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The purpose of this study was to audit positioning errors during bladder image-guided radiotherapy (IGRT) and quantify survival outcomes.
Materials and methods
We carried out a retrospective review of 141 patients treated between March 2007 and July 2010 with three-dimensional conformal radiotherapy. An offline imaging protocol using kV cone beam computed tomography (CBCT) was used. Positioning errors, clinical interventions and re-planning rates were quantified. Cancer outcomes and survival were collected by review of patient notes and a registry search.
Among all, 43% of the patients required no intervention. Isocentre corrections were used for systematic bony set-up error in 13% and to improve bladder coverage in 28%. Clinical interventions to improve bladder coverage were required in 16% of the patients and repeat computed tomography planning in a further 16%. Overall, 44% of the patients demonstrated some form of organ deformation that would have resulted in inadequate dose to the bladder or significant overdose to an organ at risk if not corrected for. Post-treatment check cystoscopy was undertaken in 107 patients (76%) with 72 noted to have a complete response. Overall survival was 47·8% at 3 years.
Organ deformation during radiotherapy for bladder cancer is a significant problem for over 40% of patients. Strategies to compensate are essential to ensure optimal plan delivery.
The aim of the present study was to report the survival outcomes and late toxicity of high-dose-rate brachytherapy (HDRBT) boost for dose escalation in patients with intermediate-to-high-risk prostate cancer.
Materials and methods
Retrospective data were collected from 137 patients who had undergone definitive radiotherapy for prostate cancer between 2006 and 2010. All patients had external-beam radiotherapy (median dose 46Gy) and HDRBT. Brachytherapy dose was 19Gy in two fractions (6 hours apart) with one implant using Ir-192.
There were 94 high-risk and 43 intermediate-risk patients (NCCN classification). The median follow-up period was 60 months. The 5-year biochemical progression-free survival was 92 and 76% for intermediate- and high-risk groups, respectively. Prostate cancer-specific survival for the intermediate-risk group was 100% and for the high-risk group it was 92% at 5 years. For the entire cohort, the 5-year rate of urethral stricture formation was 13%, and the 5-year rate of late grade 2 and grade 3 gastrointestinal toxicity was 4·7 and 4·6%, respectively. There was no grade 3 or greater genitourinary toxicity.
Our data add to the growing body of literature supporting the use of HDRBT in prostate cancer. Late toxicity rates were marginally higher than that expected.
For chest wall irradiation in breast cancer patients, three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT) have made tremendous changes in treatment delivery.
The purpose of this study is to compare the dosimetric parameters in IMRT and 3DCRT plans.
Materials and methods
IMRT and 3DCRT plans were generated for 25 randomly selected postmastectomy breast cancer patients. The prescribed dose (PD) was 50 Gray (Gy) in 25 fractions (#) at the rate of 2 Gy/# with 5#/week. Dose volume histogram was evaluated for planning target volume (PTV) coverage and dose to organs at risk (OARs). All the dosimetric parameters were compared using unpaired student’s t-test.
PTV coverage was significantly better in IMRT, although the 90% of PTV was well covered by 90% of PD in all plans by both the techniques. Homogeneity index and conformity index were better in IMRT. V5 Gy and Dmean of contralateral lung, contralateral breast and heart (right side chest wall cases) were found to be lesser in 3DCRT compared with that in IMRT. However, there was no significant difference in V20 Gy of ipsilateral lung and V25 Gy of heart (left side chest wall cases) in all the plans by both the techniques.
Adequate target coverage was achieved by both the techniques, however, dose to OARs were lesser in 3DCRT plans as compared with that in IMRT plans. Thus, it can be concluded that 3DCRT is as efficient as IMRT for the chest wall irradiation.
The novel three-dimensional (3D) radiotherapy interactive outlining tool allows volumes to be created from a handful of points within axial, sagittal and coronal planes. 3D volumetric visualisation allows users to directly manipulate the resulting volume using innovative-sculpting tools. This paper discusses the development and initial evaluation of the software ahead of formal clinical testing.
Materials and methods
User feedback was collated as part of the software development phase to ensure clinical suitability, define user training strategies and identify best practice. A loosely structured format was adopted with leading descriptive questions aiming to generate suggestions for improvements and initiate further discussion.
The four participants reported great satisfaction and value in being able to use all three planes for outlining, although orientation in 3D was evidently a problem. All participants felt that the software was capable of producing acceptable outlines rapidly and that the multi-planar capability allowed for improved outlining of the prostate apex.
Mesh generation from a small number of points placed on a range of planes is a rapid and effective means of target delineation. Multi-slice volume sculpting and 3D orientation is challenging and may indicate a need for a paradigm shift in anatomy and computed tomography training.
Emotional intelligence (EI) is an increasingly important aspect of a health professional’s skill set. It is strongly associated with empathy, reflection and resilience; all key aspects of radiotherapy practice. Previous work in other disciplines has formed contradictory conclusions concerning development of EI over time. This study aimed to determine the extent to which EI can develop during a radiotherapy undergraduate course and identify factors affecting this.
Methods and materials
This study used anonymous coded Likert-style surveys to gather longitudinal data from radiotherapy students relating to a range of self-perceived EI traits during their 3-year degree. Data were gathered at various points throughout the course from the whole cohort.
A total of 26 students provided data with 14 completing the full series of datasets. There was a 17·2% increase in self-reported EI score with a p-value<0·0001. Social awareness and relationship skills exhibited the greatest increase in scores compared with self-awareness. Variance of scores decreased over time; there was a reduced change in EI for mature students who tended to have higher initial scores. EI increase was most evident immediately after clinical placements.
Radiotherapy students increase their EI scores during a 3-year course. Students reported higher levels of EI immediately after their clinical placement; radiotherapy curricula should seek to maximise on these learning opportunities.
To review the incidence of clinically significant pulmonary toxicity following total body irradiation (TBI) as a part of the conditioning regimen for acute lymphoblastic leukaemia (ALL) patients undergoing bone marrow transplantation (BMT) at The Ottawa Hospital Cancer Centre.
This is a retrospective review of ALL patients who received TBI in The Ottawa Hospital Bone Marrow Transplant Program (TOH-BMT) as part of their conditioning regimen from 1991 to 2011 inclusive. The patients were treated using a locally developed translating-couch irradiation technique. We have analysed all available data for the first 100 days following TBI to determine the incidence of radiation-induced pulmonary toxicities.
Of the total 622 patients undergoing TBI during the specified period, 88 had ALL. Median age at BMT was 30 years and the conditioning regimens varied. A total of 74 (84%) patients received 12 Gy/6 F/BID of TBI. A total of 55 (63%) patients have died, 32 (36%) within the 1st year after BMT. In the 1st year, pulmonary events were reported for 24 (27%) patients, and the follow-up notes were unavailable for seven (8%). Pulmonary toxicities were reported as the cause of death for six patients, five (6%) within the 1st year. It is estimated that the total number of deaths in the 1st year possibly attributed to radiation-induced lung injury was four (4·5%). Eight (9%) patients had symptoms suggestive of non-lethal grade 2–3 radiation-induced pneumonitis.
TBI continues to be an important component of the conditioning regimen for ALL patients undergoing BMT, and the incidence of radiation-induced pulmonary injury, using our technique and lung dose, is comparable to the published literature.
Locally advanced head and neck cancer can be a distressing disease due to a variety of reasons. This retrospective study looks at the tolerability and outcomes for palliative split-course hypofractionated radiotherapy for this group of patients treated in our centre.
A total of 59 patients were treated with hypofractionated split-course radiotherapy for incurable mucosal squamous cell carcinoma of the head and neck region in our centre over a 10-year period. In all, 71% had stage IV disease. Radiotherapy consisted of three phases of 14·4 Gy/phase, in four to eight fractions over 4 days giving one·8–3·6 Gy/fraction. The phases were separated by 2 weeks. A total of 40 patients (63%) completed all three phases. A total of 72% patients had no acute toxicities and the palliation rate was 83% (complete and partial). Only five patients had no meaningful palliation having completed all three phases. Median duration of local control was 6 months (range: 1–63 months) and median overall survival was 8 months (range: 1–68 months). In five patients, the control was durable with no recurrence at the time of analysis with survival ranging from 6 to 57 months.
We are the first UK centre to report with long-term data, the use of a palliative three phase regime that provides meaningful palliation with acceptable toxicities. In addition, for some patients, it has resulted in durable long-term control.
During radiotherapy of the prostate it is important to minimise interfraction prostate motion to allow dose escalation and reduce normal tissue damage. Rectal volume has been identified as playing a significant role in prostate motion with various methods used to reduce it. The aim was to systematically review published literature to allow evidence based recommendations to be made to current practice to reduce interfraction prostate motion.
Materials and methods
A systematic search of CINAHL, Medline, PubMed, Science Direct, NHS Evidence and The Cochrane Library was performed. Limited searches of The Society of Radiographers website, OpenGrey and COPAC were undertaken, alongside manual searches of cross references of eligible articles. The quality of included papers was measured using a pre-existing tool. The causes, consequences and solutions to manage rectal volume and its effect on prostate position were extracted, compared and evaluated to extract solutions to be implemented into clinical practice.
Of the 2,339 unique articles systematically retrieved, 23 met the inclusion criteria, 15 of which discuss radiotherapy, five constipation and three flatulence.
A combined medicinal and dietary approach adaptable to departmental workflow is required to manage rectal volume, with special consideration to patients with pre-existing extrinsic factors.
London South Bank University (LSBU) has successfully implemented Virtual Environment for Radiotherapy Training (VERT) across the therapeutic radiography training curricula and are now supporting the use of VERT for patient education in clinical departments. A number of publications have reported on the use of VERT in education and training; more recent literature has focused on the use of VERT for patient education.
Materials and methods
The successful introduction of VERT before students’ first clinical placements resulted in the development of a ‘Pre-Clinical week’ where students practice and improve their technical skills, using the hand controls without a patient present, leading to increased confidence in clinical practice. Other examples of VERT curriculum integration at LSBU focused on the use of VERT for anatomy teaching. The more recent innovation at LSBU relevant to VERT integration has been the design, development and implementation of collaborative research projects where the aims of the studies were to explore patients’ perceptions of VERT as an information giving resource before radiotherapy delivery.
The introduction of VERT as education tool has enabled academic staff to develop a range of teaching methods to embed virtual training into the traditional classroom setting, demonstrating innovation and collaboration.
At The Radiation Medicine Program described, the entire radiation therapy (RT) workflow was previously conducted through the use of two electronic programs. It duplicated workflow and created a situation where it was difficult to measure the RT process. Recent enhancements to the electronic medical record facilitated the consolidation of RT planning and treatment workflows into one electronic system.
This report will describe the clinical implementation of electronic Radiation Oncology (RO) Care Plans at a Regional Cancer Centre, and how they can be applied as a foundation for RT process improvements.
Impact and outcome
A total of 51 Care Plans and 95 IQ Scripts were successfully implemented. The benefits of RO Care Plans include a more streamlined process, removed ambiguity, improved communication, standardised workflow and automation of tasks. In addition, multiple performance indicators can be obtained from the RO Care Plans, such as caseload reports, workflow reports and a ‘white board’.
The implementation of RO Care Plans serves as a foundation for data-driven process improvement at a local Regional Cancer Centre.
Deep inspiratory breath hold (DIBH) during left-breast irradiation helps to minimise cardiac irradiation by physically separating the heart from the left breast. The dose to organs-at-risk in intensity-modulated radiotherapy (IMRT) and opposed tangent three-dimensional conformal radiotherapy (3DCRT) during DIBH in patients with left-sided breast cancer was compared.
Materials and methods
A total of 20 consecutive patients with left-sided breast cancer had a computed tomography scan utilising DIBH. Mean volumes of the heart, left anterior descending coronary artery, total lung and right breast receiving 5–95% of the prescription dose were calculated.
Target volume homogeneity was improved with IMRT and average mean dose to target was higher for 3DCRT (51·03 Gy) compared with IMRT (50·47 Gy, p<0·01). The average mean dose to the heart was lower with 3DCRT (87 versus 77 cGy, p<0·01). The average mean dose to the contralateral breast was also lower with 3DCRT (19 versus 17 cGy, p<0·01). Less monitor units (MUs) were required with 3DCRT with an average difference of 225 MU/fraction (p<0·01).
Under DIBH, absolute differences between 3DCRT and IMRT were minimal. 3DCRT under DIBH provided excellent dosimetric results in most patients with left-sided breast cancer without the need for IMRT.
An astroblastoma is a rare primary glial tumour occurring preferentially in young adults. It is characterised by a perivascular arrangement of tumour cells forming perivascular pseudorosettes mimicking ependymomas. The histogenesis of astroblastoma is unclear.
We present the history of a 13-year-old girl with chief complaints of headache associated with vomiting, blurring of vision on the left eye and a history of diplopia on the right eye. She underwent left parietal parasagittal craniotomy and near-total excision of tumour. She was planned for postoperative radiotherapy 5,940 cGy in 28 fractions along with concurrent temozolamide100 mg. She had no neurological deficit or complaints during her last visit.
Astroblastomas are a distinct clinic pathologic entity, with well-described radiologic, pathologic and cytogenetic features. Its recurrence is high, and efforts must be made to elucidate the role and usefulness of radiotherapy and chemotherapy in these tumours.