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Compare & Contrast Analysis Part One: Trade Article

In the field of radiation oncology, there are various methods utilized to effectively treat
patients. The dose, duration, and patient position can all be adjusted to perform various treatment
combinations. In her article, “Study Reveals Long-Term Benefits with Prone Hypo-fractionated
Radiation Therapy and a Concurrent Boost in Early-Stage Breast Cancer” on the website The
ASCO Post, author Susan Reckling discusses one of these treatment techniques.

Reckling cites a study performed by Dr. Osa regarding hypo-fractionated prone breast
cancer radiation treatments. In this study, Dr. Osa evaluated 404 patients with early-stage breast
cancer. These patients were prescribed 40.5 Gy over fifteen treatments while undergoing a
concomitant daily boost of 0.5 Gy to the tumor bed.1 The total treatment time was three weeks.
Of these patients, 92% of them were treated in the prone position. The subsequent results from
this study are quite extraordinary. The five year cumulative survival rate was 98.7%.1
Researchers observed that late treatment toxicities were limited to grade one or two. On top of
that, a total of 377 patients measured their cosmetic results to be excellent. In conclusion,
Reckling reflects that the trial “may provide conclusive data on the future role of hypo-
fractionated radiation therapy in treating early-stage breast cancer.”1

I found this article fascinating and very informative. The author clearly and eloquently
displays the subject matter. She walks the reader through the study and formulates an appropriate
conclusion. As a medical dosimetrist, I believe this article could directly affect the way in which
we treat early stage breast cancer. Perhaps we, as a radiation oncology community, need to take
consider the conclusions this article arrives at.

The accuracy of this article and the information provided are of no concern to me.
Throughout the article, the author continually cites and draws information from a reputable
source. There is very little postulating and a strong focus on the concrete facts of the study. The
website itself, The ASCO Post, appears to be a reliable source as well.

In my opinion, this article contains many strengths and very few weaknesses. Throughout
her work, Reckling is focused on the data. She provides both the statistics and observed results of
the study. She cites appropriately and gives full credit to the architect of the study, Dr. Osa. One
issue I surprisingly have with this article is the author’s lack of opinion. While she provides
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useful information, she essentially just recaps the study. There is only a small section at the end
of the article where she mentions her opinion on the matter. Perhaps she feels as if she doesn’t
need to add or isn’t qualified to speculate on the material. If that is the case, then her noted
silence is commendable. It is simply something I noticed and found interesting.

In conclusion, this article brings a very interesting treatment modality to the community’s
attention. Perhaps, upon viewing this study and its results, we should consider adapting our
methods to conform to the study’s suggestions. In radiation oncology, the patient is the priority.
As medical professionals, we should offer a treatment which is as convenient as possible while
continuing to provide quality care. Hypo-fractionated prone breast radiation treatments may be a
way in which we can do this.

References:

1. Reckling, S. Study Reveals Long-Term Benefits With Prone Hypofractionated Radiation

Therapy and a Concurrent Boost in Early-Stage Breast Cancer. The ASCO Post.
http://www.ascopost.com/News/16326 . Updated 6/17/2014. Accessed 1/29/2018.
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Compare & Contrast Analysis Part Two: Peer-Reviewed Article

Cancer is a devastating disease which affects millions of people. Hepatocellular

carcinoma is the third most common cause of death from cancer worldwide.1 In their peer
reviewed article, “Stereotactic Body Radiation Therapy as an Alternative Treatment for Small
Hepatocellular Carcinoma” published by PLOS One, authors Sang Min Yoon, Young-Suk Lim,
So Yeon Kim, and others discuss the merits of using SBRT to treat this deadly disease.

In their study, these researchers utilized a database of 93 patients who were treated with
SBRT for hepatocellular carcinoma between 2007 and 2009. Each of these patients were
prescribed a dose of 10-20 Gy per fraction given over three to four consecutive days. This totaled
a dose of 30-60 Gy. After a follow-up period, the median size of tumors was two centimeters.
Patient’s survival rates at one and three years were 86.0% and 53%. Patients who did not have
recurrence had a survival rate of 92.1% at three years. The group concluded that SBRT was
effective in the local control of small hepatocellular carcinoma. They stated, “SBRT may be a
promising alternative treatment for patients with small HCC which is unsuitable for other
curative therapy.”2

This article is very well laid out. Its format is easy to follow and contains the appropriate
subsections that research articles should have. The authors clearly describe and communicate
their intentions. The problem, the effective treatment of small hepatocellular carcinoma, is made
evident from the very beginning. In the introduction, a background is provided to give context.
This review contains statistical data regarding hepatocellular carcinoma and explains the
difficulties in treating this disease. While this section is rather short, I feel it lays the groundwork
adequately for the rest of the article.

I found the overall organization of the paper to be impressive. The “Materials and
Methods” section contained multiple subsections with titles like, “Ethics Statement”, “Patients”,
“Treatment Planning and Delivery”, and “Evaluation and Statistics”. This assists the reader in
comprehending the information provided. In this study, 129 patients were registered with 93
meeting the enrollment criteria. Due to the specific nature of the research topic, this number of
patients seems sufficient to me.
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The actual methods implemented in this study were rather straightforward. These patients
were all immobilized in the supine position. A Real-time Position Management respiratory
gating system was used to record the patients breathing patterns.1 A dose of 10-20 Gy per
fraction was given over 3-4 consecutive days. This resulted in a total dose of 30-60 Gy.1 Imaging
was performed in two stages before each treatment. First, a cone-beam CT with 3D matching
was performed. This was followed by gated fluoroscopy to confirm the marker positions at the
exhale phase.1 The only area of note, for me, is the varying doses administered to the patients.
There is a substantial difference between 30 and 60 Gy. The researchers however explain this by
clarifying the rationale behind each individual’s prescription.

The results are organized in a similar fashion to the “Materials and Methods” section.
There are multiple subsections to help the reader process the information. When it comes to the
actual statistical data, the researchers do a phenomenal job of providing this to the reader.
Survival rates, tumor response, additional treatment after SBRT, and treatment-related toxicities
are all displayed in the results.

The discussion section of this article is where I feel the researchers succeeded the most.
Charts, graphs, and tables are all utilized to assist in discussing the information. This section is
easily the largest in the paper. From the beginning, the researchers are clear that hepatic resection
is the primary curative treatment for hepatocellular carcinoma.1 They want to make sure that the
reader does not draw any unfounded conclusions from their research. However, the writers are
very clear in what they want their audience gather from their study. “In conclusion, the SBRT is
a noninvasive and an excellent ablative treatment modality for patients with small,
primary/recurrent HCC.”1

The authors cite from a large list of sources. These sources date from 2001 to 2012 with
the majority dated between 2008 and 2012. Given the rapidly advancing nature of radiation
oncology, these dates seem appropriate to me. If the researchers were utilizing articles that were
older than these, there would be reason for concern.

In conclusion, I found the article fascinating. The subject material was relevant and the
conclusions seemed logical. I appreciated the way in which the researchers presented their
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findings. At my current clinical site, the physicians utilize SBRT for hepatocellular carcinoma
frequently. Evidently, they agree with the findings of this study as well.

References:

1. Sang Min Yoon, Young-Suk Lim, Mee Jin Park, So Yeon Kim, Byungchul Cho, Ju Hyun
Shim, Kang mo Kim, Han Chu Lee, Young-Hwa Chung, Yung Sang Lee, Sung Gyu Lee,
Yu Sun Lee, Jin-hong Park, Jong Hoon Kim. Stereotactic Body Radiation Therapy as an
Alternative Treatment for Small Hepatocellular Carcinoma. PLOS One. November 2013;
8(11): 1-10.
http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC3821847&blobtype=pdf .
Accessed January 30, 2018.

In conclusion, both articles I chose contained valuable information regarding various

treatment techniques. While the trade article was substantial, the peer-reviewed article
simply contained more data. For me, that is the takeaway from this exercise. While you
can find great, useful information in trade articles, nothing can replace a peer-reviewed
journal when it comes to hard data.