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Lewin J, Sayers L, Kee D, Walpole I, Sanelli A, Te Marvelde L, Herschtal A, Spillane J, Gyorki D, Speakman D, Estall V, Donahoe S, Pohl M, Pope K, Chua M, Sandhu S, McArthur GA, McCormack CJ, Henderson M, Hicks RJ, Shackleton M. Surveillance imaging with FDG-PET/CT in the post-operative follow-up of stage 3 melanoma. Ann Oncol 2019; 29:1569-1574. [PMID: 29659679 DOI: 10.1093/annonc/mdy124] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background As early detection of recurrent melanoma maximizes treatment options, patients usually undergo post-operative imaging surveillance, increasingly with FDG-PET/CT (PET). To assess this, we evaluated stage 3 melanoma patients who underwent prospectively applied and sub-stage-specific schedules of PET surveillance. Patients and methods From 2009, patients with stage 3 melanoma routinely underwent PET +/- MRI brain scans via defined schedules based on sub-stage-specific relapse probabilities. Data were collected regarding patient characteristics and outcomes. Contingency analyses were carried out of imaging outcomes. Results One hundred and seventy patients (stage 3A: 34; 3B: 93; 3C: 43) underwent radiological surveillance. Relapses were identified in 65 (38%) patients, of which 45 (69%) were asymptomatic. False-positive imaging findings occurred in 7%, and 6% had treatable second (non-melanoma) malignancies. Positive predictive values (PPV) of individual scans were 56%-83%. Negative scans had predictive values of 89%-96% for true non-recurrence [negative predictive values (NPV)] until the next scan. A negative PET at 18 months had NPVs of 80%-84% for true non-recurrence at any time in the 47-month (median) follow-up period. Sensitivity and specificity of the overall approach of sub-stage-specific PET surveillance were 70% and 87%, respectively. Of relapsed patients, 33 (52%) underwent potentially curative resection and 10 (16%) remained disease-free after 24 months (median). Conclusions Application of sub-stage-specific PET in stage 3 melanoma enables asymptomatic detection of most recurrences, has high NPVs that may provide patient reassurance, and is associated with a high rate of detection of resectable and potentially curable disease at relapse.
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Affiliation(s)
- J Lewin
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia; Princess Margaret Cancer Centre, Toronto, Canada
| | - L Sayers
- Cancer Treatment and Development Laboratory, Peter MacCallum Cancer Centre, Victoria, Australia
| | - D Kee
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia
| | - I Walpole
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia
| | - A Sanelli
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia
| | - L Te Marvelde
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Victoria, Australia
| | - A Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Victoria, Australia
| | - J Spillane
- Department of Surgery, Peter MacCallum Cancer Centre, Victoria, Australia
| | - D Gyorki
- Department of Surgery, Peter MacCallum Cancer Centre, Victoria, Australia; Department of Surgery, St Vincent's Hospital, Victoria, Australia
| | - D Speakman
- Department of Surgery, Peter MacCallum Cancer Centre, Victoria, Australia
| | - V Estall
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - S Donahoe
- Department of Surgery, Peter MacCallum Cancer Centre, Victoria, Australia
| | - M Pohl
- Department of Surgery, Peter MacCallum Cancer Centre, Victoria, Australia
| | - K Pope
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - M Chua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - S Sandhu
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia
| | - G A McArthur
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - C J McCormack
- Department of Dermatology, Peter MacCallum Cancer Centre, Victoria, Australia
| | - M Henderson
- Department of Surgery, Peter MacCallum Cancer Centre, Victoria, Australia; Department of Surgery, St Vincent's Hospital, Victoria, Australia
| | - R J Hicks
- Department of Surgery, St Vincent's Hospital, Victoria, Australia; Department of Cancer Imaging, Peter MacCallum Cancer Centre, Victoria, Australia
| | - M Shackleton
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia; Cancer Treatment and Development Laboratory, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia; Department of Pathology, The University of Melbourne, Victoria, Australia; Department of Oncology, Alfred Health, Victoria, Australia; Central Clinical School, Faculty of Medicine, Nursing and Allied Health, Monash University, Victoria, Australia.
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Bucknell N, Kron T, Herschtal A, Irving L, Siva S, Ball D. P2.17-21 A Post-Hoc Analysis of TROG 09.02 (CHISEL) Phase III Trial Investigating Pulmonary Function Changes After SABR and Conformal Radiation Therapy. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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3
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Vale C, Brihoum M, Chabaud S, Cook A, Fisher D, Forcat S, Fraser-Browne C, Herschtal A, Kneebone A, Nénan S, Parker C, Parmar M, Pearse M, Richaud P, Rogozińska E, Sargos P, Sydes M, Tierney J. Adjuvant or salvage radiotherapy for the treatment of localised prostate cancer? A prospectively planned aggregate data meta-analysis. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.041] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Kneebone A, Fraser-Browne C, Delprado W, Duchesne G, Fisher R, Frydenberg M, Haworth A, Herschtal A, Joseph D, Lim T, Martin J, Millar J, Sidhom M, Spry N, Tang C, Turner S, Williams S, Wiltshire K, Woo H, Pearse M. A Phase III Multi-Centre Randomised Trial comparing adjuvant versus early salvage Radiotherapy following a Radical Prostatectomy: Results of the TROG 08.03 and ANZUP “RAVES” Trial. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.456] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tang S, Koh E, Rai R, Otton J, Herschtal A, Tran D, Delaney G, Holloway L, Thomas L, Schmitt B, Liney G, Ananthapadmanachan S. Changes in Cardiac MRI Derived Left Ventricular Segmental Strain in Left Sided Breast Cancer Patients Treated with Tangential Radioation Therapy Alone Correlated with Dose. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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6
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Ball D, Mai G, Vinod S, Babington S, Ruben J, Kron T, Chesson B, Herschtal A, Vanevski M, Rezo A, Elder C, Skala M, Wirth A, Wheeler G, Lim A, Shaw M, Schofield P, Irving L, Solomon B. Quality of life in the CHISEL randomized trial of stereotactic ablative radiotherapy (SABR) versus standard radiotherapy for stage I non-small cell lung cancer (Trans-Tasman Radiation Oncology Group 09.02). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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7
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Liu Z, Martin J, Orme L, Seddon B, Desai J, Nicholls W, Thomson D, Porter D, McCowage G, Underhill C, Cranswick N, Michael M, Zacharin M, Herschtal A, Sivasuthan J, Thomas DM. Gender differences in doxorubicin pharmacology for subjects with chemosensitive cancers of young adulthood. Cancer Chemother Pharmacol 2018; 82:887-898. [PMID: 30206658 DOI: 10.1007/s00280-018-3683-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/01/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE For many cancers, adolescents and young adults (AYA) have worse outcomes than for children and adults. Many factors may contribute to the AYA survival gap, including differences in biology, therapeutic intent, and adherence to therapy. It has been observed that male AYAs have poorer outcomes than females. The purpose of this work was to test the proposition that gender-related pharmacologic factors may account for a component of the AYA survival gap. PATIENTS AND METHODS A prospective, multi-institutional pharmacologic study of 79 patients in total with chemosensitive cancers (Ewing sarcoma, osteosarcoma and Hodgkin lymphoma) was conducted, with conventional doxorubicin treatment. Pharmacokinetic data of 13 children, 40 AYAs and 13 adults were valid for analysis. Population pharmacokinetics models were developed for doxorubicin and its metabolite doxorubicinol based on the data created in this study. Consequently, model-based analysis was conducted to investigate the relevant topics. RESULTS The clearance of doxorubicinol (normalized to body surface area), the main active metabolite of doxorubicin, appears faster in male AYAs than female (p = 0.04, 95% CI 0.1-3.9 L/h). The exposure of doxorubicinol (normalized to dose) is lower in male AYA than female (p = 0.03, 95% CI - 0.005 to - 0.0002 h/L). These might be correlated to the observed difference on nadir neutrophil count between male AYA and female (p = 0.027, 95% CI 0.09-1.4). CONCLUSION Gender-related differences in doxorubicin pharmacology may account for worse outcomes for male AYAs with chemosensitive cancers compared to females. These findings may reduce the AYA survival gap compared to other age groups.
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Affiliation(s)
- Z Liu
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia. .,Clinical Pharmacology and Department of Medicine, The Royal Children's Hospital, Melbourne, Australia.
| | - J Martin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - L Orme
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Brisbane, QLD, Australia
| | - B Seddon
- University College London Hospital, London, UK
| | - J Desai
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - W Nicholls
- Brisbane Children's Hospital, Brisbane, QLD, Australia.,Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - D Thomson
- Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - D Porter
- Starship Children's Hospital, Auckland, New Zealand
| | - G McCowage
- Children's Hospital Westmead, Sydney, NSW, Australia
| | - C Underhill
- Border Medical Oncology, Albury-Wodonga, VIC, Australia
| | - N Cranswick
- Clinical Pharmacology and Department of Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - M Michael
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - M Zacharin
- Clinical Pharmacology and Department of Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - A Herschtal
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - J Sivasuthan
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - D M Thomas
- Cancer Division, Garvan Institute of Medical Research, Darlinghurst, NSW, Australia
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Smirk AJ, Nicholson JJ, Console YL, Hunt NJ, Herschtal A, Nguyen MNHH, Riedel B. The enhanced recovery after surgery (ERAS) Greenie Board: a Navy-inspired quality improvement tool. Anaesthesia 2018; 73:692-702. [DOI: 10.1111/anae.14157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2017] [Indexed: 12/21/2022]
Affiliation(s)
| | - J. J. Nicholson
- The Alfred Hospital; Melbourne Vic. Australia
- Monash University; Melbourne Vic. Australia
| | - Y. L. Console
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - N. J. Hunt
- NW Training Scheme; Melbourne Vic. Australia
| | - A. Herschtal
- Centre for Biostatistics and Clinical Trials; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | | | - B. Riedel
- Department of Anaesthetics; Perioperative and Pain Medicine; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Melbourne University; Melbourne Vic. Australia
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9
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Ball D, Mai T, Vinod S, Babington S, Ruben J, Kron T, Chesson B, Herschtal A, Rezo A, Elder C, Skala M, Wirth A, Wheeler G, Lim A, Vanevski M, Shaw M. MA 13.07 A Randomized Trial of SABR vs Conventional Radiotherapy for Inoperable Stage I Non-Small Cell Lung Cancer: TROG09.02 (CHISEL). J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.565] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Chang J, Gandhidasan S, Finnigan R, Whalley D, Nair R, Herschtal A, Eade T, Kneebone A, Ruben J, Foote M, Siva S. Stereotactic Ablative Body Radiotherapy for the Treatment of Spinal Oligometastases. Clin Oncol (R Coll Radiol) 2017; 29:e119-e125. [DOI: 10.1016/j.clon.2017.02.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/06/2017] [Accepted: 01/31/2017] [Indexed: 11/30/2022]
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11
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Oates R, Brown A, Tan A, Foroudi F, Lim Joon M, Schneider M, Herschtal A, Kron T. Real-time Image-guided Adaptive-predictive Prostate Radiotherapy using Rectal Diameter as a Predictor of Motion. Clin Oncol (R Coll Radiol) 2016; 29:180-187. [PMID: 27780695 DOI: 10.1016/j.clon.2016.09.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 11/28/2022]
Abstract
AIMS To investigate a relationship between maximum rectal diameter (MRD) on pre-treatment cone beam computed tomography (CBCT) and intra-fraction prostate motion, in the context of an adaptive image-guided radiotherapy (IGRT) method. MATERIALS AND METHODS The MRD was measured on 2125 CBCTs from 55 retrospective patient datasets and related to prostate displacement from intra-fraction imaging. A linear regression model was developed to determine a threshold MRD associated with a high probability of small prostate displacement. Standard and reduced adaptive margin plans were created to compare rectum and bladder normal tissue complication probability (NTCP) with each method. RESULTS A per-protocol analysis carried out on 1910 fractions from 51 patients showed with 90% confidence that for a MRD≤3 cm, prostate displacement will be ≤5 mm and that for a MRD≤3.5 cm, prostate displacement will be ≤5.5 mm. In the first scenario, if adaptive therapy was used instead of standard therapy, median reductions in NTCP for rectum and bladder were 0.5% (from 9.5% to 9%) and 1.3% (from 6.6% to 5.3%), respectively. In the second scenario, the NTCP for rectum and bladder would have median reductions of 1.1% and 2.6%, respectively. CONCLUSIONS We have identified a potential method for adaptive prostate IGRT based upon predicting small prostate intra-fraction motion by measuring MRD on pre-treatment CBCT.
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Affiliation(s)
- R Oates
- Radiation Therapy Services, Peter MacCallum Cancer Centre, Bendigo, Victoria, Australia; Medical Imaging & Radiation Sciences, Monash University, Melbourne, Victoria, Australia.
| | - A Brown
- Radiation Oncology, Townsville Cancer Centre, Townsville, Queensland, Australia
| | - A Tan
- Radiation Oncology, Townsville Cancer Centre, Townsville, Queensland, Australia; College of Medicine and Dentistry, James Cook University, Queensland, Australia
| | - F Foroudi
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Lim Joon
- Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Schneider
- Medical Imaging & Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - A Herschtal
- Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - T Kron
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia; Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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12
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Weickhardt A, Foroudi F, Sengupta S, Grimison P, Patanjali N, Leslie S, Ng S, Tang C, Goodwin R, Hovey E, Jarvis T, Chen C, Herschtal A, Galletta L, Sandhu S, Tai KH, Lawrentschuk N, Davis I. Pembrolizumab with ChemoRadiotherapy for Muscle Invasive Bladder Cancer: the ANZUP PCR-MIB trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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13
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Bell L, Cox J, Eade T, Rinks M, Herschtal A, Kneebone A. PO-1108 Optimal planning target volume and image guidance policy for post-prostatectomy intensity modulated radiotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41100-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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14
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Herschtal A, Te Marvelde L, Mengersen K, Hosseinifard Z, Foroudi F, Devereux T, Pham D, Ball D, Greer PB, Pichler P, Eade T, Kneebone A, Bell L, Caine H, Hindson B, Kron T. Calculating radiotherapy margins based on Bayesian modelling of patient specific random errors. Phys Med Biol 2015; 60:1793-805. [PMID: 25658193 DOI: 10.1088/0031-9155/60/5/1793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Collected real-life clinical target volume (CTV) displacement data show that some patients undergoing external beam radiotherapy (EBRT) demonstrate significantly more fraction-to-fraction variability in their displacement ('random error') than others. This contrasts with the common assumption made by historical recipes for margin estimation for EBRT, that the random error is constant across patients. In this work we present statistical models of CTV displacements in which random errors are characterised by an inverse gamma (IG) distribution in order to assess the impact of random error variability on CTV-to-PTV margin widths, for eight real world patient cohorts from four institutions, and for different sites of malignancy. We considered a variety of clinical treatment requirements and penumbral widths. The eight cohorts consisted of a total of 874 patients and 27 391 treatment sessions. Compared to a traditional margin recipe that assumes constant random errors across patients, for a typical 4 mm penumbral width, the IG based margin model mandates that in order to satisfy the common clinical requirement that 90% of patients receive at least 95% of prescribed RT dose to the entire CTV, margins be increased by a median of 10% (range over the eight cohorts -19% to +35%). This substantially reduces the proportion of patients for whom margins are too small to satisfy clinical requirements.
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Affiliation(s)
- A Herschtal
- Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia. Faculty of Health Arts and Design, Swinburne University of Technology, Melbourne, Australia
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15
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Lewin J, Khamly KK, Young RJ, Mitchell C, Hicks RJ, Toner GC, Ngan SYK, Chander S, Powell GJ, Herschtal A, Te Marvelde L, Desai J, Choong PFM, Stacker SA, Achen MG, Ferris N, Fox S, Slavin J, Thomas DM. A phase Ib/II translational study of sunitinib with neoadjuvant radiotherapy in soft-tissue sarcoma. Br J Cancer 2014; 111:2254-61. [PMID: 25321190 PMCID: PMC4264446 DOI: 10.1038/bjc.2014.537] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 08/29/2014] [Accepted: 09/17/2014] [Indexed: 12/16/2022] Open
Abstract
Background: Preoperative radiotherapy (RT) is commonly used to treat localised soft-tissue sarcomas (STS). Hypoxia is an important determinant of radioresistance. Whether antiangiogenic therapy can ‘normalise' tumour vasculature, thereby improving oxygenation, remains unknown. Methods: Two cohorts were prospectively enrolled. Cohort A evaluated the implications of hypoxia in STS, using the hypoxic tracer 18F-azomycin arabinoside (FAZA-PET). In cohort B, sunitinib was added to preoperative RT in a dose-finding phase 1b/2 design. Results: In cohort A, 13 out of 23 tumours were hypoxic (FAZA-PET), correlating with metabolic activity (r2=0.85; P<0.001). Two-year progression-free (PFS) and overall (OS) survival were 61% (95% CI: 0.44–0.84) and 87% (95% CI: 0.74–1.00), respectively. Hypoxia was associated with radioresistance (P=0.012), higher local recurrence (Hazard ratio (HR): 10.2; P=0.02), PFS (HR: 8.4; P=0.02), and OS (HR: 41.4; P<0.04). In Cohort B, seven patients received sunitinib at dose level (DL): 0 (50 mg per day for 2 weeks before RT; 25 mg per day during RT) and two patients received DL: −1 (37.5 mg per day for entire period). Dose-limiting toxicities were observed in 4 out of 7 patients at DL 0 and 2 out of 2 patients at DL −1, resulting in premature study closure. Although there was no difference in PFS or OS, patients receiving sunitinib had higher local failure (HR: 8.1; P=0.004). Conclusion: In STS, hypoxia is associated with adverse outcomes. The combination of sunitinib with preoperative RT resulted in unacceptable toxicities, and higher local relapse rates.
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Affiliation(s)
- J Lewin
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - K K Khamly
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - R J Young
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - C Mitchell
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - R J Hicks
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] The University of Melbourne, St Vincent's Hospital Campus, Fitzroy, Victoria, Australia
| | - G C Toner
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] The University of Melbourne, St Vincent's Hospital Campus, Fitzroy, Victoria, Australia
| | - S Y K Ngan
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - S Chander
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - G J Powell
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] Department of Orthopaedics, St. Vincent's Hospital, Fitzroy, Victoria, Australia [3] Department of Surgery, The University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - A Herschtal
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - L Te Marvelde
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - J Desai
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - P F M Choong
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] Department of Orthopaedics, St. Vincent's Hospital, Fitzroy, Victoria, Australia [3] Department of Surgery, The University of Melbourne, St. Vincent's Hospital, Fitzroy, Victoria, Australia
| | - S A Stacker
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - M G Achen
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - N Ferris
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - S Fox
- Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - J Slavin
- The University of Melbourne, St Vincent's Hospital Campus, Fitzroy, Victoria, Australia
| | - D M Thomas
- 1] Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia [2] The University of Melbourne, St Vincent's Hospital Campus, Fitzroy, Victoria, Australia [3] The Kinghorn Cancer Centre, Garvan Institute of Medical Research, 370 Victoria Street, Darlinghurst, New South Wales 2010, Australia
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16
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Kong G, Thompson M, Collins M, Herschtal A, Hofman MS, Johnston V, Eu P, Michael M, Hicks RJ. Assessment of predictors of response and long-term survival of patients with neuroendocrine tumour treated with peptide receptor chemoradionuclide therapy (PRCRT). Eur J Nucl Med Mol Imaging 2014; 41:1831-44. [PMID: 24844348 PMCID: PMC4159597 DOI: 10.1007/s00259-014-2788-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 04/15/2014] [Indexed: 01/08/2023]
Abstract
PURPOSE To review the response and outcomes of (177)Lu-DOTA-octreotate chemoradionuclide therapy (LuTate PRCRT) in patients with neuroendocrine tumour (NET) expressing high levels of somatostatin receptors with uncontrolled symptoms or disease progression. METHODS A total of 68 patients (39 men; 17 - 76 years of age) who had completed an induction course of at least three cycles of LuTate PRCRT between January 2006 and June 2010 were reviewed. Ten patients were treated for uncontrolled symptoms and 58 had disease progression despite conventional treatment. The majority had four induction LuTate cycles (median treatment duration 5 months and cumulative activity 31 GBq), and 63 patients had concomitant 5-FU radiosensitizing infusional chemotherapy. Factors predicting overall survival were assessed using the log-rank test and Cox proportional hazards regression. RESULTS Of those treated for uncontrolled symptoms, 70 % received benefit maintained for at least 6 months after treatment. Among patients with progressive disease 68 % showed stabilization or regression on CT, 67 % on molecular imaging and 56 % biochemically up to 12 months after treatment; 32 patients died. Overall survival rates at 2 and 5 year were 72.1 % and 52.1 %, respectively. Median overall survival was not estimable at a median follow-up of 60 months (range 5 - 86 months). Nonpancreatic primary sites, dominant liver metastases, lesion size <5 cm and the use of 5-FU chemotherapy were statistically significantly associated with objective response. A disseminated pattern and a high disease burden (whole-body retention index) were associated with an increased risk of death. Objective biochemical, molecular imaging and CT responses were all associated with longer overall survival. CONCLUSION A high proportion of patients with progressive NET or uncontrolled symptoms received therapeutic benefit from LuTate with concomitant 5-FU chemotherapy. The achievement of objective biochemical, molecular or CT responses within 12 months was associated with improved overall survival. Patients with a primary pancreatic site and larger lesions (>5 cm) appeared to have lower objective response rates and may need a more aggressive treatment approach.
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Affiliation(s)
- G Kong
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, VIC, 3002, Australia
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Herschtal A, Foroudi F, Greer PB, Eade TN, Hindson BR, Kron T. Finding the optimal statistical model to describe target motion during radiotherapy delivery—a Bayesian approach. Phys Med Biol 2012; 57:2743-55. [DOI: 10.1088/0031-9155/57/9/2743] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Foroudi F, Wong J, Kron T, Rolfo A, Haworth A, Roxby P, Thomas J, Herschtal A, Pham D, Williams S, Tai KH, Duchesne G. Online Adaptive Radiotherapy for Muscle-Invasive Bladder Cancer: Results of a Pilot Study. Int J Radiat Oncol Biol Phys 2011; 81:765-71. [DOI: 10.1016/j.ijrobp.2010.06.061] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2010] [Revised: 06/15/2010] [Accepted: 06/25/2010] [Indexed: 11/30/2022]
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Fox CD, Kron T, Leahy M, Duchesne G, Williams S, Tai KH, Haworth A, Herschtal A, Foroudi F. Interfraction patient motion and implant displacement in prostate high dose rate brachytherapy. Med Phys 2011; 38:5838-43. [DOI: 10.1118/1.3641865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Thompson A, Gill S, Thomas J, Kron T, Fox C, Herschtal A, Tai K, Foroudi F. In Pursuit of Individualised Margins for Prostate Cancer Patients Undergoing Image-guided Radiotherapy: The Effect of Body Mass Index on Intrafraction Prostate Motion. Clin Oncol (R Coll Radiol) 2011; 23:449-53. [DOI: 10.1016/j.clon.2011.01.511] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 12/07/2010] [Accepted: 01/01/2011] [Indexed: 11/24/2022]
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MacManus M, Herschtal A, Hicks R, Bayne M, Lau E, Ball D, Cruickshank D, Binns D, Plumridge N, Everitt S. Results of a Prospective Clinical Trial of FDG-PET/CT Scanning for Staging and Treatment Planning in Candidates for Radical Radiation Therapy with Unresectable Non-small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gregory DL, Brennan SM, Stillie A, Herschtal A, Hicks RJ, MacManus MP, Ball DL. Impact of 18F-fluorodeoxyglucose positron emission tomography in the staging and treatment response assessment of extra-pulmonary small-cell cancer. J Med Imaging Radiat Oncol 2010; 54:100-7. [PMID: 20518871 DOI: 10.1111/j.1754-9485.2010.02146.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
The aim of this study was to retrospectively evaluate the value of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in extrapulmonary small-cell cancer (EPSCC). Patients with EPSCC who underwent PET for staging or response assessment between 1996 and 2007 were identified from a database. Patient records were reviewed. PET-based, and conventional staging and restaging results were compared. The binary staging classification of limited disease (LD) versus extensive disease (ED) was used. Patients with LD had tumours that could be encompassed within a tolerable radiation therapy (RT) volume. Of 33 eligible patients, 12 had staging PET scans, 11 had restaging scans and 10 had both. All known gross disease sites were FDG-avid. PET and conventional stage groupings were concordant in 21 of 22 cases. One patient was appropriately upstaged from LD to ED by PET. PET detected additional disease sites, without causing upstaging in three further patients. Restaging PET scans identified previously unrecognised persistent or progressive disease in 4 of 21 cases. In four further cases, persistent FDG uptake after treatment was either false positive (n = 2) or of uncertain (n = 2) aetiology. PPV was 100% for staging and 82% for restaging. In 8 of 43 imaging episodes (19%), PET appropriately influenced management in five cases by changing treatment intent from radical to palliative, and in three cases by altering the RT volume. PET has incremental value compared to conventional imaging for staging EPSCC, and may also be useful for restaging after therapy. PET influenced patient management in 19% of 43 imaging episodes.
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Affiliation(s)
- D L Gregory
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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Hayman J, Callahan J, Herschtal A, Hicks R, Everitt S, Binns D, Mac Manus M. Using Molecular Imaging to Quantitatively Estimate the Distribution of Proliferating Bone Marrow in Adult Cancer Patients. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Stillie AL, Kron T, Fox C, Herschtal A, Haworth A, Thompson A, Owen R, Tai KH, Duchesne G, Foroudi F. Rectal filling at planning does not predict stability of the prostate gland during a course of radical radiotherapy if patients with large rectal filling are re-imaged. Clin Oncol (R Coll Radiol) 2009; 21:760-7. [PMID: 19804961 DOI: 10.1016/j.clon.2009.09.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 08/24/2009] [Accepted: 08/25/2009] [Indexed: 10/20/2022]
Abstract
AIMS It has been suggested that large rectal filling is associated with an increased risk of prostate motion in radiotherapy. The aim of the present study was to determine if there is a correlation between rectal distension on planning computed tomography and the intrafraction and interfraction stability of the prostate gland during a course of radical radiotherapy for prostate cancer if a protocol was used to rescan patients with excessive rectal diameter during planning. MATERIALS AND METHODS The computed tomography planning scans of 89 patients with adenocarcinoma of the prostate treated with conformal radiotherapy were reviewed. All patients had three gold seed fiducial markers implanted into the prostate before planning computed tomography. About one in five patients had repeat computed tomography because their rectum was judged to be too large at the time of the first planning computed tomography. Rectal distension was assessed on planning computed tomography using outlines following European Organization for Research and Treatment of Cancer guidelines by measuring the rectal volume, the average cross-sectional area and the mean anterior-posterior diameter of the rectum. Daily kV images were obtained before and after treatment delivery to determine positional matching of the fiducial markers in the superior-inferior, anterior-posterior and right-left dimensions. RESULTS In total, 2860 pre- and post-treatment daily kV image pairs were obtained of 89 patients (average 32.1 image pairs per patient). The median rectal cross-sectional area was 7.3cm(2) (range 2.8-17.1), the median rectal volume was 54.8cm(3) (range 20.9-128.2), and the median anterior-posterior rectal diameter was 3.03cm (range 1.58-8.30). Unifactor linear regression models showed no statistically significant relationship between intra- and interfraction prostate stability and rectal volume on planning computed tomography. CONCLUSIONS No statistically significant relationship between rectal distension on planning computed tomography and the intra- and interfraction stability of the prostate gland was identified if patients with a large rectal volume were rescanned for planning.
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Affiliation(s)
- A L Stillie
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Haworth A, Paneghel A, Herschtal A, Duchesne G, Williams S, Tai KH, Kron T, Roxby P, Soteriou S, Laferlita M, Foroudi F. Verification of target position in the post-prostatectomy cancer patient using cone beam CT. J Med Imaging Radiat Oncol 2009; 53:212-20. [PMID: 19527370 DOI: 10.1111/j.1754-9485.2009.02057.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We present the results of a pilot study designed to investigate methods that may be applied to develop a patient position correction protocol for the post-prostatectomy patient receiving radiotherapy. Imaging was carried out with cone beam CT (CBCT) to investigate its suitability for detecting changes in rectal and bladder volumes and movements of these organs relative to the treatment planning CT. Eligible patients were imaged daily during the first week of treatment and weekly thereafter. Surrogate explanatory variables, including distance from the isocentre to the anterior rectum and bladder length, were tested for their potential to substitute for contouring entire organs and predict for changes in coverage of the planning treatment volume (PTV) by the 95% isodose (PTV95) and the maximum dose delivered to 50% of the rectal volume (RECTD50). The PTV defined on the CBCT images was larger than that defined on the planning CT and resulted in a decrease in the PTV95. Bladder length correlated with bladder volume and changes in bladder volume were associated with a decrease in PTV95. Rectal volumes changed randomly during treatment. There was a trend for the rectum to move anteriorly as treatment progressed. CBCT may be used to define the PTV, rectum and bladder though the reason for an apparent increase in PTV on CBCT requires further investigation. The bladder length and distance to the anterior rectal wall are potential surrogate explanatory variables. Further studies will be designed to test values of these surrogates that predict the need for a change in isocentre position.
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Affiliation(s)
- A Haworth
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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Germain F, Brennan S, Corry J, Herschtal A. 196 HYPOPHARYNX CARCINOMA – REVIEW OF THE PETER MACCALLUM CANCER CENTRE (PMCC) EXPERIENCE. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Brennan SM, Gregory D, Stillie A, Herschtal A, MacManus MP, Ball DL. Impact of 18F-flurodeoxyglucose positron emission tomography in the staging and treatment response assessment of extrapulmonary small cell cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e14639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e14639 Background: To assess the frequency of use and impact of FDG PET in the management of extrapulmonary small cell carcinoma (EPSCC). Methods: Patients treated for EPSCC who had undergone FDG PET for staging or response assessment between 1985 and 2007 were identified from the institutional database and patient records. The PET result was compared to the conventional staging investigations and management decisions were recorded. Results: 22 patients had staging PET at diagnosis. All known disease was PET avid. Stage migration occurred in one patient. Additional disease without upstaging was noted in 3 patients. PET influenced management in 4/22 (18%) of cases, in one case changing from radical to palliative therapy, and in 3 cases altering radiation target volume. 21 patients had reassessment PET scans. There was disparity with conventional imaging in 8 cases. In 4 cases the PET was found to be correct, in 2 case the PET result was a false positive and 2 cases were not assessable. (Sensitivity 100%, specificity 80%.) PET resulted in a change in management in 25% of patients, in all cases discontinuing radical therapy in patients with persistent disease. Conclusions: PET contributes to both staging and restaging of EPSCC and may influence management in up to 25% of cases. No significant financial relationships to disclose.
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Affiliation(s)
- S. M. Brennan
- Peter Maccallum Cancer Institute, Melbourne, Australia
| | - D. Gregory
- Peter Maccallum Cancer Institute, Melbourne, Australia
| | - A. Stillie
- Peter Maccallum Cancer Institute, Melbourne, Australia
| | - A. Herschtal
- Peter Maccallum Cancer Institute, Melbourne, Australia
| | | | - D. L. Ball
- Peter Maccallum Cancer Institute, Melbourne, Australia
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Narayan K, Rejeki V, Herschtal A, Bernshaw D, Quinn M, Jobling T, Allen D. Prognostic significance of several histological features in intermediate and high-risk endometrial cancer patients treated with curative intent using surgery and adjuvant radiotherapy. J Med Imaging Radiat Oncol 2009; 53:107-13. [DOI: 10.1111/j.1754-9485.2009.02045.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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