Advanced Radiation Centers of New York

No AccessUrology PracticeHealth Policy1 Jul 2021Editorial CommentaryThis article comments on the following:A Survey of Urology Residency Program Directors Assessing Criteria to Interview Applicants during the COVID-19 Pandemic Alexandra L. Tabakin, and Nikhil K. Gupta Alexandra L. TabakinAlexandra L. Tabakin Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey More articles by this author , and Nikhil K. GuptaNikhil K. Gupta Advanced Urology Centers of New York, West Nyack, New York More articles by this author View All Author Informationhttps://doi.org/10.1097/UPJ.0000000000000233.03AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Editorial Commentary." Urology Practice, 8(4), p. 479

This randomized, multicenter, placebo-controlled, phase IV study assessed the efficacy and tolerability of onabotulinumtoxinA in patients with overactive bladder. Patients were randomized 1:1 to onabotulinumtoxinA 100 U or placebo. Assessments over 12 weeks included: change from baseline in urinary incontinence (UI) episodes/day; proportions of patients who achieved 100% and 50% or greater reductions in UI episodes/day; proportion of patients using no incontinence pads in the previous 24 hours; and changes from baseline in micturition frequency, nocturia, urgency UI, Incontinence-Quality of Life, King's Health Questionnaire, International Consultation on Incontinence Questionnaire-UI Short Form scores and time to request retreatment. Significant reductions in UI episodes/day were seen with onabotulinumtoxinA versus placebo within week 1 posttreatment (-2.9 vs -2.0, P = 0.005) through week 12 (coprimary endpoint: -3.5 vs -1.6, P < 0.001). Significantly more onabotulinumtoxinA-treated patients achieved 100% (coprimary endpoint) and 50% or greater reductions in UI episodes/day. Decreases in other urinary symptoms were also seen within 1 week with onabotulinumtoxinA that continued through at least week 12. More onabotulinumtoxinA-treated versus placebo-treated patients required no incontinence pads at weeks 1 to 12, and greater improvements in quality of life measurements were seen. Time to request retreatment was significantly longer with onabotulinumtoxinA versus placebo (30.0 weeks vs 13.1 weeks; P < 0.001). No unexpected safety signals were observed. Urinary tract infection was the most commonly observed adverse event. Urinary symptom and quality of life improvements were observed with onabotulinumtoxinA within 1 week of treatment and were sustained for at least 12 weeks.

Purpose: Recent trends in SRS use multifocal VMAT plans to simultaneously treat several, distinct targets. Conventional verification often involves low resolution measurements in a single plane, cylinder, or intersecting planes of diodes or ion chambers. This work presents an investigation into the accuracy, consistency and reproducibility of this treatment technique using a high‐resolution 3D dosimetry system (PRESAGE/Optical‐CT). Methods: A complex VMAT plan consisting of a single isocenter but 5 separate targets was created in Eclipse for a head phantom containing a cylindrical PRESAGE dosimetry insert of 10cm diameter and height. The plan contained 5 arcs delivering doses from 12–20 Gy. The treatment was delivered to four separate dosimeters positioned in the head‐phantom. Each delivery was performed after IGRT positioning using 2D and 3D kilovoltage images. A final delivery was given to a modified insert containing a pin‐point ion chamber enabling calibration of Presage data to dose. Dosimetric data was read out in an optical‐CT scanner. Consistency and reproducibility of the treatment technique (including IGRT set‐up) was investigated by comparing the dose distributions in the 4 inserts, and with the predicted TPS distribution. Results: Dose distributions from the 4 dosimeters were registered to find the mean and standard deviation at all points throughout the dosimeters. They showed less than 3% standard deviation within voxels of similar dose regions. 3D gamma maps show the calculated delivered dose matched output to within expected tolerances and errors ‐ passing rate was 98.0% (3%, 2mm). Conclusions: The deliveries of the irradiation were found to be consistent and matched the treatment plan, demonstrating high accuracy and reproducibility of the treatment machine, the IGRT procedure, and the 3D measurement. The complexity of the treatment (multiple arcs) and dosimetry (multiple strong gradients) pose a substantial challenge for comprehensive verification. 3D dosimetry can be uniquely effective in this scenario.