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Horsley PJ, Kneebone A. Stereotactic Body Radiotherapy for Oligometastatic and Oligoprogressive Genitourinary Malignancies: A Work in Progress. Eur Urol Oncol 2023; 6:39-40. [PMID: 36504002 DOI: 10.1016/j.euo.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/20/2022] [Indexed: 12/13/2022]
Affiliation(s)
- Patrick J Horsley
- Department of Radiation Oncology, Northern Sydney Cancer Centre, St. Leonards, Australia
| | - Andrew Kneebone
- Department of Radiation Oncology, Northern Sydney Cancer Centre, St. Leonards, Australia; University of Sydney, Sydney, Australia.
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Horsley PJ, Koo CM, Eade T, Hsiao E, Emmett L, Brown C, Kneebone A, Hruby G. Mapping of Local Recurrences After Radical Prostatectomy Using 68-Gallium-Prostate-Specific Membrane Antigen Positron Emission Tomography/Computed Tomography: Implications for Postprostatectomy Radiation Therapy Clinical Target Volumes. Int J Radiat Oncol Biol Phys 2023; 115:106-117. [PMID: 35716849 DOI: 10.1016/j.ijrobp.2022.05.044] [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: 04/03/2022] [Revised: 05/23/2022] [Accepted: 05/28/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Our objective is to describe the distribution of local recurrences after radical prostatectomy (RP) as delineated using 68-Gallium-prostate-specific membrane antigen positron emission tomography/computed tomography (68Ga-PSMA PET/CT) to identify areas where current consensus guideline clinical target volumes (CTVs) are insufficient or excessive and to identify predictors of recurrence location within the fossa. METHODS AND MATERIALS Retrospective review of databases from 2 tertiary referral centers was performed to identify patients who underwent 68Ga-PSMA PET/CT for biochemical recurrence after RP. Those with a component of local recurrence were included for further analysis. The epicenter of each recurrence was defined relative to reference points in 3 axes, categorized into 1 of 7 levels in the superior/inferior axis relative to the vesicourethral anastomosis, and recorded as within or outside the Faculty of Radiation Oncology Genito-urinary Group (FROGG) and Radiation Therapy Oncology Group consensus CTVs. Univariate and multivariate analysis was performed to identify predictors of recurrence location based on clinical and histopathologic variables. RESULTS One thousand forty-nine 68Ga-PSMA PET/CT scans were reviewed. One hundred forty sites of local recurrence were identified on 132 scans. Relative to the vesicourethral anastomosis, 13 (9%), 31 (22%), 17 (12%), 24 (17%), 27 (19%), 20 (14%), and 8 (6%) recurrences occurred >5 mm inferior; within 5 mm above or below; and 6 to 15 mm, 16 to 25 mm, 26 to 35 mm, 36 to 45 mm, and >45 mm superiorly, respectively. Thirteen (9%) and 2 (1.4%) recurrences occurred beyond the FROGG and Radiation Therapy Oncology Group consensus CTVs, respectively, with all below the inferior CTV margin. CONCLUSIONS In the largest study to date mapping local recurrences after RP in 3-dimensions, we provide several insights to inform future contouring guidelines; in particular, 9% of recurrences occurred inferior to the FROGG CTV.
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Affiliation(s)
- Patrick J Horsley
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
| | - Chung Mo Koo
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Thomas Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia; GenesisCare, Sydney, New South Wales, Australia; University of Sydney, Camperdown, New South Wales, Australia
| | - Edward Hsiao
- Department of Nuclear Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Louise Emmett
- Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital, Sydney, New South Wales, Australia; University of New South Wales, Sydney, New South Wales, Australia
| | - Chris Brown
- NHMRC Trials Centre, University of Sydney, Camperdown, New South Wales, Australia
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia; GenesisCare, Sydney, New South Wales, Australia; University of Sydney, Camperdown, New South Wales, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia; GenesisCare, Sydney, New South Wales, Australia; University of Sydney, Camperdown, New South Wales, Australia
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Horsley PJ, Kneebone A, Eade TN, Hruby G. Don't throw the baby out with the bath water. Prostate 2022; 82:397-398. [PMID: 34905628 DOI: 10.1002/pros.24284] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/19/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Patrick J Horsley
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
| | - Andrew Kneebone
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
- GenesisCare, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - Thomas N Eade
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
- GenesisCare, Sydney, Australia
- University of Sydney, Sydney, Australia
| | - George Hruby
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, Australia
- GenesisCare, Sydney, Australia
- University of Sydney, Sydney, Australia
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Horsley PJ, Sheehan-Dare G, Mastrocostas K, Fung C, Kneebone A, Eade TN, Emmet L, Lalak A, Hruby G. Prostate adenocarcinoma with mucinous features - is it PSMA avid? J Med Imaging Radiat Oncol 2021; 66:637-640. [PMID: 34524723 DOI: 10.1111/1754-9485.13327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/14/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
Mucinous prostate adenocarcinoma represents <0.1% of prostate cancers. To our knowledge, no previous report has described the 68 Ga-PSMA-PET characteristics of this entity at the primary site. We present a case of a fit 85-year-old with PSA 0.55 ng/mL and ISUP grade 4 acinar adenocarcinoma with mucinous features on biopsy. 68 Ga-PSMA-PET revealed an intensely avid primary lesion in the right prostate (SUVmax 10.9), concordant with biopsy findings and encompassing both the PI-RADS 5 lesion identified on MRI and a PI-RADS 1 lesion that presumably represented the mucinous component. The patient was treated with definitive radiotherapy to the prostate and lymph nodes with 6 months of androgen deprivation therapy.
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Affiliation(s)
- Patrick J Horsley
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Gemma Sheehan-Dare
- Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | - Caroline Fung
- Department of Anatomical Pathology, Concord Hospital, Concord, New South Wales, Australia
| | - Andrew Kneebone
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,GenesisCare, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Thomas N Eade
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,GenesisCare, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
| | - Louise Emmet
- Department of Nuclear Medicine and Theranostics, St. Vincent's Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Andre Lalak
- Department of Urology, Concord Hospital, Concord, New South Wales, Australia
| | - George Hruby
- Northern Sydney Cancer Centre, Royal North Shore Hospital, St Leonards, New South Wales, Australia.,GenesisCare, Sydney, New South Wales, Australia.,University of Sydney, Sydney, New South Wales, Australia
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Horsley PJ, Back M, Lamoury G, Porter B, Booth J, Eade TN. Radiation oncology during COVID-19: Strategies to avoid compromised care. Asia Pac J Clin Oncol 2020; 17:24-28. [PMID: 32894820 DOI: 10.1111/ajco.13456] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/06/2020] [Accepted: 08/03/2020] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic will present a range of challenges to radiation oncology departments. Early data suggest that cancer patients carry a higher than average, but still low absolute risk of hospitalization from COVID-19. The risk of severe events for those who are hospitalized however, is high. Resources for usual cancer care will likely be limited. Decisions to alter, delay or omit treatment during this period should consider both the risk of the cancer and of COVID-19 to the patient, as well as resource constraints. There is a need for departments to adapt with goals of maintaining an uninterrupted, high quality service and of minimizing compromise to oncologic care.
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Affiliation(s)
- Patrick J Horsley
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia
| | - Michael Back
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia.,Northern Clinical School, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Gillian Lamoury
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia
| | - Brian Porter
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia
| | - Jeremy Booth
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia.,Institute of Medical Physics, School of Physics, University of Sydney, New South Wales, Australia
| | - Thomas N Eade
- Department of Radiation Oncology, Northern Sydney Cancer Centre, Royal North Shore Hospital, New South Wales, Australia
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Horsley PJ, Perera L, Veness MJ, Stevens MJ, Eade TN, Back M, Brown C, Jayamanne DT. Outcomes for elderly patients 75 years and older treated with curative intent radiotherapy for mucosal squamous cell carcinomas of the head and neck. Head Neck 2019; 42:25-32. [DOI: 10.1002/hed.25969] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 08/06/2019] [Accepted: 09/06/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Patrick J. Horsley
- Radiation Oncology DepartmentNorthern Sydney Cancer Centre, Royal North Shore Hospital St Leonards New South Wales Australia
| | - Lakmalie Perera
- Radiation Oncology DepartmentCrown Princess Mary Cancer Centre, Westmead Hospital Westmead New South Wales Australia
| | - Michael J. Veness
- Radiation Oncology DepartmentCrown Princess Mary Cancer Centre, Westmead Hospital Westmead New South Wales Australia
- University of Sydney Sydney New South Wales Australia
| | - Mark J. Stevens
- Radiation Oncology DepartmentNorthern Sydney Cancer Centre, Royal North Shore Hospital St Leonards New South Wales Australia
| | - Thomas N. Eade
- Radiation Oncology DepartmentNorthern Sydney Cancer Centre, Royal North Shore Hospital St Leonards New South Wales Australia
| | - Michael Back
- Radiation Oncology DepartmentNorthern Sydney Cancer Centre, Royal North Shore Hospital St Leonards New South Wales Australia
| | - Chris Brown
- NHMRC Clinical Trials Centre, University of Sydney Camperdown Australia
| | - Dasantha T. Jayamanne
- Radiation Oncology DepartmentNorthern Sydney Cancer Centre, Royal North Shore Hospital St Leonards New South Wales Australia
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Horsley PJ, Aherne NJ, Edwards GV, Benjamin LC, Wilcox SW, McLachlan CS, Assareh H, Welshman R, McKay MJ, Shakespeare TP. Planning magnetic resonance imaging for prostate cancer intensity-modulated radiation therapy: Impact on target volumes, radiotherapy dose and androgen deprivation administration. Asia Pac J Clin Oncol 2014; 11:15-21. [PMID: 25227727 DOI: 10.1111/ajco.12266] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2014] [Indexed: 12/28/2022]
Abstract
AIMS Magnetic resonance imaging (MRI) scans are increasingly utilized for radiotherapy planning to contour the primary tumors of patients undergoing intensity-modulated radiation therapy (IMRT). These scans may also demonstrate cancer extent and may affect the treatment plan. We assessed the impact of planning MRI detection of extracapsular extension, seminal vesicle invasion, or adjacent organ invasion on the staging, target volume delineation, doses, and hormonal therapy of patients with prostate cancer undergoing IMRT. METHODS The records of 509 consecutive patients with planning MRI scans being treated with IMRT for prostate cancer between January 2010 and July 2012 were retrospectively reviewed. Tumor staging and treatment plans before and after MRI were compared. RESULTS Of the 509 patients, 103 (20%) were upstaged and 44 (9%) were migrated to a higher risk category as a result of findings at MRI. In 94 of 509 patients (18%), the MRI findings altered management. Ninety-four of 509 patients (18%) had a change to their clinical target volume (CTV) or treatment technique, and in 41 of 509 patients (8%) the duration of hormone therapy was changed because of MRI findings. CONCLUSION The use of radiotherapy planning MRI altered CTV design, dose and/or duration of androgen deprivation in 18% of patients in this large, single institution series of men planned for dose-escalated prostate IMRT. This has substantial implications for radiotherapy target volumes and doses, as well as duration of androgen deprivation. Further research is required to investigate whether newer MRI techniques can simultaneously fulfill staging and radiotherapy contouring roles.
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Affiliation(s)
- Patrick J Horsley
- Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
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Edwards GV, Aherne NJ, Horsley PJ, Benjamin LC, McLachlan CS, McKay MJ, Shakespeare TP. Prevalence of complementary and alternative therapy use by cancer patients undergoing radiation therapy. Asia Pac J Clin Oncol 2014; 10:346-53. [DOI: 10.1111/ajco.12203] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Grace V Edwards
- Department of Radiation Oncology; North Coast Cancer Institute; Coffs Harbour New South Wales Australia
| | - Noel J Aherne
- Department of Radiation Oncology; North Coast Cancer Institute; Coffs Harbour New South Wales Australia
- Rural Clinical School Faculty of Medicine; University of New South Wales; Coffs Harbour New South Wales Australia
| | - Patrick J Horsley
- Department of Radiation Oncology; North Coast Cancer Institute; Coffs Harbour New South Wales Australia
| | - Linus C Benjamin
- Department of Radiation Oncology; North Coast Cancer Institute; Coffs Harbour New South Wales Australia
| | - Craig S McLachlan
- Rural Clinical School Faculty of Medicine; University of New South Wales; Coffs Harbour New South Wales Australia
| | - Michael J McKay
- Department of Radiation Oncology; North Coast Cancer Institute; Lismore New South Wales Australia
- Faculty of Medicine; University of Sydney; Sydney New South Wales Australia
| | - Thomas P Shakespeare
- Department of Radiation Oncology; North Coast Cancer Institute; Coffs Harbour New South Wales Australia
- Rural Clinical School Faculty of Medicine; University of New South Wales; Coffs Harbour New South Wales Australia
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