ORCID Profile
0000-0003-3032-0059
Current Organisations
RMIT University
,
Peter MacCallum Cancer Centre
,
Department of Health Vic
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Publisher: Wiley
Date: 08-2016
DOI: 10.1111/IMJ.13157
Abstract: These guidelines, informed by the best available evidence and consensus expert opinion, provide a framework to guide the timely initiation of chemotherapy for treating cancer. They sit at the intersection of patient experience, state-of-the-art disease management and rational efficient service provision for these patients at a system level. Internationally, cancer waiting times are routinely measured and publicly reported. In Australia, there are existing policies and guidelines relating to the timeliness of cancer care for surgery and radiation therapy however, until now, equivalent guidance for chemotherapy was lacking. Timeliness of care should be informed, where available, by evidence for improved patient outcomes. Independent of this, it should be recognised that shorter waiting periods are likely to reduce patient anxiety. While these guidelines were developed as part of a proposed framework for consideration by the Victorian Department of Health, they are clinically relevant to national and international cancer services. They are intended to be used by clinical and administrative staff within cancer services. Adoption of these guidelines, which are for the timely triage, review and treatment of cancer patients receiving systemic chemotherapy, aims to ensure that patients receive care within a timeframe that will maximise health outcomes, and that access to care is consistent and equitable across cancer services. Local monitoring of performance against this guideline will enable cancer service providers to manage proactively future service demand.
Publisher: Mary Ann Liebert Inc
Date: 12-2010
Abstract: Peter MacCallum Cancer Centre has one of the world's most enduring staff Christmas choirs. Commencing in 1956, the choir performs in a cafeteria, patient wards, and outpatient waiting areas before each Christmas. With recent emphasis on oncology staff support needs the choir's relevance warranted investigation. This constructivist research examined what effect the staff Christmas choir had on the choir members and staff bystanders in 2008. S ling was convenience and purposive. Staff choir members were invited to participate during rehearsals, and staff bystanders were invited at seven choir performances in the hospital. Respondents completed anonymous and semistructured questionnaires and the conductor (of 29 years) was interviewed. The inductive, comparative, and cyclic data analyses were informed by grounded theory and qualitative interrater reliability was performed. Questionnaires from 64 staff were returned. The choir elicited positive emotions, memories, Christmas spirit, hospital community and/or work-life effects for many staff, in a cancer context described as sometimes "overwhelming" and "stressful." Choir members' reactions included stress relief, friendship and feeling rewarded. Bystanders' reactions included feeling uplifted, inspired and moved. Suggestions for future performances were offered, including musical acknowledgement of other religious festivals. Two respondents were concerned about intrusive effects on patients and work practices. A staff Christmas choir supported most choir member and staff bystander respondents in an oncology hospital and is recommended in comparable contexts. Further investigation is warranted to extend understanding about Christmas music's effects in palliative care settings.
Publisher: Springer Science and Business Media LLC
Date: 23-07-2012
Publisher: Wiley
Date: 07-01-2013
Abstract: To report a 3D conformal radiotherapy (3D-CRT) technique that utilises a specific eye immobilisation and treatment set-up method as an alternative to stereotactic radiotherapy (SRT), for treatment of juxtapapillary choroidal melanoma (CM) and report early treatment outcomes of this technique. A contact lens and rod system was designed to provide eye immobilisation and a treatment reference point for 3D-CRT. The technique is described in detail in the body of the paper. A retrospective chart review was conducted to report freedom from local progression (FFLP) and radiation toxicity in a cohort of patients treated with a dose of 50 Gy in five fractions. Eleven eligible patients with juxtapapillary CM were treated between 2003 and 2009. The median follow-up was 3.2 years (range 1.2-5.3). The FFLP was 100% (95% confidence interval 71.5-100). The reproducibility of the set-up and eye immobilisation for fractionation was excellent. The mean dose to the planning target volume was 51.4 Gy (interquartilic range 51.0-51.9). Normal tissue dose constraints were achieved however, the quality of the 3D-CRT plan was variable. The highest acute radiation toxicity score was Common Toxicity Criteria version 3 grade 1. Vision outcomes were poor. In this small series, a novel non-stereotactic technique was found to be an accurate method for the treatment of CM with a high rate of freedom from tumour progression, in keeping with the SRT series. The quality of the conformal plan was variable. Investigation of the optimal dose-fractionation schedule to minimise late radiation toxicity without compromise of tumour control is the focus of ongoing clinical research at our centre.
Publisher: Wiley
Date: 22-11-2022
Abstract: The aim of this study was to evaluate the use of post‐mastectomy hypofractionationed radiation therapy (HFRT) for breast cancer in Victoria, Australia. This is a population‐based cohort of women with breast cancer who received post‐mastectomy RT to the chest wall with or without nodal irradiation between 2012 and 2017. HFRT was defined as fractions of RT. Data were captured in the Victorian Radiotherapy Minimum Dataset (VRMDS). The changing pattern of HFRT use was evaluated using the Cochran–Armitage test. Patient‐, treatment‐ and institutional‐related factors associated with HFRT use were evaluated using multivariable logistic regression. Two thousand and twenty‐one women were included in this study, of which 238 (12%) received HFRT. This increased from 8% in 2012 to 18% in 2017 ( P ‐trend 0.001). Older women were more likely to have HFRT (26% in women above 70 years vs 6% in women under 50 years P 0.001). Women who did not have nodal irradiation were more likely to have HFRT than those who did (18% vs 9% respectively P 0.001). In multivariate analyses, the progressive increase in HFRT use over time remained statistically significant – women treated in 2017 were four times more likely to receive HFRT than those treated in 2012 (95% CI = 2.1–7.7 P 0.001). Other factors independently associated with increased likelihood of HFRT use included increasing age at RT, and lack of nodal irradiation. In this first Australian study evaluating the use of post‐mastectomy HFRT, we observed increasing HFRT use in Victoria over time. We anticipate this rising trend will continue in the coming years.
Publisher: Wiley
Date: 06-2004
Publisher: Elsevier BV
Date: 10-2013
DOI: 10.1016/J.PRRO.2012.11.009
Abstract: This study used prospective swallowing data to establish the following: (1) whether doses to the pharyngeal constrictor muscles (PCMs) were significantly associated with swallowing outcomes and (2) a mean dose constraint to aim for in intensity modulated radiation therapy planning. The PCMs were contoured and radiation dose data obtained for 55 patients with head and neck cancer. Associations between radiation dose and percentage of pharyngeal residue, penetration-aspiration and activity limitation measured at 6 months posttreatment were analyzed. Pretreatment swallowing function, tumor site, T classification, and chemotherapy were accounted for in multivariate analyses. On multivariate analysis, the percentage of pharyngeal residue was statistically significantly associated with the mean dose to the superior PCM (95% confidence interval [CI], 0.15-1.66 P = .02). Penetration-aspiration was associated with the mean dose to the superior, middle, and inferior PCMs (95% CI, 1.02-1.27 P = .003 95% CI, 1.02-1.23 P = .003 95% CI, 1.04-1.21 P = .003, respectively) and the mean dose to the total PCM (95% CI, 1.05-1.31 P = .001). Activity limitation was also associated with the mean dose to the superior, middle, and inferior PCMs (95% CI, 1.01-1.20 P = .02 95% CI, 1.00-1.15 P =.04 95% CI, 1.01-1.15 P = .02, respectively) and the mean dose to the total PCM (95% CI, 1.02-1.23 P = .01). On univariate analysis, all 3 swallowing measures were statistically significantly worse for patients who received a biologically equivalent mean dose of >60 Gy to the PCMs. This remained significant on multivariate analysis for both penetration-aspiration and activity limitation (95% CI, 2.05-58.2, P = .004 and 95% CI, 1.14-27.7, P = .03, respectively). The radiation dose to the PCMs is significantly associated with swallowing dysfunction. Limiting the mean PCM dose to less than 60 Gy results in better swallowing outcomes.
Publisher: AMPCo
Date: 30-09-2020
DOI: 10.5694/MJA2.50794
Publisher: Wiley
Date: 06-2011
DOI: 10.1111/J.1754-9485.2011.02273.X
Abstract: The purpose of the study was to determine if multi-field inverse-planned intensity-modulated radiation therapy (IMRT) improves on the sparing of organs at risk (heart, lungs and contralateral breast) when compared with field-in-field forward-planned RT (FiF). The planning CT scans of 10 women with left-sided breast cancer previously treated with whole-breast RT on an inclined breast board with both arms supported above the head were retrieved. The whole breast planning target volume (PTV) was defined by clinical mark-up and contoured on all relevant CT slices as were the organs at risk. For each patient, three plans were generated using FiF, five- and nine-field inverse-planned IMRT, all to a total dose of 50 Gy to the whole breast. Mean and maximum doses to the organs at risk and the homogeneity index (HI) of the whole-breast PTV were compared. The mean heart dose for the FiF plans was 2.63 Gy compared with 4.04 Gy for the five-field and 4.30 Gy for the nine-field IMRT plans, with no significant differences in the HI of the whole-breast PTV in all plans. The FiF plans resulted in a mean contralateral breast dose of 0.58 Gy compared with 0.70 and 2.08 Gy for the five- and nine-field IMRT plans, respectively. FiF resulted in a lower mean heart and contralateral breast dose with comparable HI of the whole-breast PTV in comparison with inverse-planned IMRT using five or nine fields.
Publisher: AMPCo
Date: 12-2009
DOI: 10.5694/J.1326-5377.2009.TB03380.X
Abstract: To examine how performances by the Staff Christmas Choir of the Peter MacCallum Cancer Centre ("Peter Mac") affected inpatients, outpatients and visitors in 2008. During the Christmas season 2008, the Peter Mac Staff Christmas Choir gave seven performances at the Centre. Locations included inpatient wards, outpatient waiting areas and a cafeteria. To assess their response to the choir, oncology inpatients, outpatients and visitors (including early-departing bystanders) were given anonymous, semi-structured questionnaires during and after performances. To analyse the responses, we used a constructivist research approach informed by grounded theory. Participants' descriptions of the choir's effects on them. Questionnaires were returned by 111 people. The performances were received favourably by 93.7% of respondents, including nine from Jewish, Hindu or atheist backgrounds. Many said the music aroused positive emotions and memories. Several described transformative thoughts and physical reactions, felt affirmed by the Christmas spirit or message, and/or appreciated the peaceful or enlivened and social atmosphere. The choir also elicited personal perspectives about Christmas and Judaism, and the importance of "enjoying the moment". Only three respondents (2.7%) reported adverse effects, relating to emotional and audible intrusiveness. The Staff Christmas Choir created a supportive and uplifting atmosphere for many oncology patients and their visitors. However, responses from people from non-Christian backgrounds were limited, and further investigation is warranted to extend our understanding of the effect of Christmas music in Australian public health settings.
Publisher: Elsevier BV
Date: 04-2014
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.RADONC.2014.03.020
Abstract: Intensity modulated radiation therapy (IMRT) is a radiation therapy technology that facilitates the delivery of an improved dose distribution with less dose to surrounding critical structures. This study estimates the longer term effectiveness and cost-effectiveness of IMRT in patients post radical prostatectomy. A Markov decision model was developed to calculate the incremental quality adjusted life years (QALYs) and costs of IMRT compared with three dimensional conformal radiation therapy (3DCRT). Costs were estimated from the perspective of the Australian health care system. IMRT was both more effective and less costly than 3DCRT over 20 years, with an additional 20 QALYs gained and over $1.1 million saved per 1000 patients treated. This result was robust to plausible levels of uncertainty. IMRT was estimated to have a modest long term advantage over 3DCRT in terms of both improved effectiveness and reduced cost. This result was reliant on clinical judgement and interpretation of the existing literature, but provides quantitative guidance on the cost effectiveness of IMRT whilst long term trial evidence is awaited.
Publisher: Elsevier BV
Date: 12-2005
DOI: 10.1016/J.CLON.2005.06.012
Abstract: Parotid-sparing radiotherapy (PSRT) was introduced for patients with selected head and neck cancer requiring bilateral upper-neck irradiation at our centre in 2000. The aim of this study was to compare the subjective degree of xerostomia in patients treated with PSRT between January 2000 and June 2003 with patients treated using conventional techniques (radiotherapy) over the same period. Eligible patients were required to have completed treatment 6 months previously and be recurrence-free at the time of interview. PSRT was defined as conformal radiotherapy, in which the mean dose to at least one parotid gland was 33 Gy or less, as determined by the dose-volume histogram. Patients receiving radiotherapy were treated with standard parallel-opposed fields, such that both parotids received a minimum of 40 Gy. Xerostomia was assessed using a validated questionnaire containing six questions with a rating between 0 and 10. Lower scores indicated less difficulty with xerostomia. Thirty-eight eligible patients treated with PSRT were identified: 25 with oropharyngeal cancer and 13 with nasopharyngeal cancer (NPC). The mean overall questionnaire score (Q1-5) for this group was 4.20 (standard error = 0.33). Forty-four patients (24 oropharyngeal, 21 NPC) treated with radiotherapy over the same period were eligible. The mean overall questionnaire score (Q1-5) for this group was 5.86 (standard error = 0.35). The difference in mean overall scores between the two groups of patients was statistically significant (P < 0.001), as were the scores for four of the six in idual questions. These results suggest that PSRT offers improved long-term xerostomia-related quality of life compared with conventional radiotherapy.
Publisher: Elsevier BV
Date: 07-2019
Publisher: Wiley
Date: 17-05-2001
DOI: 10.1046/J.1440-1673.2001.00901.X
Abstract: Quality assurance ensures that planned treatments eventuate. Programmes must include feedback loops to promptly correct any shortfall in predetermined standards. In March 1999, a weekly Chart Round was introduced to verify that certain items relevant to quality care were being completed for patients of the Head and Neck Radiotherapy Unit at the Peter MacCallum Cancer Institute. The experience was reviewed after 1 year and it was found that the initiation of Chart Rounds has assisted in raising the level of item completion from 80% to 99% in similar groups of patients treated before and after the initiation of the Chart Round. Initiation of the Chart Round has also provided a useful forum for in-house peer-review, education and effective real-time communication between medical and allied health personnel, all of which has further added to the quality of patient care.
Publisher: Elsevier BV
Date: 05-2011
Abstract: Chemotherapy plus radiotherapy is the standard of care for patients with limited stage Hodgkin lymphoma (HL). Radiotherapy is evolving from involved field radiotherapy (IFRT) to involved node radiotherapy (INRT) to decrease radiotherapy-related morbidity. In the absence of long-term toxicity data, dose-volume metrics of organs at risk (OAR) provide a surrogate measure of toxicity risk. Ten female patients with stage I-IIA supradiaphragmatic HL were randomly selected. All patients had pre-chemotherapy computerised tomography (CT) and CT-positron emission tomography staging. Using CT planning, three radiotherapy plans were produced per patient: (i) IFRT, (ii) INRT using parallel-opposed beams and (iii) INRT using volumetric modulated arc therapy (VMAT). Radiotherapy dose was 30.6 Gy in 1.8 Gy fractions. OAR evaluated were lungs, breasts, thyroid, heart and coronary arteries. Compared with IFRT, INRT significantly reduced mean doses to lungs (P < 0.01), breasts (P < 0.01), thyroid (P < 0.01) and heart (P < 0.01), on Wilcoxon testing. Compared with conventional INRT, VMAT improved dose conformality but increased low-dose radiation exposure to lungs and breasts. VMAT reduced the heart volume receiving 30 Gy (V30) by 85%. Reduction from IFRT to INRT decreased the volumes of lungs, breasts and thyroid receiving high-dose radiation, suggesting the potential to reduce long-term second malignancy risks. VMAT may be useful for patients with pre-existing heart disease by minimising further cardiac toxicity risks.
Publisher: Wiley
Date: 05-10-2016
Abstract: We tested the ability of the Assessment of New Radiation Oncology Technology and Treatments framework to determine the clinical efficacy and safety of intensity-modulated radiation therapy (IMRT) compared with 3-dimensional radiation therapy (3DCRT) for post-prostatectomy radiation therapy (PPRT) to support its timely health economic evaluation. Treatment plans produced using FROGG guidelines provided dosimetry parameters for both techniques at 64 Gy and 70 Gy and were also used to model early and late outcome probabilities. Clinical parameters were derived from early toxicity and quality of life patient data, systematic literature review and expert opinion. Dosimetry parameters were correlated with the measures of clinical efficacy and safety. Data from two patient cohorts (29 and 27 respectively) were collected within the project timeframe, providing evidence for acute toxicity and quality of life, and dosimetric comparisons. Relative rates of tumour control probability (TCP) and normal tissue control probability (NTCP) modelling were readily derived from the planning exercise and demonstrated advantages in uncomplicated TCP for IMRT over 3DCRT, predominantly due to normal tissue sparing. The safety of IMRT delivery was demonstrated with TCP uncompromised by IMRT protocol violations, which achieved rectal sparing only by reducing minimum target dose and coverage. Sources of desk-top and patient-based evidence were successfully used to demonstrate potential improved clinical efficacy and safety of applying dose escalation using IMRT instead of 3DCRT in PPRT.
Publisher: Wiley
Date: 04-2012
DOI: 10.1111/J.1754-9485.2011.02324.X
Abstract: The purpose of this study was to compare and evaluate radiotherapy treatment plans using volumetric modulated arc therapy (VMAT) and intensity modulated radiotherapy (IMRT) for post-prostatectomy radiotherapy. The quality of radiotherapy plans for 10 patients planned and treated with a seven-field IMRT technique for biochemical failure post-prostatectomy were subsequently compared with 10 prospectively planned single-arc VMAT plans using the same computed tomography data set and treatment planning software. Plans were analysed using parameters to assess for target volume coverage, dose to organs at risk (OAR), biological outcomes, dose conformity and homogeneity, as well as the total monitor units (MU), planning and treatment efficiency. The mean results for the study population are reported for the purpose of comparison. For IMRT, the median dose to the planning target volume, V(95%) and D(95%) was 71.1 Gy, 98.9% and 68.3 Gy compared with 71.2 Gy, 99.2% and 68.6 Gy for VMAT. There was no significant difference in the conformity index or homogeneity index. The VMAT plans achieved better sparing of the rectum and the left and right femora with a reduction in the median dose by 7.9, 6.3 and 3.6 Gy, respectively. The total number of monitor units (MU) was reduced by 24% and treatment delivery time by an estimated 3 min per fraction without a significant increase in planning requirements. VMAT can achieve post-prostatectomy radiotherapy plans of comparable quality to IMRT with the potential to reduce dose to OAR and improve the efficiency of treatment delivery.
Publisher: Wiley
Date: 02-2022
Abstract: To describe the pattern of the use of advanced radiation therapy (RT) techniques, including intensity‐modulated RT (IMRT), volumetric modulated arc therapy (VMAT), and stereotactic body RT (SBRT) for the management of bone metastases (BM), and the associated factors in Victoria. We used a population‐based cohort of patients from the state‐wide Victorian Radiotherapy Minimum Data Set (VRMDS) who received RT for BM between 2012 and 2017. The primary outcome was proportion of RT courses using advanced RT techniques. The Cochran‐Armitage test for trend was used to evaluate temporal trend in advanced RT use. Multinomial logistic regression was used to identify factors associated with advanced RT use. A total of 18,158 courses of RT were delivered to 10,956 patients–16,626 (91.6%) courses were 3D conformal RT, 857 (4.7%) IMRT/VMAT and 675 (3.7%) SBRT. There was a sharp increase in IMRT/VMAT use from % in 2012–2015, to 10.1% in 2016 and 16.3% in 2017 ( P ‐trend 0.001). Increase in SBRT use was more gradual, from 1.2% in 2012 to 4.8% in 2016 and 5.5% in 2017 for SBRT (P‐trend .001). In multivariate analyses, year of RT was the strongest predictor of IMRT/VMAT use (OR = 41 95%CI = 25–67 P 0.001, comparing 2012–2013 and 2016–2017). Primary tumour type (prostate cancer) was the strongest predictor of SBRT use (OR = 6.07 95% CI = 4.19–8.80 P 0.001). Overall, there was increasing trend in the use of advanced RT techniques for BM in Victoria, with a distinct pattern for IMRT/VMAT compared with SBRT – SBRT uptake was more gradual while IMRT/VMAT uptake was abrupt, occurring contemporaneously with Medicare Benefit Scheme funding changes in 2016.
Publisher: Elsevier BV
Date: 12-2003
DOI: 10.1016/J.MEDDOS.2003.08.003
Abstract: Radiation therapy dosimetry software now frequently incorporates biological predictions of the probability of normal tissue complications. This study investigates whether the length of normal structure outlined affects a normal tissue complication probability (NTCP) for that structure. It also researches the effect of any change in the dose parameter used to produce a 50% probability of a complication (the TD50) on the calculated NTCP, as this is related to the clinical observations. An NTCP was calculated for rectum and bladder on a s le of prostate cases receiving external beam radiation therapy. The length of the organs at risk was varied and the NTCP recalculated for each different length using the same treatment plan. Large variations of up to 80% in NTCP for different delineated lengths of organ for a given TD50 were observed. Changing the TD50 dose altered the calculated NTCP and the relative size of the variation in the values. This parameter will need further investigation a standardized delineated length of 2 cm beyond the beam edge for normal structures is recommended. Interpatient and interinstitution plan comparison using dose volume histograms and/or normal tissue complication probabilities will be compromised until such standardization occurs.
No related grants have been discovered for Colin Hornby.