, patients and parents should not have to suffer the considerable burden of relocation for proton therapy when very acceptable standard therapy may exist much closer to home. Page 228 and Page 231 ABR Examinations: The Why, What, and How Becker et al Every radiation oncologist and physicist in the United States has a relationship with the American Board of Radiology (ABR), which has provided certification for more than 75 years and is now addressing the publicly demanded need for ongoing eval- uation through its Maintenance of Certifi- cation program. The Board certification process is an expression of the social contract between the profession and the public by which the profession enjoys the privilege of self-regulation and the public is assured that it can expect medical profes- sionals to put the interests of the patient first, guarantee the competence of practi- tioners, and guard the public health. One of the ABR’s primary tools is the secure proctored examination. This article summarizes the seven standards, based on the science of psychometrics, that are used in the development of these examinations. Page 237 Oncology ScandLow-Grade Gliomas: Predicting and Changing Outcome Kirkpatrick In this month’s Oncology Scan, Central Nervous System Associate Editor John Kirkpatrick takes a detailed look at several important new studies in low-grade glioma from the wider oncologic literature. Those he has chosen study the question of radia- tion, with or without chemotherapy, and also ask questions about dose and frac- tionation. In addition, he has chosen studies that highlight validated prognostic scoring scales and novel molecular markers that predict for outcome. Page 234 Randomized Noninferiority Trial of Reduced High-Dose Volume Versus Standard Volume Radiation Therapy for Muscle-Invasive Bladder Cancer: Results of the BC2001 Trial (CRUK/01/004) Huddart et al The organ-sparing management of bladder cancer is a potential “growth area” for radiation oncology and several important publications in 2013 have added strong data in support of this approach. This phase 3 randomized trial from the UK takes a close look at an important technical aspect of therapy asking whether or not reducing radiation dose delivered to the uninvolved bladder can reduce toxicity without compromising local control. No significant differences in toxicity were seen between standard and reduced high-dose volume radiation therapy groups. Rates of late toxicity were lower than anticipated. Non- inferiority of local control was not formally proven. This study opens the door to future work using image-guided treatment perhaps with dose-escalation. Page 261 CME ISSUE HIGHLIGHTS October 1, 2013
