ORCID Profile
0000-0002-7556-0542
Current Organisations
Queensland Health
,
Royal Brisbane and Women's Hospital
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Publisher: Wiley
Date: 23-02-2023
Abstract: Quality assurance is integral to benchmarking and continuous improvement in the clinical care of people affected by cancer. Quality assurance systems are built upon agreed clinical and administrative standards. The Cardiovascular and Interventional Radiology Society of Europe (CIRSE) first developed a set of Standards for Interventional Oncology Services modelled on the Standards of Practice in Radiation Oncology developed in Australia and New Zealand. A subset of these Standards has been used to develop a tiered International Accreditation System in Interventional Oncology (IASIOS). This system covers the entirety of the patient care pathway from referral through to discharge and is clearly aimed at setting the benchmark for safe, quality interventional oncology (IO) services. Such a system has multiple benefits, including increasing the awareness of the availability of IO services and assurance in the quality of the care delivered to patients.
Publisher: Wiley
Date: 08-2021
Abstract: The Royal Australian and New Zealand College of Radiologists (RANZCR) led the medical community in Australia and New Zealand in considering the impact of machine learning and artificial intelligence (AI) in health care. RANZCR identified that medical leadership was largely absent from these discussions, with a notable absence of activity from governments in the Australasian region up to 2019. The clinical radiology and radiation oncology sectors were considered ripe for the adoption of AI, and this raised a range of concerns about how to ensure the ethical application of AI and to guide its safe and appropriate use in our two specialties. RANZCR’s Artificial Intelligence Committee undertook a landscape review in 2019 anddetermined that AI within clinical radiology and radiation oncology had the potential to grow rapidly and significantly impact the professions. In order to address this, RANZCR drafted ethical principles on the use of AI and standards to guide deployment and engaged in extensive stakeholder consultation to ensure a range of perspectives were received and considered. RANZCR published two key bodies of work: The Ethical Principles of Artificial Intelligence in Medicine, and the Standards of Practice for Artificial Intelligence in Clinical Radiology. RANZCR’s publications in this area have established a solid foundation to prepare for the application of AI, however more work is needed. We will continue to assess the evolution of AI and ML within our professions, strive to guide the upskilling of clinical radiologists and radiation oncologists, advocate for appropriate regulation and produce guidance to ensure that patient care is delivered safely.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-09-2010
Abstract: To determine the prognostic importance of p16 and human papillomavirus (HPV) in patients with oropharyngeal cancer treated on a phase III concurrent chemoradiotherapy trial. Patients with stage III or IV head and neck squamous cell cancer were randomly assigned to concurrent radiotherapy and cisplatin with or without tirapazamine. In this substudy, analyses were restricted to patients with oropharyngeal cancer. p16 was detected by immunohistochemistry, and HPV was detected by in situ hybridization and polymerase chain reaction. Slides were available for p16 assay in 206 of 465 patients, of which 185 were eligible, and p16 and HPV were evaluable in 172 patients. One hundred six (57%) of 185 were p16-positive, and in patients evaluable for both p16 and HPV, 88 (86%) of 102 p16-positive patients were also HPV-positive. Patients who were p16-positive had lower T and higher N categories and better Eastern Cooperative Oncology Group (ECOG) performance status. p16-positive tumors compared with p16-negative tumors were associated with better 2-year overall survival (91% v 74% hazard ratio [HR], 0.36 95% CI, 0.17 to 0.74 P = .004) and failure-free survival (87% v 72% HR, 0.39 95% CI, 0.20 to 0.74 P = .003). p16 was a significant prognostic factor on multivariable analysis (HR, 0.45 95% CI, 0.21 to 0.96 P = .04). p16-positive patients had lower rates of locoregional failure and deaths due to other causes. There was a trend favoring the tirapazamine arm for improved locoregional control in p16-negative patients (HR, 0.33 95% CI, 0.09 to 1.24 P = .13). HPV-associated oropharyngeal cancer is a distinct entity with a favorable prognosis compared with HPV-negative oropharyngeal cancer when treated with cisplatin-based chemoradiotherapy.
Publisher: Elsevier BV
Date: 05-2004
DOI: 10.1016/J.CLON.2003.10.009
Abstract: Tumour-cell proliferation is a hallmark of the malignant phenotype. Positron emission tomography (PET) offers a unique method of imaging biological and biochemical changes in vivo. Radiolabelled thymidine and thymidine analogues are currently in development as PET tracers. By studying the uptake and kinetics of such compounds using PET, a measure of DNA synthesis and hence cell proliferation can be obtained. Molecular imaging of cellular proliferation with PET is now possible, and has the potential to play an important role in the evaluation of efficacy of new anti-cancer agents.
Publisher: Wiley
Date: 26-11-2009
DOI: 10.1111/J.1754-9485.2009.02124.X
Abstract: This article reviews the efficacy and safety of radiotherapy in patients with cancer who are pregnant. Our review provided extended follow-up results in nine cases, presents a technical discussion on measures taken to minimise foetal radiation exposure and provides a comprehensive summary of the literature. Nine patients who received radiotherapy while pregnant are described. The clinical presentation and outcomes of these and 100 additional cases identified on a systematic literature review are presented. Comparisons of scattered radiation doses from three linear accelerators are presented. The average maternal follow-up in our series was 8.9 years with one patient having a recurrence of their astrocytoma. In terms of foetal outcome, there were one death in utero, one elective termination of pregnancy and one on which no data were available. Six children, on whom long-term follow-up (average 10.3 years) was obtainable, were in good health. Overall, there had been 109 cases of radiotherapy in pregnancy that met our search criteria with 13 adverse outcomes and a median follow-up of 37 months. Comparisons of three linear accelerators demonstrated significant differences in the amount of scattered radiation to the abdominal surface. In summary radiotherapy during pregnancy can be associated with a significant number of adverse outcomes. While it may be difficult for a patient not to attribute these effects to radiotherapy, it is also difficult to define the mechanisms by which radiotherapy would have caused them, if that were the case.
Publisher: Wiley
Date: 21-11-2005
DOI: 10.1111/J.1440-1673.2005.01391.X
Abstract: The purpose of this study was to document how radiation oncology departments in Australia and New Zealand manage extended waiting lists by prioritizing patients for radiotherapy and how these centres define the "waiting time". A literature search on strategies for management of waiting lists in radiotherapy, both locally and internationally, was performed. A collaborative survey of all the radiotherapy departments in Australia and New Zealand was then undertaken. Of the 32 centres surveyed around Australia and New Zealand, 25 (77%) responded. There was considerable variation in the definitions used for "waiting times". Eleven of the 25 centres had formally documented protocols. New Zealand has a national policy for prioritization of patients for radiotherapy. Six centres had verbal protocols. Four centres had no significant waiting times and did not require a protocol for prioritization. One centre prioritized according to clinician discretion, two centres used a first-come, first-served basis. One centre replied but their protocol was missing. The variation in the definition of waiting time reduces its usefulness as an indirect measure of resources and as a method of comparing centres. There is also wide variation in the management of waiting lists, particularly in the prioritization schedules used by different centres. The major factor contributing to waiting lists at present is a shortage of radiation oncology staff, particularly radiation therapists. The implementation of standardized protocols for prioritizing patients may be useful in helping to manage scarce resources not withstanding the need to increase the resource base. However, the existence of such protocols should not give legitimacy to undue delays in commencing radiation treatment.
Publisher: Elsevier BV
Date: 12-2012
Publisher: Hindawi Limited
Date: 16-03-2013
DOI: 10.1155/2013/710305
Abstract: We aim to assess the utility and safety of 18F-fluoro-L-thymidine- positron emission tomography (FLT-PET), in reference to 18F-2-fluoro-2-deoxy-D-glucose (FDG-PET) in the assessment of nodal involvement for mucosal head and neck SCC (HNSCC). Methods . Ten patients with HNSCC receiving definitive chemoradiation (CRT) were enrolled. Baseline FLT-PET and FDG-PET were obtained. The total number of involved lymph nodes and ultimate nodal staging by the baseline FDG-PET and FLT-PET was compared. Receiver Operating Characteristics (ROC) analysis for the matched nodes was performed to identify an optimal maximal standardized uptake value (SUVmax) cutpoint. Results . The tracer uptake by the involved nodes on FDG-PET was higher than those judged to be involved by FLT-PET (mean SUVmax: 5.9 versus 3.4 P 0.001 ). More abnormal lymph nodes were detected by FLT-PET than FDG-PET (Odds ratio = 3.67 P = 0.004 ). The optimal SUVmax cutpoint for FLT-PET to correspond with positive FDG-PET for the matched lymph nodes was 3.25 (range 3.1–3.4). Conclusions . It is unlikely that FLT-PET will be a more accurate staging investigation than FDG-PET. A SUVmax of 3.25 may be considered as a reference cut-off in determining if a cervical lymph node is involved for HNSCC. Validation in a surgical cohort with pathological correlation is warranted.
Publisher: Rockefeller University Press
Date: 27-07-2020
DOI: 10.1084/JEM.20200389
Abstract: Cellular immunotherapeutics targeting the human papillomavirus (HPV)–16 E6 and E7 proteins have achieved limited success in HPV-positive oropharyngeal cancer (OPC). Here we have conducted proteome-wide profiling of HPV-16–specific T cell responses in a cohort of 66 patients with HPV-associated OPC and 22 healthy in iduals. Unexpectedly, HPV-specific T cell responses from OPC patients were not constrained to the E6 and E7 antigens they also recognized E1, E2, E4, E5, and L1 proteins as dominant targets for virus-specific CD8+ and CD4+ T cells. Multivariate analysis incorporating tumor staging, treatment status, and smoking history revealed that treatment status had the most significant impact on HPV-specific CD8+ and CD4+ T cell immunity. Specifically, the breadth and overall strength of HPV-specific T cell responses were significantly higher before the commencement of curative therapy than after therapy. These data provide the first glimpse of the overall human T cell response to HPV in a clinical setting and offer groundbreaking insight into future development of cellular immunotherapies for HPV-associated OPC patients.
Publisher: Wiley
Date: 08-10-2009
Publisher: Elsevier BV
Date: 09-2014
Publisher: Springer Netherlands
Date: 26-09-2013
Publisher: Wiley
Date: 25-05-2012
Publisher: Springer Science and Business Media LLC
Date: 22-06-2004
Publisher: Wiley
Date: 17-05-2001
DOI: 10.1046/J.1440-1673.2001.00898.X
Abstract: Prior to the dissemination of evidence-based quality assurance guidelines, the Australian National Breast Cancer Centre Radiation Oncology Group conducted a process survey of breast radiotherapy treatment delivery throughout Australia. A process survey was conducted in August/September 1998. This survey comprised questions enquiring about treatment positioning, immobilization devices used, planning strategies, simulation and dose computation methods, treatment prescribing and quality assurance. The survey was sent to 123 Australian fellows of the Royal Australian and New Zealand College of Radiologists (RANZCR) and to the six directors of New Zealand radiation oncology departments. Fifty-eight questionnaires were returned of which 38 were received from in iduals and 20 represented a reply from a department with a routine breast radiotherapy protocol (representing an average of 4.5 radiation oncologists per reply). The study identified great consistency between departments with respect to dose and fractionation for breast tangents. The study also identified some areas of treatment planning and delivery that varied between in iduals or departments. These mainly reflected a lack of evidence in some areas of radiotherapy treatment delivery. The circulation of quality assurance guidelines will perhaps improve consistency of radiotherapy techniques in which studies have identified that technique changes improve outcome. This study identified that these areas include the taking of simulation and port films and the use of off-axis dosimetry. Further studies are required for areas of radiotherapy treatment delivery that have little evidence for or against their implementation.
Publisher: Wiley
Date: 11-02-2014
DOI: 10.1111/BJU.12497
Abstract: To study the influence of adjuvant androgen suppression and bisphosphonates on incident vertebral and non-spinal fracture rates and bone mineral density (BMD) in men with locally advanced prostate cancer. Between 2003 and 2007, 1071 men with locally advanced prostate cancer were randomly allocated, using a 2 × 2 trial design, to 6 months i.m. leuprorelin (androgen suppression [AS]) before radiotherapy alone ± 12 months additional leuprorelin ± 18 months zoledronic acid (ZdA), commencing at randomization. The main endpoint was incident thoraco-lumbar vertebral fractures, which were assessed radiographically at randomization and at 3 years, then reassessed by centralized review. Subsidiary endpoints included incident non-spinal fractures, which were documented throughout follow-up, and BMD, which was measured in 222 subjects at baseline, 2 years and 4 years. Incident vertebral fractures at 3 years were observed in 132 subjects. Their occurrence was not increased by 18 months' AS, nor reduced by ZdA. Incident non-spinal fractures occurred in 72 subjects and were significantly related to AS duration but not to ZdA. Osteopenia and osteoporosis prevalence rates at baseline were 23.4 and 1.4%, respectively, at the hip. Treatment for 6 and 18 months with AS caused significant reductions in hip BMD at 2 and 4 years (P < 0.01) and ZdA prevented these losses at both time points. In an AS-naïve population, 18 months of ZdA treatment prevented the sustained BMD losses caused by 18 months of AS treatment however, the study power was insufficient to show that AS duration or ZdA influenced vertebral fracture rates.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 2005
Abstract: To select one of two chemoradiotherapy regimens for locally advanced squamous cell carcinoma (SCC) of the head and neck as the experimental arm for the next Trans-Tasman Radiation Oncology Group phase III trial. One hundred twenty-two previously untreated patients with stage III/IV SCC of the head and neck were randomized to receive definitive radiotherapy (70 Gy in 7 weeks) concurrently with either cisplatin (75 mg/m 2 ) plus tirapazamine (290 mg/m 2 /d) on day 2 of weeks 1, 4, and 7, and tirapazamine alone (160 mg/m 2 /d) on days 1, 3, and 5 of weeks 2 and 3 (TPZ/CIS), or cisplatin (50 mg/m 2 ) on day 1 and infusional fluorouracil (360 mg/m 2 /d) on days 1 through 5 of weeks 6 and 7 (chemoboost). Three-year failure-free survival rates were 55% with TPZ/CIS (95% CI, 39% to 70%) and 44% with chemoboost (95% CI, 30% to 60% log-rank P = .16). Three-year locoregional failure-free rates were 84% in the TPZ/CIS arm (95% CI, 71% to 92%) and 66% in the chemoboost arm (95% CI, 51% to 79% P = .069). More febrile neutropenia and grade 3 or 4 late mucous membrane toxicity were observed with TPZ/CIS, while acute skin radiation reaction was more severe and prolonged with chemoboost. Compliance with protocol treatment was satisfactory on both arms. Both regimens are feasible and are associated with significant but acceptable toxicity profiles in the cooperative group setting. Based on the promising efficacy seen in this trial, TPZ/CIS is being evaluated in a large phase III trial.
Publisher: Elsevier BV
Date: 11-2020
Publisher: IOP Publishing
Date: 21-12-2012
DOI: 10.1088/0031-9155/58/2/187
Abstract: Intra-tumour heterogeneity is a characteristic shared by all cancers. We explored the use of texture variables derived from images of [(18)F]fluorothymidine-positron emission tomography (FLT-PET), thus notionally assessing the heterogeneity of proliferation in in idual tumours. Our aims were to study the range of textural feature values across tissue types, verify the repeatability of these image descriptors and further, to explore associations with clinical response to chemotherapy in breast cancer patients. The repeatability of 28 textural descriptors was assessed in patients who had two FLT-PET scans prior to therapy using relative differences and the intra-class correlation coefficient (ICC). We tested associations between features at baseline and clinical response measured in 11 patients after three cycles of chemotherapy, and explored changes in FLT-PET at one week after the start of therapy. A subset of eight features was characterized by low variations at baseline (<±30%) and high repeatability (0.7 ≤ ICC ≤ 1). The intensity distribution profile suggested fewer highly proliferating cells in lesions of non-responders compared to responders at baseline. A true increase in CV and homogeneity was measured in four out of six responders one week after the start of therapy. A number of textural features derived from FLT-PET are altered following chemotherapy in breast cancer, and should be evaluated in larger clinical trials for clinical relevance.
Publisher: Springer Science and Business Media LLC
Date: 02-12-2014
DOI: 10.1038/NRCLINONC.2014.211
Abstract: Interventional oncology is an evolving branch of interventional radiology, which relies on rapidly evolving, highly sophisticated treatment tools and precise imaging guidance to target and destroy malignant tumours. The development of this field has important potential benefits for patients and the health-care system, but as a new discipline, interventional oncology has not yet fully established its place in the wider field of oncology its application does not have a comprehensive evidence base, or a clinical or quality-assurance framework within which to operate. In this regard, radiation oncology, a cornerstone of modern cancer care, has a lot of important information to offer to interventional oncologists. A strong collaboration between radiation oncology and interventional oncology, both of which aim to cure or control tumours or to relieve symptoms with as little collateral damage to normal tissue as possible, will have substantial advantages for both disciplines. A close relationship with radiation oncology will help facilitate the development of a robust quality-assurance framework and accumulation of evidence to support the integration of interventional oncology into multidisciplinary care. Furthermore, collaboration between interventional oncology and radiation oncology fields will have great benefits to practitioners, people affected by cancer, and to the wider field of oncology.
Publisher: Society of Nuclear Medicine
Date: 26-09-2013
Publisher: Wiley
Date: 27-01-2006
DOI: 10.1002/CNCR.21698
Abstract: Cutaneous squamous cell carcinoma (SCC) of the head and neck is a common cancer that has the potential to metastasize to lymph nodes in the parotid gland and neck. Previous studies have highlighted limitations with the current TNM staging system for metastatic skin carcinoma. The aim of this study was to test a new staging system that may provide better discrimination between patient groups. A retrospective multicenter study was conducted on 322 patients from three Australian and three North American institutions. All had metastatic cutaneous SCC involving the parotid gland and/or neck and all were treated for cure with a minimum followup time of 2 years. These patients were restaged using a newly proposed system that separated parotid disease (P stage) from neck disease (N stage) and included subgroups of P and N stage. Metastases involved the parotid in 260 patients (149 P1 78 P2 33 P3) and 43 of these had clinical neck disease also (22 N1 21 N2). Neck metastases alone occurred in 62 patients (26 N1 36 N2). Ninety percent of patients were treated surgically and 267 of 322 received radiotherapy. Neck nodes were pathologically involved in 32% of patients with parotid metastases. Disease recurred in 105 (33%) of the 322 patients, involving the parotid in 42, neck in 33, and distant sites in 30. Parotid recurrence did not vary significantly with P stage. Disease-specific survival was 74% at 5 years. Survival was significantly worse for patients with advanced P stage: 69% survival at 5 years compared with 82% for those with early P stage (P = 0.02) and for those with both parotid and neck node involvement pathologically: 61% survival compared with 79% for those with parotid disease alone (P = 0.027). Both univariate and multivariate analysis confirmed these findings. Clinical neck involvement among patients with parotid metastases did not significantly worsen survival (P = 0.1). This study, which included a mixed cohort of patients from six different institutions, provides further information about the clinical behavior of metastatic cutaneous SCC of the head and neck. The hypothesis that separation of parotid and neck disease in a new staging system is supported by the results. The benefit of having subgroups of P and N stage is uncertain, but it is likely to identify patients with unfavorable characteristics that may benefit from further research.
Publisher: Wiley
Date: 02-2002
DOI: 10.1046/J.1440-1622.2002.02328.X
Abstract: Changes in the practice of radiation oncology have been significant over the last decade and continue to develop at an exciting rate. These advances range from our understanding of the increasingly important role of radiotherapy in the adjuvant and definitive settings to huge technological progress in the areas of tumour delineation, treatment planning, delivery and verification. In many cases, benefits have resulted from the ability of modern radiotherapy to deliver high doses with great accuracy and increasing safety in a highly in idualized manner. This has impacted favourably on the management of all major malignancies as discussed in this paper. A good understanding of what can be achieved with modern radiotherapy has never been more important in ensuring an effective multidisciplinary approach to cancer management.
Publisher: Springer Science and Business Media LLC
Date: 07-2014
Publisher: Elsevier BV
Date: 03-1998
DOI: 10.1016/S1056-8727(97)00072-X
Abstract: Young adult male Hooded Wistar rats were rendered diabetic by administration of streptozotocin and maintained for 5 weeks on a diet containing either 6% olive oil as the total source of fat (OO diet), or purified gamma-linolenic acid (GLA) at a concentration of 0.5% with the remaining 5.5% provided by olive oil (GLA diet). Rats were treated with the angiotensin converting inhibitor, cilazapril, administered in the drinking water at a dose of 20 mg kg-1 body weight day-1. For the OO diet groups, sciatic nerve conduction velocity (NCV) in diabetic rats was reduced by 32% (p < 0.01) in comparison with nondiabetic (vehicle-treated) rats and 27.5% (p < 0.05) in comparison with diabetic rats treated with cilazapril. Diabetic, cilazapril-treated rats showed no reduction in NCV. For the nondiabetic, diabetic, and diabetic plus cilazapril groups fed GLA, the NCV was not significantly different, indicating that dietary GLA also prevented the deficit in the NCV induced by the diabetic state. Analysis of the sciatic nerve endoneurial phospholipid fatty acids revealed a significant reduction in the proportion of GLA and an elevation in the proportion of linoleic acid in the diabetic groups compared with the nondiabetic groups and this was independent of the cilazapril treatment or the dietary lipid supplement. Sciatic nerve myo-inositol content was unaltered while mannose, fructose, glucose, and sorbitol levels were elevated in the diabetic groups and these changes were independent of the cilazapril treatment or the dietary lipid supplement. These results indicate that in the rat, cilazapril treatment or dietary GLA, at the doses tested, are effective in preventing the deficit in the NCV induced by diabetes.
Publisher: Wiley
Date: 12-08-2023
DOI: 10.1002/WRNA.1754
Abstract: Oral cancer (OC) is the most prevalent subtype of cancer arising in the head and neck region. OC risk is mainly attributed to behavioral risk factors such as exposure to tobacco and excessive alcohol consumption, and a lesser extent to viral infections such as human papillomaviruses and Epstein-Barr viruses. In addition to these acquired risk factors, heritable genetic factors have shown to be associated with OC risk. Despite the high incidence, biomarkers for OC diagnosis are lacking and consequently, patients are often diagnosed in advanced stages. This delay in diagnosis is reflected by poor overall outcomes of OC patients, where 5-year overall survival is around 50%. Among the biomarkers proposed for cancer detection, noncoding RNA (ncRNA) can be considered as one of the most promising categories of biomarkers due to their role in virtually all cellular processes. Similar to other cancer types, changes in expressions of ncRNAs have been reported in OC and a number of ncRNAs have diagnostic, prognostic, and therapeutic potential. Moreover, some ncRNAs are capable of regulating gene expression by various mechanisms. Therefore, elucidating the current literature on the four main types of ncRNAs namely, microRNA, lncRNA, snoRNA, piwi-RNA, and circular RNA in the context of OC pathogenesis is timely and would enable further improvements and innovations in diagnosis, prognosis, and treatment of OC. This article is categorized under: RNA in Disease and Development > RNA in Disease RNA in Disease and Development > RNA in Development.
Publisher: Wiley
Date: 03-2004
Publisher: Wiley
Date: 13-09-2013
DOI: 10.1002/HED.23146
Abstract: The "Swallowing and Nutrition Guidelines for Patients with Head and Neck Cancer" were developed to guide early identification and management of dysphagia and nutritional risk before, during, and after cancer treatment. The purpose of this study was to validate these guidelines. Patients attending a Combined Head and Neck Clinic at a major tertiary hospital in 2007 to 2008 were assessed using the guidelines, with high-risk category patients recommended for proactive gastrostomy. Data were collected on guideline adherence, gastrostomy tube insertion, and weight. Sensitivity, specificity, and positive predictive value were calculated for validation. Proactive gastrostomy tubes were inserted in 173 of 501 patients (25%). Overall guideline adherence was 87%. High-risk category adherence was 75%. Validation outcomes were sensitivity 54%, specificity 93%, and positive predictive value 82%. The risk categories in the guidelines are valid to assist early identification of swallowing and nutritional risk and guide decision-making on proactive gastrostomy tube insertion.
Publisher: Wiley
Date: 02-2012
DOI: 10.1111/J.1754-9485.2011.02330.X
Abstract: To evaluate the role of adjuvant radiotherapy in management of patients with tubular carcinoma of the breast. One hundred seventy-eight patients treated for tubular carcinoma were identified from the Queensland Radium Institute database. A retrospective review of medical records identified 115 patients meeting eligibility criteria: breast-conserving surgery for a histological diagnosis of tubular carcinoma, minimum follow up of 12 months and adequate medical records. Median follow up was 64 months. There were no significant differences between patient characteristics treated with and without radiotherapy. Median age at diagnosis was 54 (36-78) years. Ninety-five percent tumours were T1 and four patients had positive axillary lymph nodes. Of 94 patients treated with adjuvant radiotherapy, one developed local relapse. Five of 21 patients who did not have adjuvant radiotherapy failed locally. Five-year relapse-free survival with and without radiotherapy was 100 and 89%, respectively (hazard ratio for radiotherapy: 0.06 95% confidence interval 0.01-0.32, P = 0.001). Radiotherapy has a significant impact on relapse-free survival in patients treated with breast-conserving surgery for tubular carcinoma.
Publisher: Wiley
Date: 09-02-2000
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.RADONC.2012.09.018
Abstract: The RADAR trial determines whether adjuvant androgen suppression, bisphosphonates and radiation dose escalation for localised prostate cancer (PC) may improve oncologic outcomes. This study examines whether these measures increase rectal and urinary dysfunction and are secondary trial endpoints. Using a 2×2 factorial trial design men with locally advanced PC were randomly allocated 6 months i.m. leuprorelin prior to radiotherapy either alone or followed by 12 months i.m. leuprorelin. These two groups received 18 months i.v. zoledronic acid (Z) commencing at randomisation or no further treatment. Radiotherapy dose was escalated in a regulated way using external beam techniques (EBRT) or by a high dose rate brachytherapy (HDRB) boost. Prevalence rates of rectal and urinary dysfunctional symptoms were compared at baseline, the end of RT, 18 and 36 months according to treatment arm, dose and technique using multiple regression models. Between 2003 and 2007, 1071 men were randomly allocated and eligible for inclusion in this study. No persistent differences in rectal or urinary dysfunction were attributable to treatment arm or to increasing EBRT dose. However following HDRB statistical increases (p<0.001) in urinary dysfunction were measured using the EORTC PR25 instrument at 18 and 36 months. Adjuvant androgen suppression, bisphosphonates and increasing EBRT dose did not increase rectal or urinary dysfunction in this trial. However dose escalation using HDRB increased urinary dysfunction.
Publisher: Wiley
Date: 03-1993
Publisher: Wiley
Date: 03-2004
Publisher: Springer Science and Business Media LLC
Date: 28-05-2014
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: Australia
Start Date: 2013
End Date: 2016
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2009
End Date: 2016
Funder: National Health and Medical Research Council
View Funded Activity