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Padden-Modi M, Cheng J, Kirby R, Twyman N, Aslam S, Bulusu V, Gilligan D, Martin A, Pipalia N, Shiarli A, Yang H, Thippu Jayaprakash K. PD-0670 Minimising radical radiotherapy commencement time for lung cancer to improve clinical outcomes. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02917-6] [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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Rubasingham J, Gemmill J, James E, Twyman N, Gatfield E, Barnett G, Benson R, Jadon R. Improving Waiting Times from Decision to Treat to Starting Treatment in Head and Neck Cancers: An Audit of the 17-day Pathway. Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2022.01.016] [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: 11/03/2022]
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Ranger A, Dunlop A, Hutchinson K, Convery H, Maclennan MK, Chantler H, Twyman N, Rose C, McQuaid D, Amos RA, Griffin C, deSouza NM, Donovan E, Harris E, Coles CE, Kirby A. A Dosimetric Comparison of Breast Radiotherapy Techniques to Treat Locoregional Lymph Nodes Including the Internal Mammary Chain. Clin Oncol (R Coll Radiol) 2018; 30:346-353. [PMID: 29483041 DOI: 10.1016/j.clon.2018.01.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 10/17/2022]
Abstract
AIMS Radiotherapy target volumes in early breast cancer treatment increasingly include the internal mammary chain (IMC). In order to maximise survival benefits of IMC radiotherapy, doses to the heart and lung should be minimised. This dosimetry study compared the ability of three-dimensional conformal radiotherapy, arc therapy and proton beam therapy (PBT) techniques with and without breath-hold to achieve target volume constraints while minimising dose to organs at risk (OARs). MATERIALS AND METHODS In 14 patients' datasets, seven IMC radiotherapy techniques were compared: wide tangent (WT) three-dimensional conformal radiotherapy, volumetric-modulated arc therapy (VMAT) and PBT, each in voluntary deep inspiratory breath-hold (vDIBH) and free breathing (FB), and tomotherapy in FB only. Target volume coverage and OAR doses were measured for each technique. These were compared using a one-way ANOVA with all pairwise comparisons tested using Bonferroni's multiple comparisons test, with adjusted P-values ≤ 0.05 indicating statistical significance. RESULTS One hundred per cent of WT(vDIBH), 43% of WT(FB), 100% of VMAT(vDIBH), 86% of VMAT(FB), 100% of tomotherapy FB and 100% of PBT plans in vDIBH and FB passed all mandatory constraints. However, coverage of the IMC with 90% of the prescribed dose was significantly better than all other techniques using VMAT(vDIBH), PBT(vDIBH) and PBT(FB) (mean IMC coverage ± 1 standard deviation = 96.0% ± 4.3, 99.8% ± 0.3 and 99.0% ± 0.2, respectively). The mean heart dose was significantly reduced in vDIBH compared with FB for both the WT (P < 0.0001) and VMAT (P < 0.0001) techniques. There was no advantage in target volume coverage or OAR doses for PBT(vDIBH) compared with PBT(FB). CONCLUSIONS Simple WT radiotherapy delivered in vDIBH achieves satisfactory coverage of the IMC while meeting heart and lung dose constraints. However, where higher isodose coverage is required, VMAT(vDIBH) is the optimal photon technique. The lowest OAR doses are achieved by PBT, in which the use of vDIBH does not improve dose statistics.
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Affiliation(s)
- A Ranger
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - A Dunlop
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - K Hutchinson
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - H Convery
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | | | - H Chantler
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - N Twyman
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - C Rose
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - D McQuaid
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - R A Amos
- University College London, London, UK
| | - C Griffin
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - N M deSouza
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - E Donovan
- CVSSP, University of Surrey, Guildford, UK
| | - E Harris
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - C E Coles
- University of Cambridge, Cambridge, UK
| | - A Kirby
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
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Thomas SJ, Aspradakis MM, Byrne JP, Chalmers G, Duane S, Rogers J, Thomas RAS, Tudor GSJ, Twyman N. Reference dosimetry on TomoTherapy: an addendum to the 1990 UK MV dosimetry code of practice. Phys Med Biol 2014; 59:1339-52. [DOI: 10.1088/0031-9155/59/6/1339] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Coles C, Mukesh M, Barnett G, Wilkinson J, Moody A, Wilson C, Dorling L, Qian W, Twyman N, Burnet N. OC-0202: A randomised controlled trial of intensity modulated radiotherapy (IMRT) for early breast cancer: results at 5 years. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32508-1] [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: 10/23/2022]
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Mukesh M, Barnett G, Qian W, Wilkinson J, Parashar D, Twyman N, Wishart G, Moody M, Wilson C, Coles C. OC-0369 QUALITY OF LIFE IN EARLY BREAST CANCER: RESULTS FROM CAMBRIDGE BREAST INTENSITY-MODULATED RADIOTHERAPY TRIAL. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70708-9] [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: 10/28/2022]
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Coles CE, Twyman N, Earl HM, Burnet NG. Conformal radiotherapy facilitates the delivery of concurrent chemotherapy and radiotherapy: a case of primitive neuroectodermal tumour of the chest wall. Sarcoma 2011; 4:129-33. [PMID: 18521292 PMCID: PMC2395438 DOI: 10.1080/13577140020008101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We illustrate the principle of conformal radiotherapy by discussing the case of a patient with a primitive neuroectodermal
tumour of the chest wall. Recent advances in radiotherapy planning enable precise localization of the planning target volume
(PTV) and normal organs at risk of irradiation. Customized blocks are subsequently designed to produce a treatment field
that ‘conforms’ to the PTV. The use of conformal radiotherapy (CRT) in this case facilitated the delivery of concurrent
chemotherapy and radiotherapy by significantly reducing the volume of red marrow irradiated.The lack of acute and late
toxicities was attributed to optimal exclusion of normal tissues from the treatment field, made possible by CRT.
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Affiliation(s)
- C E Coles
- Department of Oncology Box 193 Addenbrooke's Hospital Hills Road Cambridge CB2 2QQ UK
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Coles CE, Wilkinson JS, Wilson CB, Burnet NG, Wishart GC, Twyman N, Hoole ACF, Moody AM. Cambridge Breast Intensity Modulated Radiotherapy Trial: dosimetry results for 1,139 patients. Breast Cancer Res 2008. [PMCID: PMC3300777 DOI: 10.1186/bcr1958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Rimmer YL, Burnet NG, Routsis DS, Twyman N, Hoole ACF, Treeby J, Welford D, Fairfoul J, 'Aho T, Vowler SL, Benson RJ. Practical issues in the implementation of image-guided radiotherapy for the treatment of prostate cancer within a UK department. Clin Oncol (R Coll Radiol) 2007; 20:22-30. [PMID: 17981443 DOI: 10.1016/j.clon.2007.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 08/20/2007] [Accepted: 10/03/2007] [Indexed: 11/25/2022]
Abstract
AIMS To study the feasibility of using implanted gold seeds in combination with a commercial software system for daily localisation of the prostate gland during conformal radiotherapy, and to assess the effect this may have on departmental workload. MATERIALS AND METHODS Six patients had three gold radio-opaque seeds implanted into the prostate gland before starting a course of radiotherapy. The seeds were identified on daily portal images and an automated online system provided immediate vector analysis of discrepancies between the planned and actual daily position of the intraprostatic seeds. In total, 138 interfractional displacements were analysed. The workload impact for the department was assessed using the basic treatment equivalence model, by comparing measurements of daily treatment session durations with a control group of patients receiving standard conformal radiotherapy, matched for treatment complexity. RESULTS No acute complications of seed insertion were observed. A number of developmental issues required solutions to be identified before clinical implementation was possible. The standard deviations of the set-up and organ motion systematic errors in the left-right, superior-inferior and anterior-posterior directions were 2.4, 3.0 and 2.5 mm, respectively. The standard deviations of the set-up and organ motion random errors calculated were 2.5, 2.9 and 3.7 mm. The mean treatment session duration with this daily prostate localisation system was increased by 3 min compared with matched controls using standard imaging practice. If all radical prostate patients in our department were to receive image-guided radiotherapy in this way, this would increase machine workload time by 2.2 h/day. CONCLUSIONS The implementation of this image-guided system is feasible. No additional linear accelerator modification is required and standard imaging devices can be used. It would be a useful addition to any department's image-guided radiotherapy developmental strategy.
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Affiliation(s)
- Y L Rimmer
- Oncology Centre, Addenbrooke's Hospital, Cambridge, UK.
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Coles C, Wilkinson J, Moody A, Wilson C, Twyman N, Hoole A, Burnet N. O-112 The Cambridge Breast Intensity Modulated Radiotherapy Trial: dosimetry results for 1089 patients. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71802-5] [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: 11/30/2022] Open
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Gregory D, Fairfoul J, Chantler H, Twyman N, Williams M, Harden S. Intensity Modulated Radiotherapy to Deliver Hemithorax Irradiation for Mesothelioma for the MARS Trial. Clin Oncol (R Coll Radiol) 2007. [DOI: 10.1016/j.clon.2007.01.362] [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: 10/23/2022]
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Coles CE, Wilkinson JS, Moody AM, Hoole ACF, Twyman N, Burnet NG. The Cambridge breast intensity modulated radiotherapy trial. Breast Cancer Res 2006. [PMCID: PMC3300281 DOI: 10.1186/bcr1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Haba Y, Twyman N, Thomas SJ, Overton C, Dendy P, Burnet NG. Radiotherapy for Glioma During Pregnancy: Fetal Dose Estimates, Risk Assessment and Clinical Management. Clin Oncol (R Coll Radiol) 2004; 16:210-4. [PMID: 15191010 DOI: 10.1016/j.clon.2004.01.009] [Citation(s) in RCA: 23] [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: 11/29/2022]
Abstract
Cancer in pregnancy is relatively uncommon, but constitutes a major problem. We report the measurement of scatter dose to the fetus and the estimated fetal risk from that exposure in an illustrative case of a patient, 20 weeks pregnant, with a grade 3 anaplastic astrocytoma. A clinical decision was made to withhold radiotherapy, if possible, until after delivery. Sequential magnetic resonance imaging (MRI) showed no progression during the pregnancy. In the event, she was managed conservatively until the successful completion of her pregnancy. In case radiotherapy was required, an estimation of the fetal risk was made. Phantom measurements were undertaken to assess the likely fetal dose. Film badges were used to estimate the scattered radiation energy. Measurements were made on a Varian 600C at 6 MV and Asea Brown Boveri (ABB) accelerator at 8 and 16 MV. Doses were measured at 30, 45 and 60 cm from the isocentre; the fetus was assumed to lie at about 60 cm and not closer than 45 cm from the isocentre. Estimated doses to the position of the fetus were lowest with the 6 MV Varian accelerator. Using this machine without additional abdominal shielding, the estimated dose on the surface at 45 cm from the tumour volume was 2.2 cGy for a tumour dose of 54 Gy; using the ABB accelerator, the dose varied between 49-59 cGy. The energy of scattered radiation was in the range 208-688 keV, so that additional shielding would be practical to further reduce the fetal dose. The risk of cancer up to the age of 15 years attributable to radiation is 1 in 1700 per cGy, of which half will be fatal (i.e. 1 in 3300 per cGy). A dose of 2.2 cGy adds a risk of fatal cancer by the age 15 years of only 1 in 1500. Because the addition of shielding might halve the fetal dose, this risk should be reduced to 1 in 3000. For comparison, the overall UK risk of cancer up to the age 15 years is 1 in 650. In conclusion, careful choice of linear accelerator for the treatment of a pregnant woman and the use of additional shielding is valuable, as this can dramatically affect fetal dose.
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Affiliation(s)
- Y Haba
- Oncology Centre, The Addenbrooke's Hospital, Cambridge, UK.
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Barnett G, Hoole A, Twyman N, Jefferies S, Burnet N. 831 Post-operative radiotherapy for soft tissue sarcoma of the anterior compartment of the thigh: should the sartorius muscle be included? EJC Suppl 2003. [DOI: 10.1016/s1359-6349(03)90857-3] [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] Open
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Abstract
In the planning of radiation treatments it is important to have a knowledge of the patient outline in order to correctly calculate the dose distribution that can be expected within the patient. This information is routinely obtained using x-ray computed tomography (CT). Although the CT data set is the ultimate data set, it can be impractical for economic and physical reasons. These impracticalities have been overcome using a commercial three dimensional (3D) laser scanning system. The system scans a laser line across the surface of the patient while a CCD camera views the patient from an offset angle. From a knowledge of the spatial orientation of the camera and the laser source, the system is able to detect the patient's surface and generate an equivalent 3D point cloud. Manipulation of 3D data sets allows the appropriate outlines of the patient to be obtained, that can then be used with the radiotherapy planning system. This has enabled the evaluation of 3D dose distributions for patients, and hence will allow the development of techniques for improving the uniformity of dose in breast treatments. The technique has no radiation overhead associated with it, is quick and is relatively cheap.
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Affiliation(s)
- A C Hoole
- Department of Medical Physics, Addenbrookes NHS Trust, Cambridge, UK
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