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Mohan R, Kneebone A, Eade T, Hsiao E, Emmett L, Brown C, Hunter J, Hruby G. Long-term outcomes of SBRT for PSMA PET detected oligometastatic prostate cancer. Radiat Oncol 2023; 18:127. [PMID: 37528487 PMCID: PMC10394924 DOI: 10.1186/s13014-023-02302-8] [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] [Received: 01/08/2023] [Accepted: 06/19/2023] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Oligometastatic disease in prostate cancer (PCa) is a challenging clinical scenario encountered more frequently with the widespread adoption of PSMA-PET. SBRT aims to defer androgen deprivation and may deliver sustained biochemical failure (BF) free survival in selected patients. Little long-term data is currently available regarding the effectiveness of this approach. METHODS A retrospective single institution study of PSMA-PET directed SBRT without initial ADT for oligo-metachronous PCa. Median dose/fractionation was 24 Gy in 2# to bones and 30 Gy in 3# to lymph nodes. The primary endpoint was time to BF (PSA + 0.2 ug/L above nadir). Secondary endpoints included time to ADT for relapse (i.e. palliative ADT), BF defined as PSA nadir + 2 ug/L, toxicity, patterns of failure and survival. Patients were excluded if they received ADT with their SBRT, had short disease-free interval, or > 3 metastases on PSMA-PET. RESULTS 103 patients treated from November-2014 to December-2019 were analysed from our prospective database. Median follow-up was 5 years. 64 patients were treated for nodal only disease, 35 bone only and 4 mixed. 15% were free of any BF at 5 years with median time to BF of 1.1 years. 32% (33/103) of patients had further curative-intent radiation treatment following their first BF after SBRT, including subsequent SBRT. Eight patients underwent potentially curative treatment for their second or third relapse. Allowing for salvage treatment, 29/103 (28%) were biochemically disease free at last follow up. At 5 years, 39% of patients had never received any ADT and 55% had not started ADT for relapse with a median time to ADT for relapse of 5.5 years. There were 2 grade 3 toxicities (rib fracture and lymphoedema), and no local failures. CONCLUSION PSMA-PET guided SBRT for oligo-metachronous PCa recurrence in appropriately triaged patients results in excellent local control, low toxicity and over 50% ADT free at 5 years.
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Affiliation(s)
- Riche Mohan
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia.
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia.
| | - A Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
| | - T Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
| | - E Hsiao
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
| | - L Emmett
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
- Garvan Institute of Medical Research, Darlinghurst, 2010, Australia
| | - Christopher Brown
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
| | - J Hunter
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
| | - G Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, NSW, 2065, Australia
- Northern Clinical School, University of Sydney, St Leonards, NSW, 2065, Australia
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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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Le Bao V, Jameson M, Cloak K, Ochoa C, Kneebone A, Haworth A, Holloway L. Automatic Post-Prostatectomy Planning: Potential for Improving Quality and Consistency in Clinical Trials. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.755] [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: 10/26/2022]
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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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Gargett M, Haddad C, Kneebone A, Booth JT, Hardcastle N. Clinical impact of removing respiratory motion during liver SABR. Radiat Oncol 2019; 14:93. [PMID: 31159840 PMCID: PMC6547575 DOI: 10.1186/s13014-019-1300-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 05/16/2019] [Indexed: 12/26/2022] Open
Abstract
Background Liver tumors are subject to motion with respiration, which is typically accounted for by increasing the target volume. The prescription dose is often reduced to keep the mean liver dose under a threshold level to limit the probability of radiation induced liver toxicity. A retrospective planning study was performed to determine the potential clinical gains of removal of respiratory motion from liver SABR treatment volumes, which may be achieved with gating or tumor tracking. Methods Twenty consecutive liver SABR patients were analysed. The treated PTV included the GTV in all phases of respiration (ITV) with a 5 mm margin. The goal prescription was 50Gy/5# (BED 100 Gy10) but was reduced by 2.5 Gy increments to meet liver dose constraints. Elimination of motion was modelled by contouring the GTV in the expiration phase only, with a 5 mm PTV margin. All patients were replanned using the no-motion PTV and tumor dose was escalated to higher prescription levels where feasible given organ-at-risk constraints. For the cohort of patients with metastatic disease, BED gains were correlated to increases in tumour control probability (TCP). The effect of the gradient of the TCP curve on the magnitude of TCP increase was evaluated by repeating the study for an additional prescription structure, 54Gy/3# (BED 151 Gy10). Results Correlation between PTV size and prescribed dose exists; PTVs encompassing < 10% of the liver could receive the highest prescription level. A monotonically increasing correlation (Spearman’s rho 0.771, p = 0.002) between the degree of PTV size reduction and motion vector magnitude was observed for GTV sizes <100cm3. For 11/13 patients initially planned to a decreased prescription, tumor dose escalation was possible (5.4Gy10–21.4Gy10 BED) using the no-motion PTV. Dose escalation in excess of 20 Gy10 increased the associated TCP by 5% or more. A comparison of TCP gains between the two fractionation schedules showed that, for the same patient geometry, the absolute increase in BED was the overarching factor rather than the gradient of the TCP curve. Conclusions In liver SABR treatments unable to be prescribed optimal dose due to exceeding mean liver thresholds, eliminating respiratory motion allowed dose escalation in the majority of patients studied and substantially increased TCP.
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Affiliation(s)
- M Gargett
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia.
| | - C Haddad
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - A Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia
| | - J T Booth
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, NSW, Australia.,Institute of Medical Physics, University of Sydney, Sydney, NSW, Australia
| | - N Hardcastle
- Institute of Medical Physics, University of Sydney, Sydney, NSW, Australia.,Department of Physical Sciences, Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
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Emmett L, Chalasani V, Kneebone A, Hruby G, Joshua A. PO-0847 Rapid modulation of PSMA expression by ADT: Serial PSMA PET in men commencing androgen blockade. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31267-8] [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: 11/30/2022]
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Keall P, Nguyen D, O'Brien R, Hewson E, Ball H, Poulsen P, Booth J, Greer P, Hunter P, Wilton L, Bromley R, Kipritidis J, Eade T, Kneebone A, Hruby G, Moodie T, Hayden A, Turner S, Arumugam S, Sidhom M, Hardcastle N, Siva S, Tai K, Gebski V, Martin J. PO-0842 Real-Time tracking improves treatment: The TROG Stereo Prostate Ablative Radiotherapy with KIM trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31262-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Hruby G, Kneebone A, Eade T, Le A, Booth J, Hunter J, Kwong C, Brown C. EP-1544 Focal Linac-based SBRT Re-treatment for local recurrence of Ca P following previous definitive RT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31964-4] [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: 10/26/2022]
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Bergamin S, Eade T, Kneebone A, Kench J, Sved P, Biset JF, Hruby G. Ductal Carcinoma of the Prostate: An Uncommon Entity With Atypical Behaviour. Clin Oncol (R Coll Radiol) 2019; 31:108-114. [DOI: 10.1016/j.clon.2018.10.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/03/2018] [Accepted: 10/10/2018] [Indexed: 10/27/2022]
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Abramowitz M, Kwon D, Freeman D, Dogan N, Eade T, Punnen S, Pra AD, Kneebone A, Stoyanova R, Pollack A. Early Toxicity and Patient Reported Outcomes from a Radiation Hypofractionation Randomized Trial of Extended vs Accelerated Therapy for Prostate Cancer (HEAT). Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.378] [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: 10/28/2022]
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Hewson E, Nguyen D, O'Brien R, Poulsen P, Booth J, Bromley R, Kipritidis J, Moodie T, Greer P, Eade T, Kneebone A, Martin J, Hayden A, Hruby G, Hunter P, Wilton L, Turner S, Gebski V, Keall P. Kilovoltage Intrafraction Monitoring (KIM) Real-Time Tracking Improves Patient Dose Distributions: Interim Primary Hypothesis Results from the First 20 Patients on the TROG 15.01 Stereotactic Prostate Ablative Radiation Therapy SPARK Trial. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.318] [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: 11/28/2022]
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Sundaresan P, Ager B, Turner S, Costa D, Kneebone A, Pearse M, Woo H, Tesson S, Juraskova I, Butow P. A Randomized Controlled Trial Evaluating the Utility of a Patient Decision Aid to Improve Clinical Trial (RAVES 08.03) Related Decision-Making. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.09.014] [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: 10/18/2022]
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Keall P, Booth J, Nguyen D, O'Brien R, Poulsen P, Caillet V, Bromley R, Alfieri F, Bell L, Eade T, Kneebone A, Martin J. The First Clinical Implementation of Real-time Adaptive Radiation Therapy Using a Standard Linear Accelerator. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Itchins M, Arena J, Nahm CB, Rabindran J, Kim S, Gibbs E, Bergamin S, Chua TC, Gill AJ, Maher R, Diakos C, Wong M, Mittal A, Hruby G, Kneebone A, Pavlakis N, Samra J, Clarke S. Retrospective cohort analysis of neoadjuvant treatment and survival in resectable and borderline resectable pancreatic ductal adenocarcinoma in a high volume referral centre. Eur J Surg Oncol 2017; 43:1711-1717. [PMID: 28688722 DOI: 10.1016/j.ejso.2017.06.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 04/04/2017] [Revised: 05/28/2017] [Accepted: 06/09/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pancreatic ductal adenocarcinoma (PDAC) is a deadly disease. Neoadjuvant therapy (NA) with chemotherapy (NAC) and radiotherapy (RT) prior to surgery provides promise. In the absence of prospective data, well annotated clinical data from high-volume units may provide pilot data for randomised trials. METHODS Medical records from a tertiary hospital in Sydney, Australia, were analysed to identify all patients with resectable or borderline resectable PDAC. Data regarding treatment, toxicity and survival were collected. RESULTS Between January 1 2010 and April 1 2016, 220 sequential patients were treated: 87 with NA and 133 with upfront operation (UO). Forty-three NA patients (52%) and 5 UO patients (4%) were borderline resectable at diagnosis. Twenty-four borderline patients received NA RT, 22 sequential to NAC. The median overall survival (OS) in the NA group was 25.9 months (mo); 95% CI (21.1-43.0 mo) compared to 26.9 mo (19.7, 32.7) in the UO; HR 0.89; log-ranked p-value = 0.58. Sixty-nine NA patients (79%) were resected, mOS was 29.2 mo (22.27, not reached (NR)). Twenty-two NA (31%) versus 22 UO (17%) were node negative at operation (N0). In those managed with NAC/RT the mOS was 29.0 mo (17.3, NR). There were no post-operative deaths with NA within 90-days and three in the UO arm. DISCUSSION This is a hypothesis generating retrospective review of a selected real-world population in a high-throughput unit. Treatment with NA was well tolerated. The long observed survival in this group may be explained by lymph node sterilisation by NA, and the achievement of R0 resection in a greater proportion of patients.
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Affiliation(s)
- M Itchins
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia.
| | - J Arena
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - C B Nahm
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - J Rabindran
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - S Kim
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - E Gibbs
- National Health and Medical Research Council Clinical Trial Centre (NHMRC CTC), The University of Sydney, Australia
| | - S Bergamin
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - T C Chua
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia
| | - A J Gill
- Sydney Medical School (Northern), The University of Sydney, Australia; Cancer Diagnosis and Pathology, Kolling Institute, Royal North Shore Hospital, Sydney, Australia
| | - R Maher
- Department of Radiology, Royal North Shore Hospital, Australia
| | - C Diakos
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia; Northern Cancer Institute, Sydney, NSW, Australia
| | - M Wong
- Department of Medical Oncology, Gosford Hospital, New South Wales, Australia
| | - A Mittal
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - G Hruby
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - A Kneebone
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - N Pavlakis
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia; Northern Cancer Institute, Sydney, NSW, Australia
| | - J Samra
- Upper GI Surgical Unit, Department of Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia
| | - S Clarke
- Department of Oncology, Royal North Shore Hospital, Sydney, NSW, Australia; Sydney Medical School (Northern), The University of Sydney, Australia; Northern Cancer Institute, Sydney, NSW, Australia
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Sundaresan P, Ager B, Butow P, Tesson S, Kneebone A, Costa D, Woo H, Pearse M, Juraskova I, Turner S. PV-0050: A randomised controlled study of decision aids to improve clinical trial decisions & recruitment. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30494-2] [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: 11/29/2022]
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Whalley D, Hruby G, Alfieri F, Kneebone A, Eade T. SpaceOAR Hydrogel in Dose-escalated Prostate Cancer Radiotherapy: Rectal Dosimetry and Late Toxicity. Clin Oncol (R Coll Radiol) 2016; 28:e148-54. [DOI: 10.1016/j.clon.2016.05.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 04/21/2016] [Accepted: 04/26/2016] [Indexed: 02/07/2023]
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Sundaresan P, Tesson S, Ager B, Butow P, Juraskova I, Costa D, Kneebone A, Woo H, Pearse M, Turner S. EP-1460: Knowledge, attitudes and decision-making preferences of men considering clinical trial participation. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32710-4] [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: 11/28/2022]
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Lac C, Sims A, Eade T, Kneebone A. OC-0560: Plan of the day approach in post prostatectomy radiation therapy. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31810-2] [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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Yates A, Carroll S, Kneebone A, Tse R, Horvath L, Byrne C, Solomon M, Hruby G. Implementing Intensity-modulated Radiotherapy with Simultaneous Integrated Boost for Anal Cancer: 3 Year Outcomes at Two Sydney Institutions. Clin Oncol (R Coll Radiol) 2015; 27:700-7. [DOI: 10.1016/j.clon.2015.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 07/14/2015] [Accepted: 08/20/2015] [Indexed: 11/29/2022]
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Harris G, Kneebone A, Whalley D, McCloud P, Thompson S, Guo L, Eade T. The Timing of Salvage Postprostatectomy Radiation Therapy: Waiting for the PSA to Climb Above 0.2 May Compromise Outcome. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Keall P, Ng J, Caillet V, Huang C, Colvill E, Simpson E, Poulsen P, Kneebone A, Eade T, Booth J. Sub-mm Accuracy Results Measured From the First Prospective Clinical Trial of a Novel Real-Time IGRT System, Kilovoltage Intrafraction Monitoring (KIM). Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Whalley D, Caine H, McCloud P, Guo L, Kneebone A, Eade T. Promising results with image guided intensity modulated radiotherapy for muscle invasive bladder cancer. Radiat Oncol 2015; 10:205. [PMID: 26407726 PMCID: PMC4583158 DOI: 10.1186/s13014-015-0499-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [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: 03/21/2015] [Accepted: 09/03/2015] [Indexed: 01/06/2023] Open
Abstract
AIM To describe the feasibility of image guided intensity modulated radiotherapy (IG-IMRT) using daily soft tissue matching in the treatment of bladder cancer. METHODS Twenty-eight patients with muscle-invasive carcinoma of the bladder were recruited to a protocol of definitive radiation using IMRT with accelerated hypofractionation with simultaneous integrated boost (SIB). Isotropic margins of .5 and 1 cm were used to generate the high risk and intermediate risk planning target volumes respectively. Cone beam CT (CBCT) was acquired daily and a soft tissue match was performed. Cystoscopy was scheduled 6 weeks post treatment. RESULTS The median age was 83 years (range 58-92). Twenty patients had stage II or III disease, and eight were stage IV. Gross disease received 66 Gy in 30 fractions in 11 patients (ten with concurrent chemotherapy) or 55 Gy in 20 fractions for those of poorer performance status or with palliative intent. All patients completed radiation treatment as planned. Three patients ceased chemotherapy early due to toxicity. Six patients (21 %) had acute Grade ≥ 2 genitourinary (GU) toxicity and six (21 %) had acute Grade ≥ 2 gastrointestinal (GI) toxicity. Five patients (18 %) developed Grade ≥2 late GU toxicity and no ≥2 late GI toxicity was observed. Nineteen patients underwent cystoscopy following radiation, with complete response (CR) in 16 cases (86 %), including all patients treated with chemoradiotherapy. Eight patients relapsed, four of which were local relapses. Of the patients with local recurrence, one underwent salvage cystectomy. For patients treated with definitive intent, freedom from locoregional recurrence (FFLR) and overall survival (OS) was 90 %/100 % for chemoradiotherapy versus 86 %/69 % for radiotherapy alone. CONCLUSION IG- IMRT using daily soft tissue matching is a feasible in the treatment of bladder cancer, enabling the delivery of accelerated synchronous integrated boost with good early local control outcomes and low toxicity.
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Affiliation(s)
- D Whalley
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia.
| | - H Caine
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia.
| | - P McCloud
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia. .,McCloud Consulting Group, 7-9 Merriwa Street, Gordon, NSW, 2072, Australia.
| | - L Guo
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia.
| | - A Kneebone
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia. .,McCloud Consulting Group, 7-9 Merriwa Street, Gordon, NSW, 2072, Australia.
| | - T Eade
- Northern Sydney Cancer Centre, Radiation Oncology, Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW, 2065, Australia. .,Northern Clinical School, University of Sydney, Camperdown, NSW, 2050, Australia.
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Booth J, Ng J, O'Brien R, Keall P, Poulsen P, Calliet V, Juneja P, Eade T, Kneebone A. TH-AB-303-09: Gated Prostate Radiotherapy: Accuracy and Dosimetric Results From First Clinical Study with Kilovoltage Intrafraction Monitoring. Med Phys 2015. [DOI: 10.1118/1.4926164] [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: 11/07/2022] Open
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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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Trada Y, Kneebone A, Paneghel A, Sidhom M, Tang C, Wiltshire K, Howarth A, Fraser-Brown C, Martin J. EP-1325: Clinical trial real time review in post-prostatectomy radiotherapy: is there room to risk adapt? Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41317-9] [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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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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Booth J, Colvill E, Eade T, Kneebone A, O'Brien R, Keall P. First Clinical Implementation of Electromagnetic Transponder-Guided MLC Tracking. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Whalley D, Caine H, Guo L, Kneebone A, Eade T. Accelerated IMRT With Image Guidance For Bladder Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1446] [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: 10/24/2022]
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Bell L, Cox J, Eade T, Rinks M, Kneebone A. PO-0940: The influence of bladder and rectum movement on geographic miss during post-prostatectomy IMRT. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33246-1] [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: 11/28/2022]
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31
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Ng J, Booth J, Poulsen P, Eade T, Hegi F, Kneebone A, Kuncic Z, Keall P. TH-E-BRA-11: Real-Time Tumor Localization with Kilovoltage Intrafraction Monitoring: First Clinical Implementation for Prostate Intensity Modulated Arc Therapy. Med Phys 2012. [DOI: 10.1118/1.4736372] [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: 11/07/2022] Open
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32
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Irvine T, Srinivasan R, Casson DH, Auth M, Crook K, Leiper K, Rhodes J, Greeg A, Kneebone A, Dalzell AM. Assessing the value of a pre-transfer meeting in IBD transition services. ACTA ACUST UNITED AC 2010. [DOI: 10.12968/gasn.2010.8.7.78431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - K Crook
- Department of Gastroenterology at Alder Hey Children′s NHS Foundation Trust
| | | | | | - A Greeg
- Royal Liverpool University Hospital, Liverpool
| | - A Kneebone
- Royal Liverpool University Hospital, Liverpool
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Boxer M, Forstner D, Kneebone A, Delaney G, Koh ES, Fuller M, Kaadan N. Impact of a real-time peer review audit on patient management in a radiation oncology department. J Med Imaging Radiat Oncol 2009; 53:405-11. [PMID: 19695048 DOI: 10.1111/j.1754-9485.2009.02096.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In September 2006, the Royal Australian and New Zealand College of Radiologists (RANZCR) endorsed the modified Peer Review Audit Tool (PRAT). We aimed to assess the feasibility of using this tool in a busy radiation oncology department using an electronic medical record (EMR) system, identify areas of compliance and assess the impact of the audit process on patient management. Fortnightly random clinical audit was undertaken by using the revised RANZCR PRAT in the departments of radiation oncology at Liverpool and Macarthur Cancer Therapy Centres (LCTC and MCTC). Following audit of the EMR, treatment plans were audited by peer review. Data were collected prospectively from June 2007 to June 2008. Audits were carried out on 208 patients. Behaviour criteria were well documented in the EMR, but scanning of histology and medical imaging reports did not occur in up to a third of cases. With electronic prescriptions, treatment prescription errors were rare. In total, 8 (3.8%) out of 208 patients had a change to management recommended. Variability in interpretation of PRAT 'protocol/study' criteria was identified. We found that real-time audit is feasible and effective in detecting both issues with documentation in the EMR, and a small number of patients in whom a change to management is recommended. Recommendations have been made in order to continue to improve the audit process including documentation of any changes recommended and whether the recommended change occurred.
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Affiliation(s)
- M Boxer
- Cancer Therapy Centres, Liverpool and Campbelltown Hospitals, New South Wales, Australia.
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Haworth A, McDermott L, Ebert M, Wiltshire K, Pearse M, Willis D, Sproston C, Thompson A, Kneebone A. DEVELOPMENT OF SOFTWARE TOOLS FOR ANALYSIS OF CLINICAL TRIAL BENCHMARKING EXERCISES. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)73261-9] [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: 11/28/2022]
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35
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Spry N, Bydder S, Harvey J, Borg M, Ngan S, Millar J, Graham P, Zissiadis Y, Kneebone A, Ebert M. Accrediting radiation technique in a multicentre trial of chemoradiation for pancreatic cancer. J Med Imaging Radiat Oncol 2009; 52:598-604. [PMID: 19178636 DOI: 10.1111/j.1440-1673.2008.02026.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Before a multicentre trial of 3-D conformal radiotherapy to treat cancer of the pancreas, participating clinicians were asked to complete an accreditation exercise. This involved planning two test cases according to the study protocol, then returning hard copies of the plans and dosimetric data for review. Any radiation technique that achieved the specified constraints was allowed. Eighteen treatment plans were assessed. Seven plans were prescribed incorrect doses and two of the planning target volumes did not comply with protocol guidelines. All plans met predefined normal tissue dose constraints. The identified errors were attributable to unforeseen ambiguities in protocol documentation. They were addressed by feedback and corresponding amendments to protocol documentation. Summary radiobiological measures including total weighted normal tissue equivalent uniform dose varied significantly between centres. This accreditation exercise successfully identified significant potential sources of protocol violations, which were then easily corrected. We believe that this process should be applied to all clinical trials involving radiotherapy. Due to the limitations of data analysis with hard-copy information only, it is recommended that complete planning datasets from treatment-planning systems be collected through a digital submission process.
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Affiliation(s)
- N Spry
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia
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Lin C, Turner S, Mai T, Kneebone A, Gebski V. Late rectal and urinary toxicity from conformal, dose-escalated radiation therapy for prostate cancer: a prospective study of 402 patients. ACTA ACUST UNITED AC 2008; 51:578-83. [PMID: 17958696 DOI: 10.1111/j.1440-1673.2007.01896.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study investigates the rate of late rectal and urinary toxicity from three-dimensional conformal radiation therapy (3DCRT) for localized prostate cancer. The influence of neoadjuvant androgen deprivation (AD) on toxicity rates was also examined. A total of 402 men at Liverpool and Westmead hospitals received radical 3DCRT for localized prostate cancer between 1999 and 2003. Patients received either 70 Gy or 74 Gy, according to their prognostic risk grouping and or date of commencing radiation therapy (RT). Late rectal and urinary toxicity data were collected prospectively using Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria. The median follow up of this cohort was 43.5 months. At 36 months, the cumulative incidence of >or=grade 2 rectal and urinary toxicities was 6.7 and 17.5%, respectively. Peak prevalence of late urinary toxicity occurred at 36 months (9.5%), although late rectal toxicity was highest at 12 months (2.9%) from completion of 3DCRT. The use of AD did not cause additional late toxicities. Patients receiving 74 Gy did not experience significantly worse toxicities than the group receiving 70 Gy.
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Affiliation(s)
- C Lin
- Radiation Oncology Network, Westmead and Nepean Hospitals, and NHMRC Clinical Trial Centre, University of Sydney, New South Wales, Australia.
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Abstract
Synovial chondromatosis is a rare, benign condition characterized by the formation of multiple cartilaginous nodules that are generally intra-articular and can lead to chronic pain and limit the function of involved joints. We report on the novel use of radiotherapy that was used to treat a 42-year-old man with rapid recurrences of extensive synovial chondromatosis in the knee refractory to multiple operations. Based on follow-up MRI scans and clinical findings, the disease process was halted with no progression seen over 5 years.
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Affiliation(s)
- C C W Chong
- Prince of Wales Clinical School, University of New South Wales, NSW, Australia.
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Holley MC, Kneebone A, Milo M. Information for gene networks in inner ear development: a study centered on the transcription factor gata2. Hear Res 2006; 227:32-40. [PMID: 16797894 DOI: 10.1016/j.heares.2006.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2006] [Revised: 04/12/2006] [Accepted: 04/27/2006] [Indexed: 01/15/2023]
Abstract
The search for molecular mechanisms to stimulate sensory regeneration in the mammalian inner ear is commonly based upon developmental studies. This has revealed many genes that regulate the differentiation of sensory cells. A major challenge is to place these genes into the context of functional networks that describe developmental processes more fully and increase the chances of identifying useful therapeutic targets. We used a novel approach to identify genes that are functionally related to the transcription factor gata2. Temporal profiles of gene expression were derived from three conditionally immortal cell lines and clustered to those of gata2 by applying the gamma model for oligonucleotide signals, a statistical method that allows quantitative analysis of oligonucleotide array data. We derived an objective list of 28 genes that clustered with gata2 in all three cell lines. A number of these genes have known functional links with gata2. Genes encoding CCAAT/enhancer binding proteins (C/EBP) and signal transducer and activation of transcription 3 (Stat3) are especially interesting as they are known to bind gata proteins directly. The results provide strong evidence that our experimental approach can reveal functional relationships between genes that regulate fundamental processes in the differentiation of sensory cells in the inner ear.
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Affiliation(s)
- M C Holley
- Department of Biomedical Science, University of Sheffield, Addison Building, Western Bank, Sheffield S10 2TN, UK.
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39
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Wong SKC, Kneebone A, Morgan M, Henderson CJA, Morgan A, Jalaludin B. Surgical management of colorectal cancer in south-western Sydney 1997−2001: a prospective series of 1293 unselected cases from six public hospitals. ANZ J Surg 2005; 75:776-82. [PMID: 16173991 DOI: 10.1111/j.1445-2197.2005.03522.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The aim of the present study is to provide local data for the management of colorectal cancers in the south-western Sydney health area from 1997 to 2001. METHODS The data were collected prospectively. Follow up was conducted in late 2001 and early 2002. Data were cross-validated with hospital and area databases and with data from the New South Wales Registry of Births, Deaths and Marriages. RESULTS This was an unselected series of 1293 patients from 36 surgeons; 16.5% of patients presented as emergencies. Only 3% presented as a result of bowel cancer screening. Of the 1293 patients, 1270 received an operation. There were 598 elective colonic resections with the mortality rate of 1.2%, reoperation rate of 2.7% and anastomotic leak rate of 0.8%. For the 410 elective rectal resections, the rates were 2.9%, 2.7% and 1.2%, respectively. For the 290 emergency operations, the rates were much worse at 7.7%, 6.6% and 4.8%, respectively. The corrected overall 3-year survival rate was 64%. For Dukes' A, B, C and D, the figures were 94%, 87%, 61% and 7%, respectively. CONCLUSIONS Colorectal cancer is a major cause of mortality and morbidity in our community. Very few bowel cancers were discovered at the asymptomatic stage. This paper strongly supports community bowel cancer screening and early diagnosis. The local database has provided a rich source of information to benchmark management and outcomes of bowel cancer patients treated in the South Western Sydney Area Health Service. An area-wide computer network with online data input facilities at individual workplaces will improve data integrity and data collection efficiency.
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Affiliation(s)
- S K Cyril Wong
- South Western Sydney Colorectal Tumour Group (SWSTG), Bankstown Hospital Medical Centre, Bankstown, New South Wales, Australia.
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40
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Nicholl AJ, Kneebone A, Davies D, Cacciabue-Rivolta DI, Rivolta MN, Coffey P, Holley MC. Differentiation of an auditory neuronal cell line suitable for cell transplantation. Eur J Neurosci 2005; 22:343-53. [PMID: 16045487 DOI: 10.1111/j.1460-9568.2005.04213.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The auditory neuroblast cell line US/VOT-N33 (N33), which is conditionally immortal, was studied as an in vitro model for the differentiation of spiral ganglion neurons (SGNs) and as a candidate for cell transplantation in rodents. It expresses numerous molecular markers characteristic of auditory neuroblasts, including the transcription factors GATA3, NeuroD, Brn3a and Islet1, as well as the neuronal cytoskeletal protein beta3-tubulin. It displays active migratory behaviour in vitro and in vivo. In the presence of the fibroblast growth factors FGF1 or FGF2 it differentiates bipolar morphologies similar to those of native SGNs. In coculture with neonatal cochlear tissue it is repelled from epithelial surfaces but not from native SGNs, alongside which it extends parallel neuronal processes. When injected into the retina in vivo, EGFP-labelled N33 cells were traced for 1-2 weeks and migrated rapidly within the subretinal space. Cells that found their way into the retinal ganglion cell layer extended multiple processes but did not express beta3-tubulin. The ability of N33 to migrate, to differentiate, to localize with native SGNs in vitro and to survive in vivo suggests that they provide an effective model for SGN differentiation and for cell transplantation into the ear.
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Affiliation(s)
- A J Nicholl
- Department of Biomedical Sciences, Addison Building, Western Bank, Sheffield, S10 2TN, UK
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Abstract
The aim of this study was to investigate the ability of Australian centres to produce high-dose intensity modulated radiation therapy (IMRT) prostate plans, and to compare the planning parameters and resultant dose distributions. Five Australian radiation therapy departments were invited to participate. Each centre received an identical 5 mm-slice CT data set complete with contours of the prostate, seminal vesicles, rectum, bladder, femoral heads and body outline. The planning team was asked to produce the best plan possible, using published Memorial Sloan-Kettering Cancer Centre prescription and dose constraints. Three centres submitted plans for evaluation. All plans covered the planning target volume adequately; however, only one plan met all the critical organ dose constraints. Although the planning parameters, beam arrangements and planning systems were different for each centre, the resulting plans were similar. In Australia, IMRT for prostate cancer is in the early stages of implementation, with routine use limited to a few centres.
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Affiliation(s)
- M Skala
- Department of Radiation Oncology, Cancer Therapy Centre, Liverpool Health Service, Liverpool, New South Wales, Australia.
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Lin P, Chu J, Kneebone A, Moylan E, Jalaludin B, Pocock N, Kiat H, Rosenfeld D. Direct comparison of18F-fluorodeoxyglucose coincidence gamma camera tomography with gallium scanning for the staging of lymphoma. Intern Med J 2005; 35:91-6. [PMID: 15705137 DOI: 10.1111/j.1445-5994.2004.00744.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The present study compared the performance of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) using a coincidence dual-head gamma camera (FDG Co-PET) with 67gallium scinti graphy (GS) in pretreatment staging of lymphoma. METHODS A total of 46 patients underwent FDG Co-PET, computed tomography (CT) scanning and GS for pretreatment staging of lymphoma (40 newly diagnosed and recurrence) between November 1997 and December 1999. RESULTS Histological subgroups comprised low grade (8 patients), intermediate grade (25) high-grade (3) non-Hodgkin's lymphoma and Hodgkin's disease (10). Based on clinical assessment, CT scan findings and biopsy, 100 nodal sites and 15 extra-nodal sites were deemed positive. FDG Co-PET was superior to GS in nodal site positivity rate (97%vs 79%, P < 0.0001). Compared with GS, FDG Co-PET detected 39 more abnormal sites in 22 patients (48%), of which 28 sites were validated by biopsy, CT and/or progress FDG Co-PET scanning. There was only one proven false negative FDG site in the spleen. CT + FDG Co-PET led to upstaging in 2 patients (4%), compared to CT + GS. CONCLUSION FDG Co-PET shows potential for providing an accurate means for pretreatment staging of lymphoma and can detect extra sites of disease activity compared to GS.
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Affiliation(s)
- P Lin
- Department of Nuclear Medicine, PET and Ultrasound, Liverpool Hospital, Sydney, New South Wales, Australia.
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Skala M, Berry M, Duchesne G, Gogna K, Tai KH, Turner S, Kneebone A, Rolfo A, Haworth A. Australian and New Zealand three-dimensional conformal radiation therapy consensus guidelines for prostate cancer. ACTA ACUST UNITED AC 2004; 48:493-501. [PMID: 15601330 DOI: 10.1111/j.1440-1673.2004.01354.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Three-dimensional conformal radiation therapy (3DCRT) has been shown to reduce normal tissue toxicity and allow dose escalation in the curative treatment of prostate cancer. The Faculty of Radiation Oncology Genito-Urinary Group initiated a consensus process to generate evidence-based guidelines for the safe and effective implementation of 3DCRT. All radiation oncology departments in Australia and New Zealand were invited to complete a survey of their prostate practice and to send representatives to a consensus workshop. After a review of the evidence, key issues were identified and debated. If agreement was not reached, working parties were formed to make recommendations. Draft guidelines were circulated to workshop participants for approval prior to publication. Where possible, evidence-based recommendations have been made with regard to patient selection, risk stratification, simulation, planning, treatment delivery and toxicity reporting. This is the first time a group of radiation therapists, physicists and oncologists representing professional radiotherapy practice across Australia and New Zealand have worked together to develop best-practice guidelines. These guidelines should serve as a baseline for prospective clinical trials, outcome research and quality assurance.
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Affiliation(s)
- M Skala
- Cancer Therapy Centre, Liverpool Health Service, Sydney, New South Wales, Australia
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Tai KH, Duchesne G, Turner S, Kneebone A, See A, Gogna K, Berry M. Three-dimensional conformal radiotherapy in the treatment of prostate cancer in Australia and New Zealand: Report on a survey of radiotherapy centres and the proceedings of a consensus workshop. ACTA ACUST UNITED AC 2004; 48:502-8. [PMID: 15601331 DOI: 10.1111/j.1440-1673.2004.01355.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is an increasing use of 3-D conformal radiotherapy (3DCRT) in the radiotherapeutic management of prostate cancer. The Faculty of Radiation Oncology Genito-Urinary Group carried out a survey of Australian and New Zealand radiotherapy centres in the preparation of a consensus workshop. Of the 19 centres that were represented, there were 24 radiation oncologists, 16 radiation therapists and 12 medical physicists. The survey collected demographic information and data on the practices undertaken at those centres when delivering curative radiotherapy in the treatment of prostate cancer. There was much variation in the delivery of treatment in the areas of patient set-up, contouring of target volumes and organs of interest during computer planning, the techniques and the dose constraints used in these techniques, the use of adjuvant androgen deprivation therapy and the quality assurance processes used in monitoring effects of treatment. This variability reflects the range of data in the published literature. Emerging trends of practices were also identified. This is a first report on a multi-disciplinary approach to the development of guidelines in 3DCRT of prostate cancer.
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Affiliation(s)
- K-H Tai
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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Ngan S, Fisher R, Burmeister B, Rischin D, Mackay J, Kneebone A, Joseph D, McKendrick J, Goldstein D, McClure B, Lim Joon D. Delayed relapse following preoperative chemoradiation and surgery for rectal cancer. Int J Radiat Oncol Biol Phys 2003. [DOI: 10.1016/s0360-3016(03)01035-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kneebone A, Mameghan H, Bolin T, Berry M, Turner S, Kearsley J, Graham P, Fisher R, Delaney G. The effect of oral sucralfate on the acute proctitis associated with prostate radiotherapy: a double-blind, randomized trial. Int J Radiat Oncol Biol Phys 2001; 51:628-35. [PMID: 11597802 DOI: 10.1016/s0360-3016(01)01660-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Acute rectal complications occur in the majority of patients receiving external-beam radiotherapy for carcinoma of the prostate. Sucralfate has been proposed to reduce radiation-induced mucosal injury by forming a protective barrier on ulcer bases, binding local growth factors, and stimulating angiogenesis. However, there is conflicting clinical evidence as to whether sucralfate, taken prophylactically during radiotherapy, can ameliorate the symptoms of acute radiation proctitis. METHODS AND MATERIALS A double-blind randomized trial was conducted at four Radiation Oncology Departments in Sydney, Australia, between February 1995 and June 1997. A total of 338 patients with clinically localized prostate cancer receiving small volume radiotherapy, of whom 335 were evaluable, were randomized to receive either 3 g of oral sucralfate suspension or placebo twice a day during radiotherapy. Patients kept a daily record of their bowel symptoms and were graded according to the RTOG/EORTC acute toxicity criteria. RESULTS One hundred sixty-four patients received sucralfate and 171 received placebo. Both groups were well balanced with regard to patient, tumor, treatment factors, and baseline symptoms, except that the placebo group had a significantly more liquid baseline stool consistency score (p = 0.004). Patients kept a daily diary of symptoms during radiotherapy. After adjusting for baseline values, there was no significant difference between the two groups with regard to stool frequency (p = 0.41), consistency (p = 0.20), flatus (p = 0.25), mucus (p = 0.54), and pain (p = 0.73). However, there was more bleeding in the sucralfate group, with 64% of patients noticing rectal bleeding, compared with 47% in the placebo group (p = 0.001). There was no significant difference between the two groups with respect to RTOG/EORTC acute toxicity (p = 0.88; sucralfate 13%, 44%, 43% and placebo 15%, 44%, 40% for grade 0, 1, and 2, respectively). CONCLUSION This study suggests that oral sucralfate taken prophylactically during radiotherapy does not ameliorate the symptoms of acute radiation proctitis and may increase acute bleeding. The cause of the increased bleeding in the sucralfate group is unclear. As the pathogenesis of acute and late reactions are different, late follow-up, which includes sigmoidoscopic evaluation, is currently being performed on this cohort of patients.
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Affiliation(s)
- A Kneebone
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia.
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47
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Chong CC, Kneebone A, Sheridan M. Managing malignant spinal cord compression. Aust Fam Physician 2001; 30:859-61. [PMID: 11676314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Spinal malignancy can present as low back pain and accounts for most cases of spinal cord compression (SCC). OBJECTIVE To assist the clinician in the diagnosis of malignant SCC and to increase awareness of various treatment modalities. A clinical approach for the workup of patients with 'metastatic carcinoma of unknown primary' is also outlined. DISCUSSION It is important to diagnose SCC early and initiate urgent treatment to obtain optimum patient outcomes. Further management includes workup for the primary tumour source if unknown.
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Chong CC, Kneebone A, Sheridan M. Back pain and metastatic spinal disease. Making the diagnosis. Aust Fam Physician 2001; 30:863-5. [PMID: 11676315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Ngan SY, Burmeister BH, Fisher R, Rischin D, Schache DJ, Kneebone A, MacKay JR, Joseph D, Bell A, Goldstein D. Early toxicity from preoperative radiotherapy with continuous infusion 5-fluorouracil for resectable adenocarcinoma of the rectum: a Phase II trial for the Trans-Tasman Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2001; 50:883-7. [PMID: 11429215 DOI: 10.1016/s0360-3016(01)01536-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the toxicity and the efficacy of preoperative radiotherapy with continuous infusion 5-fluorouracil (5-FU) for locally advanced adenocarcinoma of the rectum. METHODS AND MATERIALS Eligible patients had newly diagnosed localized adenocarcinoma of the rectum within 12 cm of the anal verge, Stage T3-4, and were suitable for curative resection. Eighty-two patients were treated with radiotherapy-50.4 Gy in 28 fractions in 5.6 weeks, given concurrently with continuous infusion 5-FU, using either 96-h/week infusion at 300 mg/m(2)/day or 7-days/week infusion at 225 mg/m(2)/day. RESULTS The median age was 59 years (range, 27-87), and 67% of patients were male. Pretreatment stages of the rectal cancer were T3, 89% and resectable T4, 11%, with endorectal ultrasound confirmation in 67% of patients. Grade 3 acute toxicity occurred in 5 of 82 patients (6%; 95% confidence interval [CI], 2-14%). Types of surgical resection were anterior resection, 61%; abdominoperineal resection, 35%; and other procedures, 4%. There was no operative mortality. Anastomotic leakage after low anterior resection occurred in 3 of 50 patients (6%; 95% CI, 1-17%). The pathologic complete response rate was 16% (95% CI, 9-26%). Pathologic Stages T2 or less occurred in 51%. CONCLUSION Preoperative radiotherapy with continuous infusion 5-FU for locally advanced rectal cancer is a safe regimen, with a significant downstaging effect. It does not seem to lead to a significant increase in serious surgical complications.
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Affiliation(s)
- S Y Ngan
- Peter MacCallum Cancer Institute, Victoria, Melbourne, Australia.
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Ngan S, Burmeister B, Fisher R, Rischin D, Schache D, Kneebone A, Mackay J, Joseph D, Bell A, Goldstein D. A phase II trial of preoperative radiotherapy with protracted infusion 5-fluorouracil for resectable adenocarcinoma of rectum. A multi-center trial for the Trans-Tasman Radiation Oncology Group. Int J Radiat Oncol Biol Phys 2000. [DOI: 10.1016/s0360-3016(00)80035-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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