ORCID Profile
0000-0003-0112-0680
Current Organisations
UNSW
,
South Western Sydney Local Health District
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Research Topics
In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Top 5 Research Topics
ANZSRC Field of Research (FoR)
Medical Physics | Radiation Therapy | Other Physical Sciences | Transport Properties and Non-Equilibrium Processes | Medical Devices | Biomedical Engineering | Condensed Matter Imaging
ANZSRC Socio-Economic Objective (SEO)
Cancer and Related Disorders | Expanding Knowledge in the Chemical Sciences | Expanding Knowledge in the Physical Sciences |
Related Links
Publications
The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies
Publisher: Elsevier BV
Date: 12-2004
DOI: 10.1016/J.CLON.2004.06.007
Abstract: The debate on the funding and availability of cytotoxic drugs raises questions about the contribution of curative or adjuvant cytotoxic chemotherapy to survival in adult cancer patients. We undertook a literature search for randomised clinical trials reporting a 5-year survival benefit attributable solely to cytotoxic chemotherapy in adult malignancies. The total number of newly diagnosed cancer patients for 22 major adult malignancies was determined from cancer registry data in Australia and from the Surveillance Epidemiology and End Results data in the USA for 1998. For each malignancy, the absolute number to benefit was the product of (a) the total number of persons with that malignancy (b) the proportion or subgroup(s) of that malignancy showing a benefit and (c) the percentage increase in 5-year survival due solely to cytotoxic chemotherapy. The overall contribution was the sum total of the absolute numbers showing a 5-year survival benefit expressed as a percentage of the total number for the 22 malignancies. The overall contribution of curative and adjuvant cytotoxic chemotherapy to 5-year survival in adults was estimated to be 2.3% in Australia and 2.1% in the USA. As the 5-year relative survival rate for cancer in Australia is now over 60%, it is clear that cytotoxic chemotherapy only makes a minor contribution to cancer survival. To justify the continued funding and availability of drugs used in cytotoxic chemotherapy, a rigorous evaluation of the cost-effectiveness and impact on quality of life is urgently required.
Limited chemotherapy and shrinking field radiotherapy for osteolymphoma (primary bone lymphoma): Results from the Trans-Tasman radiation oncology group 99.04 and Australasian Leukaemia and lymphoma group LY02 prospective trial
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.IJROBP.2010.03.036
Abstract: To establish benchmark outcomes for combined modality treatment to be used in future prospective studies of osteolymphoma (primary bone lymphoma). In 1999, the Trans-Tasman Radiation Oncology Group (TROG) invited the Australasian Leukemia and Lymphoma Group (ALLG) to collaborate on a prospective study of limited chemotherapy and radiotherapy for osteolymphoma. The treatment was designed to maintain efficacy but limit the risk of subsequent pathological fractures. Patient assessment included both functional imaging and isotope bone scanning. Treatment included three cycles of CHOP chemotherapy and radiation to a dose of 45 Gy in 25 fractions using a shrinking field technique. The trial closed because of slow accrual after 33 patients had been entered. Accrual was noted to slow down after Rituximab became readily available in Australia. After a median follow-up of 4.3 years, the five-year overall survival and local control rates are estimated at 90% and 72% respectively. Three patients had fractures at presentation that persisted after treatment, one with recurrent lymphoma. Relatively high rates of survival were achieved but the number of local failures suggests that the dose of radiotherapy should remain higher than it is for other types of lymphoma. Disability after treatment due to pathological fracture was not seen.
Estimation of an optimal chemotherapy utilisation rate for lung cancer: An evidence-based benchmark for cancer care
Publisher: Elsevier BV
Date: 09-2010
DOI: 10.1016/J.LUNGCAN.2009.11.017
Abstract: Optimal chemotherapy utilisation rates can serve as benchmarks to assess the quality of cancer service delivery. This study aims to determine the optimal proportion of patients with lung cancer that should receive chemotherapy at least once during the course of their illness, based on the best available evidence. An optimal chemotherapy utilisation tree was constructed using indications for chemotherapy identified from evidence-based treatment guidelines. Data on the proportion of patient and tumour-related attributes for which chemotherapy was indicated were obtained and merged with the treatment indications to calculate an optimal chemotherapy utilisation rate. This optimal rate was compared with reported actual rates of chemotherapy utilisation. Chemotherapy is recommended at least once in 73% of all patients with lung cancer (93% of small cell lung cancer (SCLC) patients and 69% of non-small cell lung cancer (NSCLC) patients). Comparison of these benchmark rates with international reported actual chemotherapy utilisation rates reveals under-utilisation of chemotherapy in all newly diagnosed lung cancer patients, regardless of histological type and stage, with the exception of stage I NSCLC. The optimal chemotherapy utilisation rate can serve as a feasible, evidence-based measure of the quality of cancer care. Chemotherapy may be under-utilised in the initial management of lung cancer.
Impact of radiotherapy underutilisation measured by survival shortfall, years of potential life lost and disability-adjusted life years lost in New South Wales, Australia.
Publisher: Elsevier BV
Date: 11-2018
Does waiting time affect the outcome of larynx cancer treated by radiotherapy?
Publisher: Elsevier BV
Date: 08-1997
DOI: 10.1016/S0167-8140(97)00093-5
Abstract: To determine the impact of waiting for radiotherapy on local control in early larynx cancer treated by radiotherapy alone. Records of patients with T1 and T2, N0-2 larynx cancer were examined at three radiotherapy centres. Waiting time was defined in three ways, (1) time from biopsy to radiotherapy, (2) time from presentation to radiation department to start of radiotherapy and (3) the minimum of (1) and (2). Time to relapse was the major end point. There were 581 patients with a median follow-up of 6.8 years. Stage distribution was as follows: T1, 370 T2a, 106 T2b, 94 T2 unspecified, 11 N0, 563 N+, 18. Median times from biopsy, presentation and minimum time to treatment were 24, 16 and 15 days, respectively. Ninety percent of minimum waiting times were < or = 31 days. The median dose was 61 Gy in a median of 30 fractions over a median 46 days. Local recurrence occurred in 126 patients. The actuarial recurrence free rate at 5 years was 77% (SE 2%). In a multivariate analysis the significant predictors of relapse were higher T stage, longer treatment duration and increasing field area. Waiting time was not significantly associated with local relapse. This study did not show longer waiting time to be a significant predictor of relapse in early larynx cancer. Other end-points which are relevant, such as quality of life, have not been examined. Longer treatment times were significantly associated with relapse.
Estimating the optimal utilization rates of radiotherapy for hematologic malignancies from a review of the evidence: part II-leukemia and myeloma.
Publisher: Wiley
Date: 05-01-2005
DOI: 10.1002/CNCR.20755
Abstract: The objective of this study was to estimate the ideal proportion of new patients with leukemia and myeloma who should receive radiotherapy at some time during the course of their illness based on the best evidence. Available evidence of the efficacy of radiotherapy in most clinical situations for leukemia and myeloma was identified through extensive literature reviews and treatment guideline searches. Epidemiologic data concerning the distribution of types, disease stages, and other factors that influence the use of radiotherapy were identified. Decision trees were constructed to merge the evidence-based recommendations with the epidemiological data to calculate the optimal proportion of patients who should receive radiotherapy according to the best available evidence. Actual radiotherapy utilization rates also were identified. The proportion of patients diagnosed with myeloma in Australia who should receive radiotherapy based on the evidence was 38%. There was wide variation in the proportion of patients who actually received radiotherapy for myeloma from 24% up to 55%. The recommended proportion of patients diagnosed with myeloma in Australia who, according to the best available evidence, should receive at least a single course of radiotherapy was 38%. The proportion of patients diagnosed in Australia with leukemia who should receive radiotherapy at some point in their management, according to the best available evidence, was calculated at 4%, which corresponded with actual practice. Further research will be required to determine why more patients who are diagnosed with myeloma are not treated with radiotherapy.
Estimating the optimal utilization rates of radiotherapy for hematologic malignancies from a review of the evidence: part I-lymphoma.
Publisher: Wiley
Date: 05-01-2005
DOI: 10.1002/CNCR.20754
Abstract: The objective of this study was to estimate the ideal proportion of new patients with lymphoma who should receive radiotherapy at some time during the course of their illness, based on the best evidence. Available evidence of the efficacy of radiotherapy in most clinical situations for lymphoma were identified through extensive literature reviews and treatment guideline searches. Epidemiologic data concerning the distribution of histologic type, disease stage, and other factors that influence the use of radiotherapy were identified. Decision trees were constructed to merge the evidence-based recommendations with the epidemiologic data to calculate the optimal proportion of patients who should receive radiotherapy according to the best available evidence. Actual radiotherapy utilization rates also were identified. The proportion of patients with lymphoma in Australia that should receive radiotherapy at some point in their management, according to the best available evidence, was calculated at 65.0%. Multivariate analysis with a Monte Carlo simulation yielded a radiotherapy utilization rate of 64.4%. The actual utilization rates of radiotherapy for lymphoma reported in clinical practice were 22-29%, substantially lower than the optimal rate calculated in this project. Further research will be required to identify why more patients who are diagnosed with lymphoma are not treated with radiotherapy.
Estimation of an optimal chemotherapy utilisation rate for head and neck carcinoma: setting an evidence-based benchmark for the best-quality cancer care.
Publisher: Elsevier BV
Date: 08-2009
Multicentre dosimetry study of mantle treatment in Australia and New Zealand
Publisher: Elsevier BV
Date: 08-1996
DOI: 10.1016/0167-8140(96)01779-3
Abstract: To determine the difference between expected and measured dose for patients prescribed a mantle treatment for Hodgkin's disease and estimate the range of dose at critical sites and between different treatment centres. Twenty three radiotherapy centres were surveyed with regard to the accuracy of dose delivery to a custom-built upper-torso phantom. Thermoluminescent dosimeters were used to monitor the delivered dose at sites such as mid-plane, spinal cord, neck, axilla and lung. The intended dose to the phantom at each centre was 1 Gy to central axis mid-plane. Of the centres surveyed, the median measured dose to this region was 0.96 Gy with a minimum of 0.92 and a maximum of 1.00 Gy. Median dose to the axilla region was low (0.90 Gy) whereas median dose to the blocked lung and neck region were higher than expected, 0.18 Gy and 1.25 Gy, respectively. The 95% confidence interval on the reported relative dose using the 4000 thermoluminescence dosimetry readings in this study was +/- 1.5% In this controlled experiment, using conventional methods to calculate dose, there was a surprising variability in the dose delivered at the central axis mid-plane position. This was traced to lack of uniformity in the use of equivalent squares to calculate the output factor. The measured doses to axilla and lung are explained by photon and electron scattering effects. Centres, where dose compensation was included, had a superior dose homogeneity in the neck. The off-axis dose calculations depend on computer planning software but the magnitude of these differences is secondary to that of central axis mid-point dose differences. Improved consistency of dose calculation techniques between centres would enable more reliable dose response evaluation from multicentre clinical studies of Hodgkin's disease.
The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines.
Publisher: Wiley
Date: 03-08-2005
DOI: 10.1002/CNCR.21324
Glioma of the Central Nervous System Surveillance Counterpoint: Australia
Publisher: Humana Press
Date: 20-12-2012
Global demand for cancer surgery and an estimate of the optimal surgical and anaesthesia workforce between 2018 and 2040: a population-based modelling study
Publisher: Elsevier BV
Date: 02-2021
Workforce shortages in medical oncology: a looming threat to quality cancer care
Publisher: AMPCo
Date: 2012
DOI: 10.5694/MJA11.10356
Abstract: Supply must meet demand to maintain our high standards of cancer care.
The optimal utilization proportion of external beam radiotherapy in European countries: An ESTRO-HERO analysis
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.RADONC.2015.04.018
Abstract: The absolute number of new cancer patients that will require at least one course of radiotherapy in each country of Europe was estimated. The incidence and relative frequency of cancer types from the year 2012 European Cancer Observatory estimates were used in combination with the population-based stage at diagnosis from five cancer registries. These data were applied to the decision trees of the evidence-based indications to calculate the Optimal Utilization Proportion (OUP) by tumour site. In the minimum scenario, the OUP ranged from 47.0% in the Russian Federation to 53.2% in Belgium with no clear geographical pattern of the variability among countries. The impact of stage at diagnosis on the OUP by country was rather limited. Within the 24 countries where data on actual use of radiotherapy were available, a gap between optimal and actual use has been observed in most of the countries. The actual utilization of radiotherapy is significantly lower than the optimal use predicted from the evidence based estimates in the literature. This discrepancy poses a major challenge for policy makers when planning the resources at the national level to improve the provision in European countries.
The effect of treatment duration on local control of squamous carcinoma of the tonsil and carcinoma of the cervix
Publisher: Elsevier BV
Date: 1992
The population benefit of radiotherapy for cervical cancer: local control and survival estimates for optimally utilized radiotherapy and chemoradiation.
Publisher: Elsevier BV
Date: 03-2015
Patterns of care study of brachytherapy in New South Wales: cervical cancer treatment quality depends on caseload.
Publisher: Termedia Sp. z.o.o.
Date: 2014
Combined-modality therapy for primary central nervous system lymphoma: Long-term data from a Phase II multicenter study (Trans-Tasman Radiation Oncology Group)
Publisher: Elsevier BV
Date: 02-2006
DOI: 10.1016/J.IJROBP.2005.07.958
Abstract: To assess, in a multicenter setting, the long-term outcomes of a brief course of high-dose methotrexate followed by radiotherapy for patients with primary central nervous system lymphoma (PCNSL). Forty-six patients were entered in a Phase II protocol consisting of methotrexate (1 g/m(2) on Days 1 and 8), followed by whole-brain irradiation (45-50.4 Gy). The median follow-up time was 7 years, with a minimum follow-up of 5 years. The 5-year survival estimate was 37% (+/-14%, 95% confidence interval [CI]), with progression-free survival being 36% (+/-15%, 95% CI), and median survival 36 months. Of the original 46 patients, 10 were alive, all without evidence of disease recurrence. A total of 11 patients have developed neurotoxicity, with the actuarial risk being 30% (+/-18%, 95% CI) at 5 years but continuing to increase. For patients aged>60 years the risk of neurotoxicity at 7 years was 58% (+/-30%, 95% CI). Combined-modality therapy, based on high-dose methotrexate, results in improved survival outcomes in PCNSL. The risk of neurotoxicity for patients aged>60 years is unacceptable with this regimen, although survival outcomes for patients aged>60 years were higher than in many other series.
Multicenter evaluation of MRI‐based radiomic features: A phantom study
Publisher: Wiley
Date: 30-04-2020
DOI: 10.1002/MP.14173
Abstract: This work describes the development of a novel radiomics phantom designed for magnetic resonance imaging (MRI) that can be used in a multicenter setting. The purpose of this study is to assess the stability and reproducibility of MRI‐based radiomic features using this phantom across different MRI scanners. A set of phantoms were three‐dimensional (3D) printed using MRI visible materials. One set of phantoms were imaged on seven MRI scanners and one was imaged on one MRI scanner. Radiomics analysis of the phantoms, which included first‐order features, shape and texture features was performed. Intraclass correlation coefficient (ICC) was used to assess the stability of radiomic features across eight scanners and the reproducibility of two printed models on one scanner. Coefficient of variation (COV) was used to assess the reproducibility of radiomics measurements in the phantom on a single scanner. The phantom models provide sufficient signal‐to‐noise and contrast in all the tumor models permitting robust automatic segmentation. During a 12‐month period of monitoring, the phantom material was stable with T1 and T2 of 150.7 ± 6.7 ms and 56.1 ± 3.9 ms, respectively. Of all the radiomic features computed, 34 of 69 had COV 10%. Features from first‐order statistics were the most robust in stability across the eight scanners with eight of 12 (67%) having high stability. About 29 of 50 (58%) texture features had high stability and no shape features had high stability features across the eight scanners. A novel MRI radiomics phantom has been developed to assess the reproducibility and stability of MRI‐based radiomic features across multiple institutions. The variation in radiomic feature stability demonstrates the need for caution when interpreting these features for clinical studies.
Radiotherapy in small countries
Publisher: Elsevier BV
Date: 10-2017
Evidence-based Estimates of the Demand for Radiotherapy
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.CLON.2014.10.005
Abstract: There are different methods that may be used to estimate the future demand for radiotherapy services in a population ranging from expert opinion through to complex modelling techniques. This manuscript describes the use of evidence-based treatment guidelines to determine indications for radiotherapy. It also uses epidemiological data to estimate the proportion of the population who have attributes that suggest a benefit from radiotherapy in order to calculate the overall proportion of a population of new cases of cancer who appropriately could be recommended to undergo radiotherapy. Evidence-based methods are transparent and adaptable to different populations but require extensive information about the indications for radiotherapy and the proportion of cancer cases with those indications in the population. In 2003 this method produced an estimate that 52.4% of patients with a registered cancer-type had an indication for radiotherapy. The model was updated in 2012 because of changes in cancer incidence, stage distributions and indications for radiotherapy. The new estimate of the optimal radiotherapy utilisation rate was 48.3%. The decrease was due to changes in the relative frequency of cancer types and some changes in indications for radiotherapy. Actual rates of radiotherapy utilisation in most populations still fall well below this benchmark.
Estimation of an optimal chemotherapy utilisation rate for breast cancer: setting an evidence-based benchmark for the best-quality cancer care.
Publisher: Elsevier BV
Date: 03-2010
Artificial intelligence in medical imaging and radiation oncology: Opportunities and challenges
Publisher: Wiley
Date: 08-2021
Evidence-based benchmarks for use of cancer surgery in high-income countries: a population-based analysis
Publisher: Elsevier BV
Date: 02-2021
Palliative radiotherapy of bone metastases: An evaluation of outcome measures
Publisher: Wiley
Date: 02-2001
DOI: 10.1046/J.1365-2753.2001.00262.X
Abstract: The objective of this study was to identify and evaluate important patient-based outcomes that are specific to the palliative radiotherapy of bone metastases. We first conducted a literature review to identify and evaluate outcomes that are currently in use. To identify outcomes that are important to patients, in-depth patient interviews were conducted. Finally, issues identified through the interviews were quantified through a prospective survey, in which patients completed a questionnaire prior to commencing radiotherapy and again after 6 weeks. In our literature review, we found that there was no standardized definition of either response to radiotherapy or assessment of pain relief. Pain measurement in many studies was undertaken using very simple measures, which could possibly yield inaccurate results. The vast majority of studies did not include quality of life as an endpoint. The patient interviews and survey showed that chronic pain and associated limitation of movement were the disease symptoms causing the most concern. Having a clear, alert mind and being able in self-care were the aspects of daily living given the highest priority. Sustained pain relief and minimizing the risk of future complications were the main priorities relating to radiotherapy treatment. The practical aspects of treatment (travelling distance, remaining at home and brevity of treatment) were of least importance. This study indicates the complexity of evaluating the outcomes of palliative interventions, and confirms the deficiencies of pain relief as the primary end-point. The patient's quality of life is affected by many factors other than pain (such as limited mobility, reduced performance, side effects and impaired role functioning) hence a wider range of end-points is required. Greater sensitivity is required than in currently used end-points. Concurrent diseases as well as concurrent therapies can make it difficult to attribute effects with precision. Unless such factors are considered in research design, the results may prove unreliable.
Great expectations or waiting for Godot? Time for development of a near real‐time national reporting system of radiotherapy utilisation
Publisher: Wiley
Date: 24-05-2022
Factors affecting radiotherapy utilisation in geriatric oncology patients in NSW, Australia
Publisher: Elsevier BV
Date: 12-2020
Comparison of patterns of care in lung cancer in three area health services in New South Wales, Australia
Publisher: Wiley
Date: 12-2004
DOI: 10.1111/J.1445-5994.2004.00645.X
Abstract: Lung cancer is the leading cause of cancer deaths in New South Wales (NSW). The incidence of and mortality from lung cancer differ throughout different area health services in NSW. To compare patterns of care in lung cancer among three area health services in NSW. South-western Sydney Area Health Service (SWSAHS), Northern Sydney Area Health Service (NSAHS) and Hunter Area Health Service (HAHS) residents diagnosed with lung cancer in 1996 were identified from the NSW Central Cancer Registry and their medical records were reviewed. The main outcome measures were specialist care, investigations, treatment and survival. The study population comprised 256 SWSAHS, 270 NSAHS and 212 HAHS residents. NSAHS residents were older, with a median age of 73 years compared with 68 years in SWSAHS and 70 years in HAHS (P = 0.001). The performance status and stage distributions of the populations were similar. Twenty per cent of HAHS residents did not have a pathological diagnosis compared with 10% in SWSAHS and 9% in NSAHS (P = 0.005). Forty-five per cent of HAHS residents received no treatment compared with 25 and 22% in SWSAHS and NSAHS, respectively (P < 0.001). Despite these differences, there was no significant difference in overall survival. Lung cancer patterns of care were significantly different among the areas. The variability of practice identified in this study needs to be addressed to ensure optimum care for all patients with lung cancer. Although there was no significant difference in survival, under-utilization of efficacious treatment is likely to have affected patients' quality of life.
Scale-up of radiotherapy for cervical cancer in the era of human papillomavirus vaccination in low-income and middle-income countries: a model-based analysis of need and economic impact
Publisher: Elsevier BV
Date: 07-2019
Surgical procedures for melanoma in public and private New South Wales Hospitals, 2001-2002
Publisher: Wiley
Date: 05-2006
DOI: 10.1111/J.1445-2197.2006.03717.X
Abstract: Evidence suggests that there is considerable variation in the types of procedures used to treat cancer. This variation may result in suboptimal or cost-ineffective care. The present study examined the variation in surgical treatment of melanoma before the establishment of a Melanoma Network that could promote more uniform high-quality care in New South Wales (NSW). The variations in the use of surgical procedures for melanoma by NSW Area Health Service of patient residence were examined. Data in the Health Information Exchange of NSW Health collected on procedures carried out on patients with a diagnosis of melanoma in NSW public and private hospitals from 1 July 2001 to 30 June 2002 were examined. Data were aggregated by Area Health Services of patient residence. These data were compared with the numbers of new cases of melanoma notified to the NSW Central Cancer Registry in the same areas in 2001-2002. Excision of skin lesions, skin grafting and numbers and types of lymph node procedures were examined. During the study period, the Central Cancer Registry reported that there were 3085 notifications of melanoma, whereas hospital inpatient data recorded that 6864 procedures were carried out for patients with a melanoma diagnosis in NSW public and private hospitals. Sixty-seven per cent of procedures were carried out in private hospitals. A total of 852 skin grafting procedures were recorded. Of these, 60% were carried out in private hospitals. The average proportion of skin grafts associated with excisions in NSW was 30% (range, 0-53%). Eight hundred and fifty-eight lymph node procedures were recorded for 747 NSW residents. These were biopsies, excisions or both. Forty per cent were carried out in private hospitals. The average proportion of new cases of melanoma associated with a lymph node procedure in NSW was 28% (range, 0-47%). Most of the inpatient procedures for patients with melanoma were carried out in private hospitals. The proportions of new cases that underwent skin grafting after excision, or underwent lymph node dissection, varied more than fivefold from one Area Health Service to another. This may indicate variations in casemix, variations in clinical practice or both.
Utility-adjusted analysis of the cost of palliative radiotherapy for bone metastases
Publisher: Wiley
Date: 11-08-2003
DOI: 10.1046/J.1440-1673.2003.01175.X
Abstract: Palliative radiotherapy is effective in the treatment of bone metastases but is under-utilized, possibly because it is perceived to be expensive. We performed a cost-utility analysis of palliative radiotherapy for bone metastases, evaluating both the actual cost of radiotherapy as well as its impact on quality of life by adjusting for the variation in response to treatment. Hospital records between July 1991 and July 1996 were reviewed to ascertain the number of patients treated with palliative radiotherapy for bone metastases, the average number of fields of radiation delivered to each patient and the average duration of survival. Partial and complete response rates to palliative radiotherapy were obtained from a review of all published randomized controlled trials of radiation treatment of bone metastases. Utility values were assigned to the response rates, and an overall adjusted response rate to radiotherapy was derived. The cost of delivering a field of radiation was calculated. The total cost was ided by the total number of response months to give a utility-adjusted cost per month of palliative radiotherapy. The utility-adjusted cost per month of palliative radiotherapy of bone metastases was found to be AUS dollars 100 per month or AUS dollars 1200 per utility-adjusted life-year. This study demonstrates that, contrary to popular perception, palliative radiotherapy is a cost-effective treatment modality for bone metastases.
Radiotherapy underutilisation and its impact on local control and survival in New South Wales, Australia.
Publisher: Elsevier BV
Date: 12-2019
Poor Outcomes after Whole Brain Radiotherapy in Patients with Brain Metastases: Results from an International Multicentre Cohort Study
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.CLON.2013.07.002
Abstract: To describe the characteristics and outcomes of cancer patients receiving Whole Brain Radiotherapy (WBRT) and delineate poor outcome groups after WBRT. From 1991 to 2007, 3459 patients receiving WBRT for brain metastases at three centres (in Australia and the Netherlands) were retrospectively reviewed. The effect of clinicodemographic factors, including age, gender, primary cancer, time to WBRT from primary cancer diagnosis and WBRT timing relative to other radiotherapy courses on overall survival, survival from WBRT commencement (WBRT-SV) and death within 6 weeks were analysed. WBRT was the first radiotherapy course in 2161/3459 (63%) and the last in 2932/3459 (85%). The most common primary cancer sites with brain metastases were lung (n = 1800 52%), breast (n = 568 16%), melanoma (n = 350 10%) and colorectal (n = 209 6%). The median time to WBRT from primary cancer diagnosis was 34 weeks, overall survival 1.42 years (0.04-28.70) and WBRT-SV 0.33 years (0-8.60). Older age, male gender and a shorter time from the primary cancer diagnosis to WBRT predicted worse overall survival and WBRT-SV. Seventeen per cent survived less than 6 weeks. Older patients with a shorter time from the primary cancer diagnosis to WBRT and a lower WBRT episode number were more likely to die less than 6 weeks after WBRT. Cancer patients with brain metastases have poor overall outcomes. High mortality within 6 weeks of starting WBRT suggests patient selection remains challenging.
Cancer control in the Caribbean island countries and territories: some progress but the journey continues
Publisher: Elsevier BV
Date: 09-2019
Waiting times for radiotherapy—a survey of patients' attitudes
Publisher: Elsevier BV
Date: 03-2004
Radiotherapy might not be the answer in Africa - Authors' reply
Publisher: Elsevier BV
Date: 09-2006
Frontiers of cancer care in Asia-Pacific region: Cancer care in Australia
Publisher: Department of Biomedical Imaging, University of Malaya, Malaysia
Date: 07-2008
DOI: 10.2349/BIIJ.4.3.E30
A comparison of systemic breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of optimal therapy.
Publisher: Elsevier BV
Date: 08-2012
Estimation of the optimal utilisation rates of radical prostatectomy, external beam radiotherapy and brachytherapy in the treatment of prostate cancer by a review of clinical practice guidelines.
Publisher: Elsevier BV
Date: 2016
Cost analysis of Gamma Knife stereotactic radiosurgery
Publisher: Cambridge University Press (CUP)
Date: 10-2007
DOI: 10.1017/S0266462307070584
Abstract: Objectives: Stereotactic radiosurgery (SRS) is used to treat intracranial lesions and vascular malformations as an addition or replacement to whole brain radiotherapy and microsurgery. SRS can be delivered by hardware and software appended to standard linear accelerators (Linacs) or by dedicated systems such as Gamma Knife, which has been proposed as a more accurate and user friendly technology. Internationally, dedicated systems have been funded, despite limitations in evidence. However, some countries including Australia have not recommended additional reimbursement for dedicated systems. This study compares the costs of Linac radiosurgery with Gamma Knife radiosurgery. Methods: Due to limited evidence on comparative effects, the economic analysis was restricted to a cost evaluation. The base-case analysis assumed a modified Linac was used only to treat SRS patients. However, because a modified Linac could be used to treat other radiotherapy patients, a second analysis assumed spare time was used to meet other radiotherapy needs, and Linac capital costs were apportioned according to SRS use. Results: The incremental cost of Gamma Knife versus a modified Linac was estimated as AU$209 per patient. This result is sensitive to variations in assumptions. A second analysis proportioning capital costs according to SRS use showed that Gamma Knife may cost up to AU$1673 more per patient. Conclusions: Gamma Knife may be cost competitive only if demand for SRS services is high enough to fully use equipment working time. However, given low patient demand and competing radiotherapy needs, Gamma Knife appears more costly and further evidence of survival or quality of life advantages may be required to justify reimbursement.
Functional MRI for quantitative treatment response prediction in locally advanced rectal cancer
Publisher: British Institute of Radiology
Date: 04-2017
DOI: 10.1259/BJR.20151078
Comparison of face-to-face and videoconferenced multidisciplinary clinical meetings.
Publisher: Wiley
Date: 12-2004
DOI: 10.1111/J.1440-1673.2004.01349.X
Abstract: A trial of videoconferencing of multidisciplinary breast cancer clinical meetings between three public hospitals was conducted in an attempt to increase attendance by medical staff at the meetings, and thus facilitate multidisciplinary care for breast cancer patients. The videoconferences were compared with the previously existing face-to-face clinical meetings through questionnaires, attendance, number of cases discussed and anthropological analysis. Although more people attended the videoconferences than the face-to-face meetings, most of the participants in the trial preferred the face-to-face meetings to the videoconferences. The mean number of cases discussed at the videoconferences was significantly less than the mean number of cases presented at the face-to-face clinical meetings. The face-to-face meetings were informal, spontaneous and conducive to open discussion. In contrast, the videoconferences were formal and regimented. Multidisciplinary case discussion can be facilitated by videoconferencing. Some of the negative experiences we encountered could be overcome with changes in meeting format. Our experience may help others in setting up a successful multidisciplinary team via videoconference.
3D printed phantoms mimicking cortical bone for the assessment of ultrashort echo time magnetic resonance imaging:
Publisher: Wiley
Date: 30-12-2018
DOI: 10.1002/MP.12727
Abstract: Human cortical bone has a rapid T2∗ decay, and it can be visualized using ultrashort echo time (UTE) techniques in magnetic resonance imaging (MRI). These sequences operate at the limits of gradient and transmit-receive signal performance. Development of multicompartment anthropomorphic phantoms that can mimic human cortical bone can assist with quality assurance and optimization of UTE sequences. The aims of this study were to (a) characterize the MRI signal properties of a photopolymer resin that can be 3D printed, (b) develop multicompartment phantoms based on the resin, and (c) demonstrate the feasibility of using these phantoms to mimic human anatomy in the assessment of UTE sequences. A photopolymer resin (Prismlab China Ltd, Shanghai, China) was imaged on a 3 Tesla MRI system (Siemens Skyra) to characterize its MRI properties with emphasis on T2∗ signal and longevity. Two anthropomorphic phantoms, using the 3D printed resin to simulate skeletal anatomy, were developed and imaged using UTE sequences. A skull phantom was developed and used to assess the feasibility of using the resin to develop a complex model with realistic morphological human characteristics. A tibia model was also developed to assess the suitability of the resin at mimicking a simple multicompartment anatomical model and imaged using a three-dimensional UTE sequence (PETRA). Image quality measurements of signal-to-noise ratio (SNR) and contrast factor were calculated and these were compared to in vivo values. The T2∗ and T A solid resin material, which can be 3D printed, has been found to have similar magnetic resonance signal properties to human cortical bone. Phantoms replicating skeletal anatomy were successfully produced using this resin and demonstrated their use for image quality and segmentation assessment of ultrashort echo time sequences.
Technical Note: Experimental results from a prototype high‐field inline MRI‐linac
Publisher: Wiley
Date: 24-08-2016
DOI: 10.1118/1.4961395
Abstract: The pursuit of real-time image guided radiotherapy using optimal tissue contrast has seen the development of several hybrid magnetic resonance imaging (MRI)-treatment systems, high field and low field, and inline and perpendicular configurations. As part of a new MRI-linac program, an MRI scanner was integrated with a linear accelerator to enable investigations of a coupled inline MRI-linac system. This work describes results from a prototype experimental system to demonstrate the feasibility of a high field inline MR-linac. The magnet is a 1.5 T MRI system (Sonata, Siemens Healthcare) was located in a purpose built radiofrequency (RF) cage enabling shielding from and close proximity to a linear accelerator with inline (and future perpendicular) orientation. A portable linear accelerator (Linatron, Varian) was installed together with a multileaf collimator (Millennium, Varian) to provide dynamic field collimation and the whole assembly built onto a stainless-steel rail system. A series of MRI-linac experiments was performed to investigate (1) image quality with beam on measured using a macropodine (kangaroo) ex vivo phantom (2) the noise as a function of beam state measured using a 6-channel surface coil array and (3) electron contamination effects measured using Gafchromic film and an electronic portal imaging device (EPID). (1) Image quality was unaffected by the radiation beam with the macropodine phantom image with the beam on being almost identical to the image with the beam off. (2) Noise measured with a surface RF coil produced a 25% elevation of background intensity when the radiation beam was on. (3) Film and EPID measurements demonstrated electron focusing occurring along the centerline of the magnet axis. A proof-of-concept high-field MRI-linac has been built and experimentally characterized. This system has allowed us to establish the efficacy of a high field inline MRI-linac and study a number of the technical challenges and solutions.
Factors Associated With Radiotherapy Utilisation In New South Wales, Australia: Results From The 45 and Up Study
Publisher: Elsevier BV
Date: 05-2020
Long-term outcome after radiotherapy alone for lymphocyte-predominant Hodgkin lymphoma: A retrospective multicenter study of the Australasian Radiation Oncology Lymphoma Group
Publisher: Wiley
Date: 10-08-2005
DOI: 10.1002/CNCR.21303
Abstract: The curative potential of radiotherapy (RT) alone as initial treatment for patients with Stage I-II lymphocyte-predominant Hodgkin lymphoma (LPHL) has not been defined well. Two hundred two patients who were treated between 1969 and 1995 were evaluated in a retrospective, multicenter study. Patient characteristics were as follows: The median age was 31 years, 75% of patients were male, 80% of patients had Ann Arbor Stage I disease, 1% of patients had bulky disease, 3% of patients had B symptoms, 1% of patients had extranodal involvement, and 80% of patients had supradiaphragmatic disease. The RT fields were a full mantle field in 52% of patients, less than a full mantle field in 24% of patients, an inverted-Y field in 17% of patients, less than an inverted-Y field in 3% of patients, and total lymph node irradiation in 3% of patients. The median dose was 36 Gray. The median follow-up was 15 years. The overall survival (OS) rate at 15 years was 83%, and freedom from progression (FFP) was observed in 82% of patients, including 84% of patients with Stage I disease and 73% of patients with Stage II disease. No recurrent LPHL and only 1 patient with non-Hodgkin lymphoma (NHL) were reported after 15 years. Adverse prognostic factors that were identified on multifactor analysis were as follows: for OS, age 45 years or older (P < 0.0005), the presence of B symptoms (P = 0.002), increasing number of sites (P = 0.015) for FFP, increasing number of sites (P = 0.002). No significant difference was found in FFP in a comparison of patients who received elective mediastinal RT with patients who did not receive mediastinal RT (P = 0.11). Causes of death at 15 years were LPHL in 3% of patients, NHL in 2% of patients, in-field malignancy in 2% of patients, in-field cardiac/respiratory in 4% of patients, and other in 6% of patients. The current data suggested that RT potentially may be curative for patients with Stage I-II LPHL and raise the possibility that limited-field RT may be used without loss of treatment efficacy. Involved-field RT warrants further investigation for patients with early-stage LPHL.
Study protocol: Multi-parametric magnetic resonance imaging for therapeutic response prediction in rectal cancer
Publisher: Springer Science and Business Media LLC
Date: 04-07-2017
Patterns of retreatment by radiotherapy.
Publisher: Elsevier BV
Date: 02-2011
Estimation of an optimal radiotherapy utilization rate for breast carcinoma: a review of the evidence.
Publisher: Wiley
Date: 22-10-2003
DOI: 10.1002/CNCR.11740
Abstract: Radiotherapy utilization rates for breast carcinoma vary widely, both within and between countries. Current estimates of the proportion of patients with carcinoma who optimally should receive radiotherapy are based either on expert opinion or on the measurement of actual utilization rates, and not on the best scientific evidence. To develop an evidence-based benchmark for radiotherapy utilization in patients with breast carcinoma, the authors undertook a systematic review of treatment guidelines on the use of radiotherapy for breast carcinoma. A decision tree was constructed, and the proportions of patients with clinical features that lead to a decision for radiotherapy were obtained from epidemiological data. This ideal utilization rate was compared with the utilization rates of radiotherapy over the last decade for breast carcinoma in Australia and internationally. The proportion of patients with breast carcinoma in whom radiotherapy would be recommended according to the best available evidence was calculated at 83% (95% confidence interval, 82-85%) of all patients with breast carcinoma. A review of actual radiotherapy utilization rates for breast carcinoma revealed that, in clinical practice, actual utilization rates varied between 24% and 71%. A substantial difference was found between the recommended optimal utilization of radiotherapy based on evidence and the actual rates reported in clinical practice. The reasons for these differences need to be examined, and a plan for addressing the suboptimal use of radiotherapy needs to be implemented. Cancer 2003.
Lung cancer patterns of care in south western Sydney, Australia
Publisher: BMJ
Date: 08-2003
Abstract: Lung cancer is the leading cause of cancer deaths in New South Wales (NSW). There is a significantly higher incidence of lung cancer in the South Western Sydney Area Health Service (SWSAHS) than the NSW average. The aim of this study was to document patterns of lung cancer care for SWSAHS residents. SWSAHS residents diagnosed with lung cancer in 1993 and 1996 were identified from the NSW Central Cancer Registry and their medical records reviewed. The study population comprised 527 patients of median age 68 years. 12% did not see a lung cancer specialist, 9% did not have a pathological diagnosis, and 28% did not receive any active treatment throughout the course of their illness. The median survival was 6.7 months and the 5 year overall survival was 8% (95% CI 6 to 10). The rates of pathological diagnosis, specialist referral, and treatment decreased with older age and poorer performance status. The management of lung cancer patients in SWSAHS is suboptimal. A significant proportion of patients are not receiving treatment. To improve patient care and outcomes, all lung cancer patients should be referred to a specialist for management, ideally in a multidisciplinary setting. Both consumers and general practitioners need to be educated about options available for the management of lung cancers and ageist and nihilistic attitudes need to be overcome.
Mantle planning: Report of the Australasian Radiation Oncology Lymphoma Group film survey and consensus guidelines
Publisher: Wiley
Date: 11-2000
DOI: 10.1046/J.1440-1673.2000.00847.X
Abstract: The purpose of the present paper was to measure the variation in mantle planning in Australia and New Zealand. A chest X-ray (CXR) of a patient in the supine position with a neck node marked by wire was sent to every radiation oncologist in Australia and New Zealand. They were to mark on the CXR the lung blocks that they would use to treat this patient, assuming that the patient had stage IA Hodgkin's disease. These marks were compared with a small s le of radiologists who were asked to define the mediastinum on the same CXR. Radiation oncologists were also asked to complete a short questionnaire about other modifications to their treatment fields and their experience with this technique. One hundred and six films were sent out and 44 radiation oncologists replied. There was a maximum variation in the placement of their lung blocks of 6 cm. Half of the lung blocks were within a 2-cm range. One respondent said they would not use a mantle field to treat this patient. Mediastinal coverage was inadequate in at least 50% of cases. There was a very large variation in mantle field planning practices within Australia and New Zealand. For this reason Australasian Radiation Oncology Lymphoma Group has produced consensus guidelines for mantle block design. These are appended to the present paper.
Imaging performance of a dedicated radiation transparent RF coil on a 1.0 Tesla inline MRI-linac
Publisher: IOP Publishing
Date: 25-06-2018
Abstract: This work describes the first imaging studies on a 1.0 Tesla inline MRI-Linac using a dedicated transmit/receive RF body coil that has been designed to be completely radio transparent and provide optimum imaging performance over a large patient opening. A series of experiments was performed on the MRI-Linac to investigate the performance and imaging characteristics of a new dedicated volumetric RF coil: (1) numerical electromagnetic simulations were used to measure transmit efficiency in two patient positions (2) image quality metrics of signal-to-noise ratio (SNR), ghosting and uniformity were assessed in a large diameter phantom with no radiation beam (3) radiation induced effects were investigated in both the raw data (k-space) and image sequences acquired with simultaneous irradiation (4) radiation dose was measured with and without image acquisition (5) RF heating was studied using an MR-compatible fluoroptic thermometer and (6) the in vivo image quality and versatility of the coil was demonstrated in normal healthy subjects for both supine and standing positions. Daily phantom measurements demonstrated excellent imaging performance with stable SNR over a period of 3 months (42.6 ± 0.9). Simultaneous irradiation produced no statistical change in image quality (p > 0.74) and no interference in raw data for a 20 × 20 cm radiation field. The coil was found to be efficient over large volumes and negligible RF heating was observed. Volunteer scans acquired in both supine and standing positions provided artefact free images with good anatomical visualisation. The first completely radio transparent RF coil for use on a 1.0 Tesla MRI-Linac has been described. There is no impact on either the imaging or dosimetry performance with a simultaneous radiation beam. The open design enables imaging and radiotherapy guidance in a variety of positons.
'GAP' in radiotherapy services in Australia and New Zealand in 2009
Publisher: Wiley
Date: 06-2010
DOI: 10.1111/J.1754-9485.2010.02172.X
Abstract: In this study we estimated (a) the number of linear accelerators required in Australia and New Zealand to achieve a 52.3% treatment rate (b) the 'GAP' between the actual and required number of linear accelerators c) the number of persons not treated (PNT), premature deaths (PD) and years of life lost (YLL) as a result of the 'GAP' and (d) to review the actions being taken by health jurisdictions in Australia and in New Zealand to address the 'GAP' and reach the 52.3% treatment rate. The actual number of fully staffed and operating linear accelerators (A) in Australian and New Zealand was obtained from a survey of radiotherapy facilities in December 2009. The required number of linear accelerators (R) was calculated from the projected cancer incidence figures for 2009 and was based on 1.6 linear accelerators being required per 1000 new cancer patients. The 'GAP' in Radiotherapy services (G) was R minus A. The maximum treatment capacity (MTC) was the ratio of A over R multiplied by 52.3%, assuming that all linear accelerators were operating at 100% capacity. As each linear accelerator can treat 331 new patients each year, the number of new cancer PNT is G x 331. The estimated 5-year survival benefit from radiotherapy is 16%, and the average survival for all patients receiving radiotherapy (radical and palliative) is 0.76 year. Hence, the number of PD attributed to the 'GAP' is PNT x 16%, and the YLL to cancer is PNT x 0.76. A literature search and local knowledge of health department Radiotherapy Plans in all jurisdictions were used to determine the action being taken to achieve a 52.3% treatment rate. In 2009, the 'GAP' was 50 linear accelerators in Australia and the MTC was 38%, the same as it was in 1999, but there has been an increase in PNT each year from 7419 in 1999 to 16,550 in 2009, and PD each year increased from 1187 in 1999 to 2649 in 2009, and YLL each year increased from 5638 in 1999 to 12,585 in 2009. In New Zealand in 2009, the 'GAP' was nine linear accelerators and the MTC was 38%. An estimated 3310 persons did not receive radiotherapy in 2009 in New Zealand, and as a result, there were 523 PD and 2266 YLL. The review showed that new and replacement machines were being installed in all jurisdictions in Australia and in New Zealand. Only Victoria and Queensland have a Radiotherapy Plan beyond 2010, but both have underestimated the projected cancer incidence. Urgent action is needed by health departments and governments on both sides of the Tasman to improve access and equity to this essential cancer treatment. There is merit in the Baume Report recommendation of establishing a national body to oversee radiotherapy services in all jurisdictions in Australia. A similar central body should also be considered for New Zealand.
Estimating the referral rate for cancer genetic assessment from a systematic review of the evidence
Publisher: Springer Science and Business Media LLC
Date: 2007
Referral pathways in colorectal cancer: An audit of surgeons' records
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH13038
Abstract: Purpose. To explore the referral pathways of patients with newly diagnosed colorectal cancer to surgeons. Method. Australian surgeons from three states completed a questionnaire and their records were audited. Results. Thirty-three surgeons provided data on 530 patients seen in the preceding 12 months. The median time between colonoscopy and first surgical consult was 10 days, with 19% of patients waiting more than 28 days. After adjustment for clustering, no surgeon factors were associated with the number of days between colonoscopy and surgery. A report back to the general practitioner (GP) was found in 78% of patients’ records. This feedback varied between surgeons but none of the specific surgeon characteristics examined could explain this. Conclusion. Surgeons usually communicated with GP regardless of whether they were the referral source. However, communication with GP varied considerably among surgeons, with no evidence of a report to the GP in one-fifth of cases. What is known about the topic? Referral from general practice is the main pathway to specialist services in Australia. There has been little research describing factors that affect referral patterns, particularly following diagnosis of cancer to investigation for surgery. What does this paper add? A significant minority of GP were not informed of the referral for colonoscopy and did not receive a copy of the report. No surgeon factors were associated with the number of days between colonoscopy and surgery. What are the implications for practitioners? Although the referral pathway for colorectal cancer often begins in general practice, GP are not always fully informed of the pathways used and other important treatment decisions. Improved use of audit, dissemination of results and improved information exchange generally may all make a significant impact.
Estimation of optimal brachytherapy utilization rate in the treatment of malignancies of the uterine corpus by a review of clinical practice guidelines and the primary evidence.
Publisher: Elsevier BV
Date: 11-2008
Radiation therapy for early stage Hodgkin's disease: Australasian patterns of care
Publisher: Elsevier BV
Date: 1995
DOI: 10.1016/0360-3016(94)E0261-H
Abstract: Analysis of treatment outcome for Stage I-IIA supradiaphragmatic Hodgkin's disease treated solely by irradiation in Australia and New Zealand. Patients with supradiaphragmatic Hodgkin's disease only who were treated by irradiation alone with curative intent between 1969 to 1988 were retrospectively reviewed. Ten radiation oncology departments in Australia and New Zealand contributed patient data to the study. Patient, tumor, and treatment variables were recorded. Disease-free interval, survival, and complications were analyzed. Eight hundred and twenty patients were reviewed. The median age was 29 years. There were 437 men and 383 women. The distribution of 310 clinically staged patients was 170 stage IA, 5 IB, and 135 IIA. Five hundred and ten patients received laparotomies, and pathologic staging was as follows: IA 214, IB 13, IIA 283. The 10-year actuarial disease-free rate was 69% and overall survival rate was 79%. Increasing age, male sex, higher number of involved sites, the use of involved field irradiation, no staging laparotomy, and earlier year of treatment were significantly associated with an increased risk of relapse and lower survival. Actuarial 10-year survival following recurrence was 48%. Acute complications requiring interruption to treatment occurred in 46 patients (6%), but < 1% had their treatment permanently suspended. Actuarial complication rates at 10 years were: cardiac 2%, pulmonary 3% and thyroid 5%. There were 44 second malignancies including 10 non-Hodgkin's lymphomas, 3 leukemias, 7 lung, and 6 breast cancers. Mean delay to the development of a second cancer was 6 years. The 10-year actuarial rate of second malignancy was 5%. The Australasian experience of early stage Hodgkin's disease is consistent with the results in the published literature and confirms that irradiation produces a high cure rate with minimal toxicity.
Estimation of the optimal number of radiotherapy fractions for breast cancer: A review of the evidence.
Publisher: Elsevier BV
Date: 08-2015
The Cancer, Lifestyle and Evaluation of Risk Study (CLEAR): Rationale and design of an unmatched case-spouse control study of over 10,000 participants in New South Wales, Australia
Publisher: Elsevier BV
Date: 06-2015
DOI: 10.1016/J.CANEP.2015.03.006
Abstract: The New South Wales (NSW) Cancer, Lifestyle and Evaluation of Risk Study (CLEAR) is an open epidemiological bioresource, using an all cancer unmatched case-spouse control design. Participant characteristics and selected confirmed associations are compared to published estimates: current smoking and lung cancer country of birth and melanoma body mass index (BMI) and bowel cancer and paternal history of prostate cancer and prostate cancer, to illustrate the validity of this design. Cases are NSW residents, ≥18 years, with an incident cancer of any type. Controls are cancer-free spouses of cases. Participants complete a consent form, a questionnaire, and provide an optional blood s le. For analyses, odds ratios for males and females are calculated for cancers and exposures of interest, by sex-matching controls to cases. 10,816 participants (8569 cases, 2247 controls, 54% female) recruited to-date, median age: 61.6 y cases, 61.3 y controls. The top five cancer types are female breast (n=1691), prostate (n=1102), bowel (n=888), melanoma (n=608), and lung (n=265). Adjusted odds ratios (OR) were: 20.65 (95% CI: 13.25-32.19) for lung cancer in current versus never smokers 1.16 (1.05-1.28) for bowel cancer per 5 kg/m(2) increment in BMI 1.41 (1.01-1.96) for melanoma in Australian-born compared to those born in UK/Ireland and 2.47 (1.82-3.37) for prostate cancer in men with versus without a paternal history of prostate cancer. This study design, where controls are the spouses of cases diagnosed with a variety of cancers and which are analysed unmatched, avoids potential biases due to overmatching, considered problematic in standard case-spouse control studies, and illustrates that risk estimates analysed are consistent with the published literature. CLEAR methodology provides a practical design to advance local knowledge on the causes of various leading and emerging cancers.
The development of a model of outpatient chemotherapy delivery--chemotherapy basic treatment equivalent (CBTE).
Publisher: Elsevier BV
Date: 10-2002
Abstract: The aims of this study were to study the patient-, tumour- and treatment-related factors that significantly impact on treatment episode duration for outpatient chemotherapy treatment delivery, and to develop a new measure of outpatient chemotherapy throughput that considers variations in treatment duration compared with the older measures of patients treated per day. A pilot study in our institution randomly measured the duration of outpatient chemotherapy delivery for 266 occasions of service. Patient, tumour and treatment factors were collected and assessed for their impact on treatment duration using multivariate analysis. A new model of outpatient chemotherapy was developed using various modeling processes. Median treatment duration was 90 min. Significant factors that impacted on treatment duration were the chemotherapy regimen, type of infusion, patient age and whether the patients required a community nurse to be organized. A measure was developed (Chemotherapy Basic Treatment Equivalent or CBTE) that considers the variations in treatment duration and showed that although the daily number of patients treated in our department each day remained stable, there were wide fluctuations in workload when variations in treatment duration were considered. A new measure of chemotherapy workload has therefore been proposed although further testing across departments is required. If broadly implemented this could substantially improve resource planning, resource use and patient satisfaction as it considers variations in treatment duration, which is not previously considered in chemotherapy throughput statistics.
Do cancer follow-up consultations create anxiety?
Publisher: Informa UK Limited
Date: 2008
Role of radiotherapy in cancer control in low-income and middle-income countries
Publisher: Elsevier BV
Date: 07-2006
Estimation of an optimal radiotherapy utilization rate for gynecologic carcinoma: part II--carcinoma of the endometrium.
Publisher: Wiley
Date: 02-08-2004
DOI: 10.1002/CNCR.20445
Abstract: Radiotherapy utilization rates for cancer vary widely, both within and between countries. Current estimates of the proportion of cancer patients who should optimally receive radiotherapy are based either on expert opinion or on the measurement of actual utilization rates, rather than on the best scientific evidence. Evidence-based treatment guidelines regarding endometrial carcinoma were reviewed to develop an evidence-based benchmark for radiotherapy utilization. An optimal radiotherapy utilization tree was constructed and the proportions of endometrial carcinoma patients with clinical indications for radiotherapy were obtained from epidemiologic data. The ideal utilization rates were compared with actual radiotherapy utilization rates for endometrial carcinoma both in Australia and internationally. According to the best available evidence, radiotherapy is indicated at least once in 46% of all patients with endometrial carcinoma. A review of the limited data available concerning actual radiotherapy utilization rates revealed that the actual rates are approximately 10% lower than the optimal rates. Further research into the patterns of actual treatment and the development of optimal chemotherapy and surgery utilization rates for endometrial carcinoma is recommended. The difference between the optimal and the actual utilization rates warrants investigation into the reasons for the low radiotherapy utilization rates encountered in clinical practice.
Estimation of an optimal radiotherapy utilization rate for gynecologic carcinoma: part I--malignancies of the cervix, ovary, vagina and vulva.
Publisher: Wiley
Date: 02-08-2004
DOI: 10.1002/CNCR.20444
Abstract: Radiotherapy usage rates exhibit wide variations both within and between countries. Current estimates of the proportion of cancer patients who should optimally receive radiotherapy are based either on expert opinion or on the measurement of actual usage rates rather than on the best available scientific evidence. With the goal of developing an evidence-based benchmark for radiotherapy use in the treatment of malignancies of the cervix, vagina, vulva, and ovary (endometrial malignancies are covered in a separate article), the authors reviewed international evidence-based treatment guidelines. Optimal radiotherapy usage trees were constructed, and proportions of patients with clinical indications for radiotherapy were obtained from epidemiologic data. These ideal usage rates were compared with actual radiotherapy utilization rates recorded in Australia and elsewhere. According to the best available evidence, radiotherapy is indicated at least once for 58% of patients with cervical carcinoma, 4% of patients with ovarian carcinoma, 100% of patients with vaginal carcinoma, and 34% of patients with vulvar carcinoma. A review of the limited data available suggests that actual radiotherapy usage rates for patients with gynecologic malignancies are comparable to optimal usage rates. Actual practice appears to approximate the authors' model of optimal radiotherapy use. This finding reflects the high level of agreement among treatment guidelines as well as the existence of high-quality evidence related to the management of gynecologic malignancies, and it may also be indicative of the fact that a large proportion of patients are treated in specialist units. The management of gynecologic malignancies may serve as a good ex le in the development of management strategies for other types of cancer.
Patient reported outcomes of slow, single arc rotation: Do we need rotating gantries?
Publisher: Wiley
Date: 15-11-2017
Abstract: Patient rotation could greatly simplify radiation therapy delivery, with particularly important ramifications for fixed beam treatment with protons, heavy ions, MRI-Linacs, and low cost Linacs. Patient tolerance is often cited as a barrier to widespread implementation to patient rotation however, no quantitative data addressing this issue exists. In this study, patient reported experiences of slow, single arc rotation in upright (sitting) and lying orientations are reported. Fifteen patients currently or previously treated for cancer were slowly (~2 rpm) rotated in upright and lying orientations using an existing medical device. Patients were rotated 360° in 45° increments. Rotation was paused for 30 seconds at each angle to simulate beam delivery. Claustrophobia, anxiety and motion sickness were monitored via validated questionnaires. The Wilcoxon signed rank test was used to test for significant differences in anxiety and motion sickness before, during and after the study. No significant differences in anxiety or motion sickness were found between before and after the study, or upright and lying rotation (P > 0.05). The median percentage scores for anxiety and motion sickness immediately following the study were both 0. In general, anxiety and motion sickness scores were low throughout the study. All patients except one completed the study. Slow, single arc rotation in upright and lying orientations was well tolerated in this study. These results support the need for further studies into the clinical implementation of patient rotation, which could have a major impact on the practice and cost of radiotherapy.
Comparison of four methods for estimating actual radiotherapy utilisation using the 45 and up study cohort in New South Wales, Australia
Publisher: Elsevier BV
Date: 02-2019
DOI: 10.1016/J.RADONC.2018.10.039
Abstract: To compare four methods for estimating actual radiotherapy utilisation (A-RUR) reported in the literature. Participants in the 45 and Up Study in New South Wales (NSW) Australia completed a baseline questionnaire during 2006-2009 and consented to record linkage with administrative health datasets. Incident primary cancers (2006-2010) were identified through linkage with the NSW Cancer Registry. Radiotherapy receipt was identified through linkage with the Medicare Benefits Schedule and/or NSW Admitted Patient Data Collection (2006-2014). The four methods for estimating A-RUR were: 1 - crude proportion 2 - crude proportion for patients followed for a defined period 3 - life table without censoring of deaths 4 - life table with censoring of deaths. There were 9817 participants with a diagnosis of cancer between recruitment and end of 2010, median follow-up 5.4 years. Crude A-RUR for the cancer cohort was 30.2%, below the "optimal" 48%. The 5 yr A-RUR was 29.7%, 29.8% and 33.4% using methods 2-4 respectively. A-RUR estimates differed depending on the method used and all were below optimal. The method for estimating A-RUR for future studies should depend on the availability of the data as well as the intended audience for the results.
Estimation of an optimal radiotherapy utilization rate for gastrointestinal carcinoma: a review of the evidence.
Publisher: Wiley
Date: 02-08-2004
DOI: 10.1002/CNCR.20443
Abstract: Radiotherapy utilization rates for cancer vary widely, both within and between countries. The optimal proportion of patients with gastrointestinal malignancies who should receive at least one course of radiotherapy at some time during their illness is an important benchmark. The authors studied treatment guidelines and treatment reviews to identify the indications for radiotherapy for patients with gastrointestinal malignancies. Optimal radiotherapy utilization trees were constructed to show the clinical attributes of patients with gastrointestinal carcinomas who will benefit from radiotherapy. Epidemiologic incidence data for each of these clinical attributes were obtained to calculate the optimal proportion of all patients with gastrointestinal malignancies for whom radiotherapy was considered appropriate. Optimal rates of radiotherapy use were compared with actual rates in population-based studies to assess any discrepancies between actual and optimal radiotherapy utilization rates. Radiotherapy was indicated in 80% of patients with esophageal carcinoma, 68% of patients with gastric carcinoma, 57% of patients with pancreatic carcinoma, 13% of patients with carcinoma of the gallbladder, 0% of patients with hepatic carcinoma, 14% of patients with colon carcinoma, and 61% of patients with rectal carcinoma. The actual radiotherapy utilization rates for most of these gastrointestinal malignancies fell well short of optimal rates, which were derived from evidence-based treatment guidelines. It is possible to model optimal radiotherapy utilization using published treatment guidelines and existing incidence data. There was a discrepancy between the optimal and actual rates of radiotherapy utilization for patients with carcinomas of the esophagus, stomach, pancreas, and rectum. Strategies to implement evidence-based clinical guidelines are recommended.
Prostate brachytherapy in New South Wales: patterns of care study and impact of caseload on treatment quality.
Publisher: Termedia Sp. z.o.o.
Date: 2015
The population benefit of radiotherapy for gynaecological cancer: Local control and survival estimates.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.RADONC.2016.04.008
Abstract: The population benefit of radiotherapy for gynaecological cancer (GC) if evidence-based guidelines were routinely followed is not known. This study's aim was to address this. Decision trees were utilised to estimate benefit. Radiotherapy alone (RT) benefit was the absolute proportional benefit of radiotherapy over no radiotherapy for radical indications, and over surgery alone for adjuvant indications. Chemoradiotherapy (CRT) benefit was the absolute incremental benefit of concurrent chemotherapy and RT over RT alone. Citation databases were systematically queried for the highest level of evidence defining 5-year Local Control (LC), and 2-year and 5-year Overall Survival (OS) benefit. Meta-analysis was performed if there were multiple sources of the same evidence level. Deterministic and probabilistic sensitivity analysis was performed. Guidelines supported 22 radiotherapy indications, of which 8 were for CRT. 21% of all GC had an adjuvant or curative radiotherapy indication. The absolute estimated population-based 5-year LC and OS benefits of RT, if all patients were treated according to guidelines, were: endometrial cancer LC 5.7% (95% CI (3.5%,8.2%)), OS 2.3% (1.2%,3.4%), ovarian cancer (nil), vulval cancer LC 10.0% (1.6%,18.2%), OS 8.5% (0.5%,15.9%). Combined with prior estimates for cervical cancer, RT benefits for all GC were LC 9.0% (7.8%,10.3%), OS 4.6% (3.8%,5.4%). The incremental benefit of CRT for all GC was LC 0.7% (0.4%,0.9%), OS 0.5% (0.2%,0.8%). Benefits were distinct from the contribution of other modalities. The model was robust in sensitivity analysis. Most radiotherapy benefit was irreplaceable by other modalities. Radiotherapy provides important and irreplaceable LC and OS benefits for GC when optimally utilised. The population model provided a robust means for estimating this benefit.
The doses received by the breast during mantle radiotherapy
Publisher: Elsevier BV
Date: 04-1998
DOI: 10.1016/S0360-3016(97)00902-4
Abstract: To accurately measure the dose received by the breast during mantle radiotherapy. A phantom containing lung-equivalent material was used to measure the doses received by the breast during mantle radiotherapy given by anterior and posterior opposing fields. These were measured using thermoluminescent dosimeters and compared with point dose calculations obtained by computer planning. Most of the breast lies under the lung shields or inferior to the mantle field, but the upper outer quadrant of the breast remains unshielded. In the unshielded areas of the breast, the average dose measured was nearly 13% higher than the dose prescribed at the central axis. In the shielded parts of the breast, the average measured dose was nearly 10% of the dose prescribed at the central axes, decreasing from 18% superiorly to 4% inferiorly. The posterior field contributed 45% to the dose in the breast, even though doses were prescribed at the midplane. The computer calculations systematically varied from measured doses by up to 35%, becoming less accurate towards the inferior edge of the field. In a conventional course of mantle radiotherapy (for ex le, 36 Gy in 20 fractions), most of the breast is shielded but will receive a dose of 3-4 Gy, higher than expected largely due to internally scattered radiation passing through the lungs from the posterior field. Computer dose calculations may poorly reflect actual off-axis doses in large fields with complex shielding, containing inhomogeneous tissue.
How many new cancer patients in Europe will require radiotherapy by 2025? An ESTRO-HERO analysis
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.RADONC.2016.02.016
Abstract: The objective of this HERO study was to assess the number of new cancer patients that will require at least one course of radiotherapy by 2025. European cancer incidence data by tumor site and country for 2012 and 2025 was extracted from the GLOBOCAN database. The projection of the number of new cases took into account demographic factors (age and size of the population). Population based stages at diagnosis were taken from four European countries. Incidence and stage data were introduced in the Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) model. Among the different tumor sites, the highest expected relative increase by 2025 in treatment courses was prostate cancer (24%) while lymphoma (13%), head and neck (12%) and breast cancer (10%) were below the average. Based on the projected cancer distributions in 2025, a 16% expected increase in the number of radiotherapy treatment courses was estimated. This increase varied across European countries from less than 5% to more than 30%. With the already existing disparity in radiotherapy resources in mind, the data provided here should act as a leverage point to raise awareness among European health policy makers of the need for investment in radiotherapy.
An evidence-based estimation of local control and survival benefit of radiotherapy for breast cancer.
Publisher: Elsevier BV
Date: 07-2007
Radiotherapy for early infradiaphragmatic Hodgkin's disease: The Australasian experience
Publisher: Elsevier BV
Date: 04-1996
DOI: 10.1016/0167-8140(96)01715-X
Abstract: To review the Australasian results of Stage I and IIA Infradiaphragmatic Hodgkin's Disease (IHD) treated solely by irradiation. Eligible patients had IHD only and were treated by irradiation with curative intent over the period of 1969 to 1988. Ten radiation oncology centres from within Australia and New Zealand were surveyed for patient, tumour and treatment variables. Disease free rates, survival and complications were analysed. 106 patients with IHD were studied. The average potential follow up was 9.4 years. The male to female ratio was 3.3:1. The median age was 37.5 years. Histological subgroups were as follows lymphocyte predominant 43%, mixed cellularity 21%, lymphocyte depleted 5%, nodular sclerosing 27% and unclassifiable 4%. Fifty nine patients had laparotomy of which 22 (37%) were positive for tumour. Nine laparotomies were performed for diagnosis and the remainder for staging. One patient was up-staged by laparotomy and three were down-staged. Sixty-eight patients presented with inguinal disease alone, five with abdominal disease alone, 19 with two sites of involvement and 12 with inguinal, pelvic and abdominal disease. In two patients the site was unknown. There was no correlation between site of involvement, age, sex or histological subtype. Forty seven cases were clinically staged (CS) as follows: CS IA-23, CS IIA-24. The other 59 were pathologically staged (PS) as follows: PS IA-37, PS IB-1, PS IIA-21. Treatment consisted of involved field alone (16), inverted Y (68), inverted Y and spleen (13), para-aortic irradiation only (3), or total nodal irradiation (6). Mean dose was 37 Gy. There were 30 recurrences to give an acturial 10-year disease-free rate of 70%. In multivariate analysis lower number of tumour sites, lymphocyte predominant histology and higher dose were all significantly correlated with higher disease free rates. Eight patients died of Hodgkin's disease and 19 of other causes. The 10-year overall survival rate was 71%. Older age and higher number of disease sites were significantly correlated with shorter survival. Fourteen of 30 relapses may have been avoidable by the use of total nodal irradiation. In particular ten of 21 patients with abdominal disease relapsed in nodal sites which would have been covered by total nodal irradiation. The rate of control in IHD could perhaps be improved by avoiding involved field irradiation or by aggressive therapy with total nodal irradiation or combined modality chemo-irradiation in Stage II disease. Staging laparotomy does not appear to be indicated.
The Australian Magnetic Resonance Imaging-Linac Program
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.SEMRADONC.2014.02.015
Abstract: The Australian magnetic resonance imaging (MRI)-Linac program is a $16-million government-funded project to advance the science and clinical practice of exquisite real-time anatomical and physiological adaptive cancer therapy. The centerpiece of the program is a specifically designed 1-T open-bore MRI/6-MV linac system that is planned for delivery and completion of installation in 2014. Current scientific endeavors include engineering discovery in MRI component design, quantifying MRI and linac interactions, and developing image guidance and adaptation strategies.
Development of an age- and comorbidity- adjusted optimal radiotherapy utilisation rate for lung, rectal, prostate and cervical cancers
Publisher: Elsevier BV
Date: 11-2023
Importance of radiation time and dose factors on outcome for childhood medulloblastoma*
Publisher: Wiley
Date: 12-07-2005
DOI: 10.1111/J.1440-1673.2005.01468.X
Abstract: The purpose of this study was to investigate the relationship of posterior fossa radiation therapy duration (PFRTD) and relapse-free survival (RFS) following adjuvant craniospinal RT for childhood medulloblastoma. A retrospective audit was performed assessing all children aged 180 days) pre-RT chemotherapy were excluded. Data were obtained for potential prognostic factors in domains of patient, tumour and treatment factors. Radiation therapy time factors assessed were PFRTD and time interval from surgery to commencement of RT (SRTD). The end-point assessed was RFS and analysis was performed using Cox regression and Kaplan-Meier survival. One hundred and eighty-nine children were identified from 10 oncology units, with data available from 182 children for analysis. Median follow up was 5.3 years. Seventy-three per cent of children presented with disease confined to the cerebellum 13% had initial neuraxis disease. Macroscopic resection was described in 54% 42% received adjuvant chemotherapy. Median RT dose and RT duration to PF was 55 Gy and 45 days, respectively. Seventy-eight relapses occurred with a 10-year actuarial RFS of 58.2% (standard error +/- 4%). On univariate analysis, increasing PF dose (P = 0.002), age >5 years (P = 0.006), and more thorough extent of surgical resection (P = 0.043) were associated with improved RFS PFRTD (P = 0.20) and SRTD (P = 0.51) were not associated with RFS. On multivariate analysis, although both PF dose (P = 0.004) and extent of surgery (P = 0.045) remained strongly significant, RT duration was now associated with RFS (P = 0.049). Other factors assessed that did not reach significance were patient age, local tumour extent, presence of internal shunt and use of chemotherapy. The importance of local treatment factors was confirmed in this audit with established prognostic factors such as primary tumour macroscopic resection and adequate PF RT dose being associated with RFS. A treatment time effect is weakly suggested, although less significant than RT dose delivered.
Irisin in Liver Cirrhosis
Publisher: MDPI AG
Date: 29-09-2020
DOI: 10.3390/JCM9103158
Abstract: Background: Sarcopenia is a prevalent muscle abnormality characterized by progressive and generalized loss of skeletal muscle mass and strength, common among patients with decompensated advanced chronic liver disease (dACLD). Irisin is a recently identified myokine, which is mainly expressed and secreted by skeletal muscle. Pointing to the essential role of irisin in metabolic regulation and energy expenditure we hypothesize that it plays an important role in cirrhosis development and progression. Aim: To assess irisin serum levels in patients with dACLD, with different cirrhosis stage and etiology. To analyze relationship between sarcopenia and irisin serum levels. Methods: Serum irisin concentrations were measured with commercially available ELISA kits in 88 cirrhotic patients. Recorded parameters of muscle mass were hand-grip strength (HGS), mid-arm muscle circumference (MAC), and transversal psoas muscle index (TPMI). Results: There was no difference in serum irisin levels between cirrhotic patients with different Child-Pugh (CTP) and model of end-stage liver disease (MELD) score, and those with and without ascites. The Liver Frailty Index (LFI) was significantly higher in patients with more advanced liver disease according to CTP and MELD. There was no association between serum irisin level with MAC (r = 0.04, p = 0.74) nor with TPMI (r = 0.20, p = 0.06). We observed significant negative correlation between serum irisin level and age (r = −0.35, p 0.001). Conclusions: Serum irisin levels did not correlate with sarcopenia. There was no difference in serum irisin levels between cirrhotic patients with and without diabetes. There was no difference in serum irisin levels among patients with more severe dACLD, although we observed significant LFI increase among patients with more advanced liver disease.
The use of categorized time-trend reporting of radiation oncology incidents: a proactive analytical approach to improving quality and safety over time.
Publisher: Elsevier BV
Date: 12-2010
The Radiation Oncology trainee research programme is working well, so can anything else be done to help our trainees acquire research skills?
Publisher: Wiley
Date: 11-02-2020
The value of first‐line chemotherapy and targeted therapy in the treatment of breast cancer
Publisher: Hindawi Limited
Date: 04-11-2020
DOI: 10.1111/ECC.13352
Cancer control in the Pacific: big challenges facing small island states
Publisher: Elsevier BV
Date: 09-2019
Actual versus optimal utilization of radiotherapy in lung cancer: Where is the shortfall?
Publisher: Wiley
Date: 18-01-2007
The potential for an enhanced role for MRI in radiation-therapy treatment planning.
Publisher: SAGE Publications
Date: 10-2013
Abstract: The exquisite soft-tissue contrast of magnetic resonance imaging (MRI) has meant that the technique is having an increasing role in contouring the gross tumor volume (GTV) and organs at risk (OAR) in radiation therapy treatment planning systems (TPS). MRI-planning scans from diagnostic MRI scanners are currently incorporated into the planning process by being registered to CT data. The soft-tissue data from the MRI provides target outline guidance and the CT provides a solid geometric and electron density map for accurate dose calculation on the TPS computer. There is increasing interest in MRI machine placement in radiotherapy clinics as an adjunct to CT simulators. Most vendors now offer 70 cm bores with flat couch inserts and specialised RF coil designs. We would refer to these devices as MR-simulators. There is also research into the future application of MR-simulators independent of CT and as in-room image-guidance devices. It is within the background of this increased interest in the utility of MRI in radiotherapy treatment planning that this paper is couched. The paper outlines publications that deal with standard MRI sequences used in current clinical practice. It then discusses the potential for using processed functional diffusion maps (fDM) derived from diffusion weighted image sequences in tracking tumor activity and tumor recurrence. Next, this paper reviews publications that describe the use of MRI in patient-management applications that may, in turn, be relevant to radiotherapy treatment planning. The review briefly discusses the concepts behind functional techniques such as dynamic contrast enhanced (DCE), diffusion-weighted (DW) MRI sequences and magnetic resonance spectroscopic imaging (MRSI). Significant applications of MR are discussed in terms of the following treatment sites: brain, head and neck, breast, lung, prostate and cervix. While not yet routine, the use of apparent diffusion coefficient (ADC) map analysis indicates an exciting future application for functional MRI. Although DW-MRI has not yet been routinely used in boost adaptive techniques, it is being assessed in cohort studies for sub-volume boosting in prostate tumors.
Oropharyngeal cancer in the elderly
Publisher: Elsevier BV
Date: 07-1995
DOI: 10.1016/0360-3016(95)00515-Z
Abstract: The poor prognosis of elderly patients in many cancers may be due to less thorough investigation and less aggressive treatment because of the perception that radical treatment will be poorly tolerated and that elderly patients have a limited life expectancy. We wished to assess whether older age is associated with (a) less radical treatment, (b) poorer outcome, or (c) greater toxicity, after adjusting for other possible contributing factors. A retrospective study of patients with loco-regional oropharyngeal cancer treated between January 1980 and December 1985 was conducted. Patients were treated with radiotherapy, surgery, chemotherapy, or combinations. Cox regression was used to assess age effects while allowing for the influence of other factors. Eighty-eight patients were treated radically and 16 palliatively. Treatment intent (radical or palliative) did not appear to be related to age, before (p = 0.42) or after adjusting for other factors (p = 0.34). In a selected group of 86 radically treated patients ages ranged from 33 to 85 (median 60). There were 35 loco-regional failures and 58 deaths (38 related to oropharyngeal cancer). Older patients were prescribed and received lower doses of radiation. However, older age was not related to the risk of loco-regional recurrence (p = 0.96) or shorter survival (p = 0.67), and was not associated with duration of treatment interruption or severity of toxicity after adjustment for prognostic factors. There was some suggestion of a higher risk of recurrence with increasing age for patients under 70 years but with a risk for patients over 70 at least equal to that of the youngest group. Elderly patients in our study may have been a selected group. Older patients with loco-regional oropharyngeal cancer, or at least a subset of them, appear to be able to tolerate radical courses of radiotherapy, and to have similar outcomes as do younger patients.
What do undergraduate doctors really need to know about radiation oncology?
Publisher: Wiley
Date: 11-11-2018
Estimation of the optimal brachytherapy utilization rate in the treatment of carcinoma of the uterine cervix: review of clinical practice guidelines and primary evidence.
Publisher: Wiley
Date: 2006
DOI: 10.1002/CNCR.22337
An MRI-compatible patient rotation system - design, construction, and first organ deformation results
Publisher: Wiley
Date: 02-2017
DOI: 10.1002/MP.12065
Abstract: Conventionally in radiotherapy, a very heavy beam forming apparatus (gantry) is rotated around a patient. From a mechanical perspective, a more elegant approach is to rotate the patient within a stationary beam. Key obstacles to this approach are patient tolerance and anatomical deformation. Very little information on either aspect is available in the literature. The purpose of this work was therefore to design and test an MRI-compatible patient rotation system such that the feasibility of a patient rotation workflow could be tested. A patient rotation system (PRS) was designed to fit inside the bore of a 3T MRI scanner (Skyra, Siemens) such that 3D images could be acquired at different rotation angles. Once constructed, a pelvic imaging study was carried out on a healthy volunteer. T2-weighted MRI images were taken every 45° between 0° and 360°, (with 0° equivalent to supine). The prostate, bladder, and rectum were segmented using atlas-based auto contouring. The images from each angle were registered back to the 0° image in three steps: (a) Rigid registration was based on MRI visible markers on the couch. (b) Rigid registration based on the prostate contour (equivalent to a rigid shift to the prostate). (c) Nonrigid registration. The Dice similarity coefficient (DSC) and mean average surface distance (MASD) were calculated for each organ at each step. The PRS met all design constraints and was successfully integrated with the MRI scanner. Phantom images showed minimal difference in signal or noise with or without the PRS in the MRI scanner. For the MRI images, the DSC (mean ± standard deviation) over all angles in the prostate, rectum, and bladder was 0.60 ± 0.11, 0.56 ± 0.15, and 0.76 ± 0.06 after rigid couch registration, 0.88 ± 0.03, 0.81 ± 0.08, and 0.86 ± 0.03 after rigid prostate guided registration, and 0.85 ± 0.03, 0.88 ± 0.02, 0.87 ± 0.02 after nonrigid registration. An MRI-compatible patient rotation system has been designed, constructed, and tested. A pelvic study was carried out on a healthy volunteer. Rigid registration based on the prostate contour yielded DSC overlap statistics in the prostate superior to interobserver contouring variability reported in the literature.
Correlation of ultra-high field MRI with histopathology for evaluation of rectal cancer heterogeneity
Publisher: Springer Science and Business Media LLC
Date: 27-06-2019
DOI: 10.1038/S41598-019-45450-2
Abstract: Current clinical MRI techniques in rectal cancer have limited ability to examine cancer stroma. The differentiation of tumour from desmoplasia or fibrous tissue remains a challenge. Standard MRI cannot differentiate stage T1 from T2 (invasion of muscularis propria) tumours. Diffusion tensor imaging (DTI) can probe tissue structure and organisation (anisotropy). The purpose of this study was to examine DTI-MRI derived imaging markers of rectal cancer stromal heterogeneity and tumour extent ex vivo . DTI-MRI at ultra-high magnetic field (11.7 tesla) was used to examine the stromal microstructure of malignant and normal rectal tissue ex vivo , and the findings were correlated with histopathology. Images obtained from DTI-MRI (A0, apparent diffusion coefficient and fractional anisotropy (FA)) were used to probe rectal cancer stromal heterogeneity. FA provided the best discrimination between cancer and desmoplasia, fibrous tissue and muscularis propria. Cancer had relatively isotropic diffusion (mean FA 0.14), whereas desmoplasia (FA 0.31) and fibrous tissue (FA 0.34) had anisotropic diffusion with significantly higher FA than cancer (p 0.001). Tumour was distinguished from muscularis propria (FA 0.61) which was highly anisotropic with higher FA than cancer (p 0.001). This study showed that DTI-MRI can assist in more accurately defining tumour extent in rectal cancer.
A comparison of surgical and radiotherapy breast cancer therapy utilization in Canada (British Columbia), Scotland (Dundee), and Australia (Western Australia) with models of optimal therapy.
Publisher: Elsevier BV
Date: 08-2012
Radiotherapy service need in the Pacific Island countries
Publisher: Wiley
Date: 25-09-2021
DOI: 10.1111/AJCO.13437
Abstract: Pacific Island Countries and Territories (PICTs) have experienced an increase in cancer burden in the recent years. There is need for major investments in the cancer treatment facilities including radiotherapy (RT). This study aimed to provide a quantitative estimation of the effect of establishing new RT facilities on patient access through Geographic Information System (GIS) modelling of population density and service availability to assess the best location for a new RT centre when there are multiple competing locations. Methods involved cancer epidemiological data collection and assessing RT demand (proportion needing RT) in 2040, assessment of current RT facilities meeting the demand, GIS‐based assessment of minimal travel distance in relation to RT demand and scenario‐based location planning with adoption of the principles of efficiency, availability and equity for establishment of suitability of new RT facilities. In 2040, three highest new cancer case projections are for Papua New Guinea (PNG) (22662), Fiji (2058) and New Caledonia (2037). Twenty‐nine megavoltage machines (MVMs) are needed to meet adequate RT demand with three existing in New Caledonia, Guam and French Polynesia meeting 2–6% demand. PNG with highest RT demand of 68% and Fiji with second highest (6%) demand are found as the choice venues for maximum accessibility of cancer population within the PICTs. The travel distance‐based GIS modelling estimation of establishment of new RT facilities will provide useful information for planning of RT services in the PICTS with improved patient outcome.
Patterns of care for men with prostate cancer: the 45 and Up Study.
Publisher: AMPCo
Date: 04-03-2021
DOI: 10.5694/MJA2.50966
Radiotherapy for bone metastases: A critical appraisal of outcome measures
Publisher: Elsevier BV
Date: 03-1999
DOI: 10.1016/S0885-3924(98)00123-7
Abstract: Pain from bone metastases is a common problem in patients with advanced cancer, and radiotherapy plays an important role in its palliation. Single fraction treatments are often prescribed, but there is no clear consensus on this issue and clinical practice shows significant variability. This situation is unsatisfactory for all patients--the patient, the clinician, and the health care administrator. Randomized trials may use poor outcome measures and this contributes to practice variability. The credibility of outcome studies is often reduced due to poor study design, small s le sizes, and the use of endpoints that are both unreliable and unsuitable. The endpoints used have been narrowly defined, the patient's perspective has generally been overlooked, and quality of life has only once been used as an endpoint. A review of the current literature suggests that instruments specific to bone metastases are required. These must be based on patient experience, and rely on self-report. In addition, there is a need to understand the relative priority that patients attribute to treatment outcomes. The use of better instruments and methodologies in future trials will enhance the credibility of results and reduce practice variations.
A 'Catch Up' Plan for radiotherapy in New South Wales to 2012
Publisher: Wiley
Date: 30-07-2009
DOI: 10.1111/J.1754-9485.2009.02098.X
Abstract: In New South Wales (NSW) from 1996 to 2006, only 34-37% of newly diagnosed cancer patients were treated with radiotherapy instead of the 50% proposed by NSW Health in Radiotherapy Plans released in 1991, 1995 and 2003. As a consequence, over 50 000 cancer patients were not treated and has resulted in the estimated premature death of over 8000 patients and over 40 000 years of life lost. In 2008, there were 42 linear accelerators in NSW rather than the 62 recommended. Based on cancer incidence projections, NSW will require 69 linear accelerators in 2012--a shortfall of 27 linear accelerators. Already 15 linear accelerators have been approved. NSW Health has funding for seven extra linear accelerators, and eight extra linear accelerators are to be funded by the private sector. To make up the shortfall, a 'Catch Up' Plan is proposed for an additional 12 linear accelerators by the end of fiscal year 2012. This is estimated to cost $200 million over 4 years for one-off establishment costs for buildings and equipment plus $50 million per year for recurrent operating costs such as staff salaries. The 'Catch Up' Plan will create five new departments of radiation oncology in country hospitals and three new departments in metropolitan hospitals. These will be in addition to those already approved by NSW Health and will markedly improve access for treatment and result in an improvement in cancer survival. This significant increase in departments and equipment can only be achieved by the creation of an NSW Radiotherapy Taskforce similar to that proposed in the Baume report of 2002, 'A vision for radiotherapy'. Even if the 'Catch Up' Plan bridges the gap in service provision, forward planning beyond 2012 should commence immediately as 76 linear accelerators will be required for NSW in 2015 and 81 linear accelerators in 2017.
Testing criterion-based benchmarking for the appropriate use of radiotherapy.
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.RADONC.2018.05.023
Abstract: Planning for radiotherapy (RT) services requires information on the proportion of patients who should be given radiotherapy. Criterion-Based Benchmark (CBB) has been proposed in Canada to estimate the proportion of cancer patients who should be treated with radiotherapy. The aim of this study was to assess CBB in a health system outside of Canada. Radiotherapy data for all new cases of cancer in New South Wales (NSW), and the Australian Capital Territory (ACT) Australia in 2004-06 and were linked to Central Cancer Registry records. Road distances between patient residence and the nearest RT centre were calculated. Local Government Areas (LGAs) with public radiotherapy departments were selected as CBB LGAs if they met the following criteria: 1. Patients make no direct payment for radiotherapy. 2. All RT is provided by site-specialised radiation oncologists in multi-disciplinary centres. 3. Radiation oncologists receive salary for their service. 4. More than 75% of patients live within 30 km from the nearest RT, and 5. Patients' waiting times were <4 weeks. 25,383 (26%) out of 98,000 eligible patients in NSW and ACT received radiotherapy in the study period as part of their initial treatment. An average of 31% of patients in the CBB LGAs received radiotherapy compared to an average of 26% in all LGAs during the study period. NSW-ACT RT utilisation for selected tumour sites was 7-16% higher in the CBB LGAs than in all LGAs, but was still 30-65% below the estimated optimal radiotherapy utilisation rates and differed significantly from Canadian CBBs. CBB is based on the assumption that there is perfect service delivery in some parts of the health service that can be used to benchmark the whole service. It may be applicable in well-resourced publicly-funded services in Canada, but the CBB approach may not be reproducible in other jurisdictions.
What should doctors know about cancer? Undergraduate medical education from a societal perspective
Publisher: Elsevier BV
Date: 07-2006
Development and application of reverse osmosis for separation
Publisher: Wiley
Date: 29-06-2015
Functional imaging equivalence and proof of concept for image-guided adaptive radiotherapy with fixed gantry and rotating couch
Publisher: Elsevier BV
Date: 10-2016
Variation in the use of radiotherapy fractionation for breast cancer: Survival outcome and cost implications.
Publisher: Elsevier BV
Date: 11-2020
Estimation of an evidence-based benchmark for the optimal endocrine therapy utilization rate in breast cancer.
Publisher: Elsevier BV
Date: 10-2010
Estimating the optimal external-beam radiotherapy utilization rate for genitourinary malignancies.
Publisher: Wiley
Date: 2005
DOI: 10.1002/CNCR.20789
Abstract: Benchmark radiotherapy utilization rates for genitourinary malignancies are largely unknown, despite the finding that genitourinary cancers comprise approximately 19% of all registered malignancies in Australia. To develop an evidence-based benchmark of the optimal proportion of patients with genitourinary malignancies who should receive at least one course of radiotherapy at some time during their illness, the authors studied treatment guidelines and treatment reviews regarding genitourinary malignancies. Optimal radiotherapy utilization trees were constructed to show the clinical attributes that indicated possible benefit from radiotherapy based on evidence. Epidemiologic incidence data for each of these clinical attributes were obtained to calculate the optimal proportion of all patients with genitourinary cancer for whom radiotherapy was considered appropriate. The proportion of patients with genitourinary malignancies for whom radiotherapy was indicated at some point in their illness, according to the best available evidence, was estimated to be 27% of patients with renal cancer, 58% of patients with bladder cancer, 60% of patients with prostate cancer, and 49% of patients with testicular cancer. The occurrence of ureteric and penile cancers among patients was too rare, and, therefore, these patients were not included in the current study. There was a large discrepancy between actual radiotherapy utilization and the evidence-based optimal rate. The authors recommended strategies to implement the evidence-based guidelines. Evidence-based benchmarks for radiotherapy utilization rates such as the ones described in the current study were important in the evaluation of the appropriate use of radiotherapy.
Radiation Therapy and the Global Health Agenda
Publisher: Elsevier BV
Date: 02-2015
Factors Affecting the Use of Single-Fraction Radiotherapy for the Palliation of Bone Metastases in Australia
Publisher: Elsevier BV
Date: 04-2015
DOI: 10.1016/J.CLON.2014.11.027
Abstract: Palliative radiotherapy for bone metastases remains an important treatment in patients with metastatic malignancy. Previous studies have indicated a reluctance to adopt single-fraction treatment despite considerable evidence. This study aims to describe the factors determining the use of palliative radiotherapy in patients with bone metastases and assess whether fractionation patterns have changed over time with emerging evidence. A retrospective review of radiotherapy databases at Liverpool/Macarthur Cancer Therapy Centre and the Royal Brisbane and Women's Hospital was conducted for the period 1997-2009. Patients receiving palliative radiotherapy for bony metastases were identified and treatment sites were grouped into 'spine', 'limb', 'multiple' or 'other'. Treatment courses were ided into single- or multiple-fraction treatments. The effects of socioeconomic and geographical factors on radiotherapy utilisation and fractionation were assessed. In total, 5683 patients were identified in the cohort they received a total of 8211 bone treatments. The overall proportion of single-fraction radiotherapy was 29%, with significant variation over the study period (P < 0.001). Age under 70 years and spine or multiple treatment sites were all associated with lower usage of single-fraction radiotherapy on multivariate analysis. Prostate and lung primary sites were associated with higher usage of single-fraction treatment. The proportion of single-fraction treatment remained low (35%), even for patients who survived less than 22 days from their last treatment. Socioeconomic and geographical factors had little effect on the number of fractions used. The rate of single-fraction radiotherapy for bone metastases has remained low in two large Australian institutions, despite considerable evidence that single-fraction treatment provides equivalent pain relief to fractionated therapy. This trend towards fractionated treatment was largely maintained, even in patients with limited life expectancy. Further measures to increase the rate of single-fraction therapy are needed.
Sites of local recurrence after surgery, with or without chemotherapy, for rectal cancer: Implications for radiotherapy field design
Publisher: Elsevier BV
Date: 2003
DOI: 10.1016/S0360-3016(02)03812-9
Abstract: To examine the sites of pelvic recurrence in patients with rectal cancer previously untreated with radiotherapy to determine the relative frequency and location of recurrence within the pelvis. The records of patients with locally recurrent rectal cancer referred to three radiation oncology departments between 1984 and 1997 were reviewed. The data collected included the date and type of the initial resection and the pathologic findings. The site of recurrence within the pelvis, presence of metastasis, and date of recurrence were documented. A total of 269 patients were included. Tumor had invaded through the muscularis in 74% and involved other organs in 9%. Fifty-two percent of patients were node positive at initial surgery. The median time to local recurrence from surgery was 18 months (range 15-20) and from local recurrence to death was 14 months (range 12-17). Both the initial tumor stage and the resection type influenced the recurrence location within the pelvis (p <0.01). T4 tumors comprised only 9% of initial T stage tumors but accounted for 38% of anterior central pelvic recurrences (p <0.01). All perineal recurrences occurred after abdominoperineal resection. The sites of recurrence within the pelvis were the posterior central pelvis (47%) and anastomotic (21%). If those patients with T4 tumors at presentation were excluded, 89% had local recurrence at, or posterior to, the anastomosis. Furthermore, if we exclude both patients who underwent abdominoperineal resection and those with T4 tumors at presentation, the rate increases to 93%. The rate of recurrence anteriorly (7%) does not justify routine radiation of the anterior pelvis beyond that required to adequately cover the anastomotic site.
Patients’ and health care professionals’ evaluation of health-related quality of life issues in bone metastases
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.EJCA.2009.05.024
Abstract: The objective of this study was to examine the agreement between health care professionals' (HCPs) and patients' evaluation of health-related quality of life (HRQOL) issues for cancer patients with bone metastases. A total of 413 patients and 152 HCPs were interviewed across five centres worldwide. Mean scores were almost always higher for HCPs than for patients. Patients and HCPs agreed that four issues affect HRQOL of bone metastases patients profoundly: 'long-term (chronic) pain', 'difficulty in carrying out usual daily tasks', 'able to perform self-care' and 'able to perform role functioning'. A substantial difference was found with respect to the perceived importance of psychosocial and somatic issues. Patients emphasised psychosocial issues with a particular focus on 'worry' about loss of mobility, dependence on others and disease progression, HCPs however rated 'symptom' issues as more important, specifically those related to 'pain'. In conclusion, patients and HCPs agreed that pain and physical/role functioning are important to the HRQOL of cancer patients with bone metastases, but patients also emphasized the importance of psychosocial issues to HRQOL. This information has been an important component in the development of a health-related quality of life questionnaire for patients with bone metastases (EORTC QLQ-BM 22).
Australia and New Zealand's responsibilities in improving oncology services in the Asia‐Pacific: A call to action
Publisher: Wiley
Date: 25-02-0029
DOI: 10.1111/AJCO.13544
Abstract: To review the expected increasing demand for cancer services among low and middle‐income countries (LMICs) in the Asia‐Pacific (APAC), and to describe ways in which Australia and New Zealand (ANZ) can provide support to improve cancer outcomes in our region. We first review the current and projected incidence of cancer within the APAC between 2018 and 2040, and the estimated demand for chemotherapy, radiotherapy and surgery. We then explore potential ways in which ANZ can increase regional collaborations to improve cancer outcomes. We identify 6 ways that ANZ can collaborate with LMICs to improve cancer care in the APAC through the ANZ Regional Oncology Collaboration Strategy: Increasing education and institutional collaborations in the APAC region through in‐country training, twinning partnerships, observerships and formalised training programs in order to increase cancer care quality and capacity. Promoting and assisting in the establishment and maintenance of population‐based cancer registries in LMICs. Increasing research capacity in LMICs through collaboration and promoting high quality global oncology research within ANZ. Engaging and training Australian and New Zealand clinicians in global oncology, increasing awareness of this important career path, and increasing health policy engagement. Increasing web‐based endeavours through virtual tumour boards, web‐based advocacy platforms and web‐based teaching programs. Continuing to leverage for funding through professional bodies, government, industry, not‐for‐profit organisations and local hospital funds. We propose the creation of an Australian and New Zealand Interest Group to provide formalised and sustained collaboration between researchers, clinicians and stakeholders.
A model for decision making for the use of radiotherapy in lung cancer
Publisher: Elsevier BV
Date: 02-2003
DOI: 10.1016/S1470-2045(03)00984-7
Abstract: To develop an evidence-based benchmark for the use of radiotherapy in lung cancer, we did a systematic review of treatment guidelines on radiotherapy for lung cancer. We then constructed an optimum use of radiotherapy "tree" from epidemiological data, which shows the proportion of patients with clinical attributes indicating that they would benefit from radiotherapy. We calculated that the proportion of patients with lung cancer in whom radiotherapy is indicated (according to the best available evidence) is 76%. We then compared this ideal rate with the actual rates of use of radiotherapy for lung cancer in Australia, and internationally, in the past decade. A substantial discrepancy was found between the evidence-based recommended rate of use and the actual rates reported in clinical practice. We hope this model will be used to plan efficient and cost-effective radiotherapy services.
Estimation of an optimal chemotherapy utilisation rate for colon cancer: an evidence-based benchmark for cancer care.
Publisher: Elsevier BV
Date: 09-2009
Patterns of care study of brachytherapy in New South Wales: malignancies of the uterine corpus.
Publisher: Termedia Sp. z.o.o.
Date: 2015
Colorectal cancer patterns of care in the Western Sydney and Wentworth Area Health Services
Publisher: Wiley
Date: 06-2004
The effect of treatment duration in the local control of cervix cancer
Publisher: Elsevier BV
Date: 12-1992
DOI: 10.1016/0167-8140(92)90247-R
Abstract: A significant effect of treatment duration on pelvic control was found in 830 patients with cervix cancer treated by radical radiation therapy. Using three methods of analysis, the loss of control consistently approximated 1% per day of treatment prolongation beyond 30 days, although analysis of stage subgroups showed that this effect was predominantly manifested in Stages III/IV compared with Stages I/II. In multivariate analyses using both a logistic regression and a Cox regression model, stage (p = 0.0001 for Stage I/IIA and 0.0036 for Stage IIB relative to Stage III/IV) treatment time (p = 0.0001), and age (p = 0.0067) were independently correlated with pelvic control. Exclusion from analysis of patients with delays due to tumour or treatment related complications, intercurrent illness or manifestations of poor tumour response did not significantly change the magnitude of the time effect nor the ranking of the significant covariates. These results are consistent with the occurrence of accelerated repopulation and warrant further investigation, preferably in a randomized trial of accelerated versus conventionally fractionated radiation therapy.
Estimates of global chemotherapy demands and corresponding physician workforce requirements for 2018 and 2040: a population-based study
Publisher: Elsevier BV
Date: 06-2019
Modern radiotherapy for modern surgeons: An update on radiation oncology
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.
Health Economic and Health Service Issues of Palliative Radiotherapy
Publisher: Elsevier BV
Date: 11-2020
The development of a new basic treatment equivalent model to assess linear accelerator throughput.
Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1016/J.CLON.2005.02.016
Abstract: The basic treatment equivalent (BTE) model was developed in 1996 in an attempt to improve the measurement of linear accelerator throughput in radiotherapy. This study aimed to assess the effect of treatment set-up and patient characteristics on fraction duration, to update the BTE model and to determine the better throughput measure between fields per hour and BTE per hour. Stopwatch measurements of the duration of each radiotherapy treatment fraction delivered on each linear accelerator in participating New South Wales radiation oncology departments over a 5-day period in 2003 were undertaken. Patient, equipment and staff data were collected to assess the effect of these variables on fraction duration. A new BTE equation was derived, including the most significant variables. Statistical comparison of fields and BTE per unit time was made to assess the better predictor of fraction duration. Data collected on 27 linear accelerators in 13 departments included a total of 135 days of linear accelerator operation, 4316 fractions and 12 892 treatment fields. Seventeen factors significantly influenced fraction duration (P < 0.01). These accounted for 46% of the total variance in the models. The eight most influential predictors of prolonged fraction duration were included in the BTE model. These were as follows: high number of fields, high number of port films/electronic portal imaging, absence of automatic field-sequencing and multi-leaf collimation, high number of junctions, use of bolus and first fraction of a treatment course. The BTE per hour was shown to be a better predictor of throughput than fields per hour. The BTE model is a better measure of linear accelerator throughput. It incorporates weightings for treatment and patient factors that significantly influenced fraction duration. This measure could be routinely collected by the radiation oncology departments and included in the electronic radiotherapy information systems.
Establishing treatment benchmarks for mammography-screened breast cancer population based on a review of evidence-based clinical guidelines.
Publisher: Wiley
Date: 21-04-2008
DOI: 10.1002/CNCR.23384
Stability of kalman filters subject to intermittent observations
Publisher: IEEE
Date: 12-2013
Reply to letter by Drs. Dubray and Thames
Publisher: Elsevier BV
Date: 03-1992
Estimating the demand for radiotherapy from the evidence: a review of changes from 2003 to 2012.
Publisher: Elsevier BV
Date: 07-2014
Radiotherapy utilization in developing countries: An IAEA study
Publisher: Elsevier BV
Date: 09-2018
DOI: 10.1016/J.RADONC.2018.05.014
Abstract: The planning of national radiotherapy (RT) services requires a thorough knowledge of the country's cancer epidemiology profile, the radiotherapy utilization (RTU) rates and a future projection of these data. Previous studies have established RTU rates in high-income countries. Optimal RTU (oRTU) rates were determined for nine middle-income countries, following the epidemiological evidence-based method. The actual RTU (aRTU) rates were calculated iding the total number of new notifiable cancer patients treated with radiotherapy in 2012 by the total number of cancer patients diagnosed in the same year in each country. An analysis of the characteristics of patients and treatments in a series of 300 consecutive radiotherapy patients shed light on the particular patient and treatments profile in the participating countries. The median oRTU rate for the group of nine countries was 52% (47-56%). The median aRTU rate for the nine countries was 28% (9-46%). These results show that the real proportion of cancer patients receiving RT is lower than the optimal RTU with a rate difference between 10-42.7%. The median percent-unmet need was 47% (18-82.3%). The optimal RTU rate in middle-income countries did not differ significantly from that previously found in high-income countries. The actual RTU rates were consistently lower than the optimal, in particular in countries with limited resources and a large population.
Erratum: Delaney G, Barton M, Jacob S. Estimation of an optimal radiotherapy utilization rate for gastrointestinal carcinoma: a review of the evidence.Cancer. 2004; 101(4):657–60.
Publisher: Wiley
Date: 2006
DOI: 10.1002/CNCR.22056
Erratum: Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines.Cancer. 2005; 10
Publisher: Wiley
Date: 2006
DOI: 10.1002/CNCR.22057
Actual Versus Optimal Radiotherapy Utilisation for Metastatic Cancer Patients in the 45 and Up Study Cohort, New South Wales.
Publisher: Elsevier BV
Date: 10-2021
Technology enhancements and changes in radiotherapy throughput in New South Wales.
Publisher: Elsevier BV
Date: 08-2005
DOI: 10.1016/J.CLON.2005.02.011
Abstract: To assess the effect that the age of linear accelerators and recent changes in technology have had on linear accelerator throughput in New South Wales, Australia. Duration was measured (time of patient entry into the treatment room to time of exit) of each radiotherapy treatment fraction delivered on each linear accelerator over a 5-day period. Patient-, treatment- and equipment-based variables were collected for all treatment fractions, and assessed for their effect on fraction duration. Comparisons were made between these data and similar productivity data collected from a study carried out in 1996. Since the s le sizes for both the study periods were large enough, the distributions of the means were assumed normal (Central Limit Theorem). Specific analyses were carried out to assess the affect that new technologies, such as automatic field-sequencing (AFS) and multi-leaf collimator (MLC), have had on fraction duration. A total of 12 892 treatment fields and 4316 treatment fractions were delivered on 27 linear accelerators over 135 days. Comparison between the 2003 and 1996 productivity data showed an increase in the mean number of patients treated per hour by 11% and fields treated per hour by 31%. The mean number of fields treated per fraction increased by 15%. The mean fraction duration was reduced by 13% for linear accelerators of less than the median age of 7 years that were equipped with MLC/AFS, or both, compared with older linear accelerators without AFS and MLC. This reduction was more obvious for complex techniques, such as four-field breast treatments (27% decrease in fraction duration). The mean number of fields treated per hour was 43% more on the newer machines equipped with AFS and MLC. An increase in productivity has been observed between the 1996 and 2003 study periods, as measured by patients or fields per hour, despite an increase in treatment complexity as measured by fields per fraction. The application of AFS and MLC, and the use of newer linear accelerators, significantly shortened the mean duration per fraction for the common treatment techniques.
Patterns of retreatment by radiotherapy.
Publisher: Elsevier BV
Date: 10-2014
Cancer in small states – No small matter
Publisher: Elsevier BV
Date: 10-2017
Estimation of an optimal chemotherapy utilisation rate for upper gastrointestinal cancers: setting an evidence-based benchmark for the best-quality cancer care.
Publisher: Hindawi Limited
Date: 2015
DOI: 10.1155/2015/753480
Abstract: Aims . The proportion of patients with upper gastrointestinal cancers that received chemotherapy varies widely in Australia and internationally, indicating a need for a benchmark rate of chemotherapy utilisation. We developed evidence-based models for upper gastrointestinal cancers to estimate the optimal chemotherapy utilisation rates that can serve as useful benchmarks for measuring and improving the quality of care. Materials and Methods . Optimal chemotherapy utilisation models for cancers of the oesophagus, stomach, pancreas, gallbladder, and primary liver were constructed using indications for chemotherapy identified from evidence-based guidelines. Results . Based on the best available evidence, the optimal proportion of upper gastrointestinal cancers that should receive chemotherapy at least once during the course of the patients’ illness was estimated to be 79% for oesophageal cancer, 83% for gastric cancer, 35% for pancreatic cancer, 80% for gallbladder cancer, and 27% for primary liver cancer. Conclusions . The reported chemotherapy utilisation rates for upper gastrointestinal cancers (with the exception of primary liver cancer) appear to be substantially lower than the estimated optimal rates suggesting that chemotherapy may be underutilised. Further studies to elucidate the reasons for the potential underutilisation of chemotherapy in upper gastrointestinal tumours are required to bridge the gap between the ideal and actual practice identified.
Quality of radiotherapy services in post-Soviet countries: An IAEA survey
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.RADONC.2018.03.028
Abstract: The quality of radiotherapy services in post-Soviet countries has not yet been studied following a formal methodology. The IAEA conducted a survey using two sets of validated radiation oncology quality indicators (ROIs). Eleven post-Soviet countries were assessed. A coordinator was designated for each country and acted as the liaison between the country and the IAEA. The methodology was a one-time cross-sectional survey using a 58-question tool in Russian. The questionnaire was based on two validated sets of ROIs: for radiotherapy centres, the indicators proposed by Cionini et al., and for data at the country level, the Australasian ROIs. The overall response ratio was 66.3%, but for the Russian Federation, it was 24%. Data were updated on radiotherapy infrastructure and equipment. 256 radiotherapy centres are operating 275 linear accelerators and 337 Cobalt-60 units. 61% of teletherapy machines are older than ten years. Analysis of ROIs revealed significant differences between these countries and radiotherapy practices in the West. Naming, task profile and education programmes of radiotherapy professionals are different than in the West. Most countries need modernization of their radiotherapy infrastructure coupled with adequate staffing numbers and updated education programmes focusing on evidence-based medicine, quality, and safety.
Are NCCN Resource-Stratified Guidelines for Breast Cancer Systemic Therapy Achievable? A Population-Based Study of Global Need and Economic Impact
Publisher: American Society of Clinical Oncology (ASCO)
Date: 12-2021
DOI: 10.1200/GO.21.00028
Abstract: Resource-stratified guidelines (RSG) for cancer provide a hierarchy of interventions, based on resource availability. We quantify treatment need and cost if National Comprehensive Cancer Network (NCCN) RSGs for breast cancer (BC) are adopted globally. We developed decision trees for first-course systemic therapy, merged with SEER and Global Cancer Observatory 2018 incidence data to estimate treatment need and cost if NCCN RSG are implemented globally based on country-level income. Simulations were used to quantify need and cost of globally scaling up services to Maximal. Based on NCCN RSG, first-course chemotherapy is indicated in 0% (Basic), 87% (Core), and 86% (Enhanced) but declined to 50% (Maximal) because of incorporation of genomic profiling. First-course endocrine therapy (ET) is indicated in 80% in all settings. In 2018, treatment need was 1.4 million people for chemotherapy, 183,943 for human epidermal growth factor receptor 2 (HER2) therapies and 1.6 million for ET. The cost per person for chemotherapy or HER2 or immunotherapy increased by 17-fold from Core to Maximal ($1,278-$22,313 Australian dollars [AUD]). The cost of ET per person rose eight-fold from Basic to Maximal ($1,236-$9,809 AUD). If all patients with BC globally were treated with Maximal resources, the need for chemotherapy would decline by 28%, whereas cost of first-course treatment would rise by 1.8-fold ($21-$37 billion AUD) because of more costly therapies. NCCN RSGs for BC could result in chemotherapy overtreatment in Core and Enhanced settings. The absence of chemotherapy in Basic settings should be reconsidered, and future iterations of RSG should perform cross-tumor comparisons to ensure equitable resource distribution and maximize population-level outcomes. Our model is flexible and can be tailored to the costs, population attributes, and resource availability of any institution or country for health-services planning.
Estimation of an optimal external beam radiotherapy utilization rate for head and neck carcinoma.
Publisher: Wiley
Date: 2005
DOI: 10.1002/CNCR.21084
Abstract: Radiotherapy is used commonly in the treatment of patients with head and neck carcinoma. The benchmark radiotherapy utilization rates for head and neck carcinoma largely are unknown. The objective of the current study was to determine the optimal radiotherapy utilization rate for patients with head and neck carcinoma and to compare this optimal rate with actual utilization rates where actual utilization data were available. An optimal radiotherapy utilization tree was constructed that depicted all patients with head and neck carcinoma in whom radiotherapy was indicated according to evidence-based treatment guidelines. The proportions of patients with clinical attributes that indicated possible benefit from radiotherapy were obtained from epidemiological data and were inserted into the utilization tree. The optimal proportion of patients with carcinoma of the head and neck who should receive radiotherapy was calculated by merging the evidence-based recommendations with the epidemiological data in the tree. Optimal rates of radiotherapy utilization were compared with actual rates obtained from population-based studies. Radiotherapy was indicated at some point during their illness in 74% of all patients with head and neck carcinoma. By subsite, the optimal radiotherapy utilization rates were oral cavity, 74% lip, 20% larynx, 100% oropharynx, 100% salivary gland, 87% hypopharynx, 100% nasopharynx, 100% paranasal sinuses, 100% and unknown squamous cell carcinoma of the head and neck, 90%. All treatment recommendations were based on Level III or IV evidence. Assessment of actual radiotherapy utilization rates indicated an increased use of radiotherapy over time for head and neck carcinoma. However, there also were some decreases in the use of radiotherapy for some carcinoma subsites over the past 20 years, despite the lower actual rates compared with the optimal rates. The reasons for these reductions in use were not identified. The actual radiotherapy utilization rate for patients with head and neck carcinoma corresponded reasonably closely to the optimal rate for some populations but also identified some shortfalls for other patient groups. The results of this study provide a way of assessing shortfalls in radiotherapy.
Socio-demographic and other patient characteristics associated with time between colonoscopy and surgery, and choice of treatment centre for colorectal cancer: a retrospective cohort study
Publisher: BMJ
Date: 2012
Estimation of an optimal chemotherapy utilisation rate for primary malignant brain tumours: an evidence-based benchmark for cancer care.
Publisher: Elsevier BV
Date: 02-2011
Assessing the Gap Between Evidence Based Indications for Radiotherapy and Actual Practice in European Countries.
Publisher: Elsevier BV
Date: 11-2015
Radiation therapy: Are we getting value for money?
Publisher: Elsevier BV
Date: 1995
DOI: 10.1016/S0936-6555(05)80535-7
Abstract: The aim of this study was to examine the long term cost effectiveness of radiotherapy (RT) in the treatment of cancer at the Department of Radiation Oncology, Westmead Hospital, from its inception in 1980 to December 1993. A Kaplan-Meier survival curve was constructed for all patients treated by RT during the study period. The area under this curve represented the average survival. The total number of life years was calculated by multiplying the number of patients by the average survival. Costing for one RT treatment field had previously been derived. The cost included capital costs, building costs and overheads as well as labour, goods and services, and operating costs. The cost per field was multiplied by the total number of fields given each year and the yearly total summed to give the total cost. The total cost was ided by the number of life years to give a cost per life year. An overall percentage survival gain was estimated from departmental results and the literature. Cost per life year gained (LYG) was derived by iding the cost per life year by the percentage survival gain. Sensitivity analysis was performed with best- and worst-case survival scenarios, and high and low cost per field estimates. A total of 9868 patients were treated by radiotherapy between January 1980 and December 1993. Median follow-up was 4.2 years. Median survival was 2 years. The 5- and 10-year survival rates were 35% and 22%, respectively. The area under the survival curve (the average survival) was 4.75 years. The total number of life years of survival was thus 4.75 x 9868 = 46,873. In 1993, the cost per field was $71.52 (Australian dollars). The total number of fields treated in the study period was 758,097. Hence, the total cost in 1993 dollars was $54,219,097. The survival gain (excluding skin cancer) with RT was 16.1% and the cost/LYG was $7186. Sensitivity analysis of best and worst case scenarios gave costs/LYG of $3920 and $15,632 respectively. Efficient resource allocation can be aided by examining the relative cost-effectiveness of different prevention and treatment strategies. RT is shown to have a lower cost/LYG than other accepted treatments in current practice. Other major treatment modalities should be subjected to the same scrutiny of cost effectiveness as has been applied to RT.
Dr David Green 22/07/1923 to 10/07/2020
Publisher: Wiley
Date: 05-10-2020
Utilization of radiotherapy for rectal cancer in Greater Western Sydney 1994-2001
Publisher: Wiley
Date: 08-06-2007
A decade of investment in radiotherapy in New South Wales: why does the gap between optimal and actual persist?
Publisher: Wiley
Date: 08-2011
Malignant retroperitoneal paraganglioma: Case report and review of treatment options
Publisher: Wiley
Date: 11-2000
DOI: 10.1046/J.1440-1673.2000.00860.X
Abstract: A case of retroperitoneal paraganglioma metastasizing to bone is presented. This is followed by a literature review of treatment options, including external beam radiotherapy, chemotherapy and 131I-metaiodobenzylguanidine.
The effect of treatment time and treatment interruption on tumour control following radical radiotherapy of laryngeal cancer
Publisher: Elsevier BV
Date: 03-1992
DOI: 10.1016/0167-8140(92)90323-M
Abstract: A significant effect of overall treatment time on local control was found in a retrospective review of 1012 radically irradiated squamous cell carcinomas of the larynx. The actuarial local relapse free rate (LRFR) at 5 years for the whole group was 59%. The effect of treatment time on local control was modelled to the linear-quadratic equation. Using logistic regression analysis treatment time and dose were significant (p = 0.008 and p = 0.04, respectively). When the analysis was adjusted for the influence of stage and laryngeal subsite treatment time remained a significant prognostic factor (p = 0.02). The derived value of gamma/alpha was 0.7 Gy/day and when adjusted for stage and sub-site 0.8 Gy/day. This equates to a dose increment to maintain iso-effective local control of 0.64 Gy/day and 0.73 Gy/day respectively for daily fractions of 2.5 Gy and an assumed alpha/beta for tumour of 25 Gy. To provide an estimate of the clinical impact of treatment interruptions not compensated for by dose escalation a Cox regression was performed. Significant variables were T stage, N stage, sex, total dose and total length of treatment interruption. Using the proportional hazard model it was calculated that each day of treatment interruption resulted in an increase in the hazard of local relapse by 4.8% (p = 0.006). Based on our data it was calculated that this would result in a decrease in local control of 1.4% for each day of uncompensated treatment interruption.
Management of skin toxicity during radiation therapy: A review of the evidence
Publisher: Wiley
Date: 06-2010
DOI: 10.1111/J.1754-9485.2010.02170.X
Abstract: Acute skin toxicity occurs in the majority of the patients undergoing radical radiotherapy. While a variety of topical agents and dressing are used to ameliorate side effects, there is minimal evidence to support their use. The aims of this study were to systematically review evidence on acute skin toxicity management and to assess the current practices in ANZ. A systematic review of the literature was conducted on studies published between 1980 and 2008. A meta-analysis was performed on articles on clinical trials reporting grade II or greater toxicity. Analyses were ided into breast (the most common site) and other sites. A survey of Radiation Oncology departments across ANZ was conducted to identify patterns of practices and compare these with the published evidence. Twenty-nine articles were reviewed. Only seven articles demonstrated statistically significant results for management of side-effects. These were for topical corticosteroids, hyaluronic acid, sucralfate, calendula, Cavilon cream (3M, St Paul, Minnesota, USA) and silver leaf dressing. Meta-analysis demonstrated statistical significance for the prophylactic use of topical agents in the management acute toxicity. The survey of departments had a low response rate but demonstrated variation in skin care practices across ANZ. A considerable number of these practices were based only on anecdotal evidence. Lack of evidence in the literature for the care of radiation skin reactions was associated with variation in practice. Only a limited number of studies have demonstrated a significant benefit of specific topical agents. There is a need for objective and prospective recording of skin toxicity to collect meaningful comparative data on which to base recommendations for practice.
The varying role of the GP in the pathway between colonoscopy and surgery for colorectal cancer: a retrospective cohort study
Publisher: BMJ
Date: 2013
The population benefit of radiotherapy for malignant brain tumors: Local control and survival estimates for guideline-based use
Publisher: Harborside Press, LLC
Date: 09-2016
Abstract: To estimate the population benefit of radiotherapy (RT) for primary malignant brain tumors if evidence-based guidelines were routinely followed. This study investigated 5-year local control (LC) and 2- and 5-year overall survival (OS) benefits. RT benefit was the absolute proportional benefit of RT alone over no RT for radical indications, and over surgery alone for adjuvant indications. Chemoradiotherapy (CRT) benefit was the absolute incremental benefit of concurrent chemotherapy and RT over RT alone. Decision tree models were adapted to define the incidence of each indication. Citation databases were systematically queried for the highest level of evidence defining indication benefits. Meta-analysis was performed if there were multiple sources of the same evidence level, and deterministic and probabilistic sensitivity analysis was also performed. Among all patients with malignant brain tumors, 82% had indications for curative- or adjuvant-intent RT. The magnitude of benefit was based on level I or II evidence in 44% of all patients. A total of 25 relevant studies were used to quantify indication benefits. All RT benefit included in the model was irreplaceable. For malignant brain tumors, the estimated population benefit for RT alone was 9% for 5-year LC (95% CI, 7%-10%), 9% for 2-year OS (95% CI, 8%-11%), and 5% for 5-year OS (95% CI, 4%-5%). The incremental benefit of CRT was 1% for 5-year LC (95% CI, 0%-2%), 7% for 2-year OS (95% CI, 4%-11%), and 3% for 5-year OS (95% CI, 1%-5%). The model was robust in sensitivity analysis. When optimally used, RT provides an important benefit for many patients with malignant brain tumors. The model provided a robust means for estimating the magnitude of this benefit.
Split-course accelerated therapy in head and neck cancer: an analysis of toxicity.
Publisher: Elsevier BV
Date: 06-1995
Estimating the optimal radiotherapy utilization for carcinoma of the central nervous system, thyroid carcinoma, and carcinoma of unknown primary origin from evidence-based clinical guidelines.
Publisher: Wiley
Date: 14-12-2006
DOI: 10.1002/CNCR.21596
The effect of waiting for radiotherapy for grade III/IV gliomas
Publisher: Elsevier BV
Date: 11-2000
DOI: 10.1016/S0167-8140(00)00257-7
Abstract: To determine the effect of waiting time for radiotherapy on the overall survival of patients with high-grade gliomas. We examined records of patients with grade III/IV gliomas who were referred to radiotherapy after surgery or biopsy - ECOG 50 Gy, no interstitial or radiosurgery boost. Waiting time was defined in two ways, time from biopsy to radiotherapy and time from presentation to radiotherapy department to start of radiotherapy. There were 182 patients in the study having a median survival of 8.5 months, with a median follow up of 10.5 months. The group comprised of 63 (35%) grade III and 119 (65%) grade IV gliomas. Median times and ranges from biopsy and presentation to treatment were 26 days (4-78 days) and 15 days (1-62 days), respectively. The median dose was 60 Gy in a median of 30 fractions over a median of 46 days. Tumour progression before and during radiotherapy occurred in seven patients (4%) and 19 patients (11%), respectively. One hundred and seventy-nine patients died of disease. The seven patients whose tumour progressed before radiotherapy were excluded from the analysis of prognostic variables. In a multivariate analysis the variables that were significantly associated with worse survival were older age, reduced dose and prolonged waiting time from presentation. The risk of death increased by 2% for each day of waiting for radiotherapy. The study showed longer waiting time from presentation at radiotherapy department to treatment to be a significant predictor of overall survival for patients with high-grade glioma.
Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial
Publisher: Elsevier BV
Date: 09-2005
The Benefits of Providing External Beam Radiotherapy in Low- and Middle-income Countries.
Publisher: Elsevier BV
Date: 02-2016
The city and the bush: Where is the best place for radiotherapy departments?
Publisher: Wiley
Date: 09-2002
Optimal radiotherapy utilisation rate in developing countries: An IAEA study
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.RADONC.2015.06.012
Abstract: Optimal radiotherapy utilisation rate (RTU) is the proportion of all cancer cases that should receive radiotherapy. Optimal RTU was estimated for 9 Middle Income Countries as part of a larger IAEA project to better understand RTU and stage distribution.
The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population based analysis by the ESTRO-HERO project
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.RADONC.2015.04.021
Abstract: The impact of differences in the distribution of major cancer sites and stages at diagnosis among 4 European countries on the optimal utilization proportion (OUP) of patients who should receive external beam radiotherapy was assessed within the framework of the ESTRO-HERO project. Data from Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) were used. Population based stages at diagnosis from the cancer registries of Belgium, Slovenia, the Greater Poland region of Poland, and The Netherlands were used to assess the OUP for each country. A sensitivity analysis was carried out. The overall OUP by country varied from the lowest of 48.3% in Australia to the highest of 53.4% in Poland among European countries the variation was limited to 3%. Cancer site specific OUPs showed differences according to the variability in stage at diagnosis across countries. The most important impact on the OUP by country was due to changes in relative frequency of tumours rather than stage at diagnosis. This methodology can be adapted using European data, thus facilitating the planning of resources required to cope with the demand for radiotherapy in Europe, taking into account the national variability in cancer incidence.
A Basic Treatment Equivalent for High-Dose-Rate Gynaecological Brachytherapy–A Pilot Study
Publisher: Elsevier BV
Date: 10-2002
Abstract: The aims of this pilot study were to assess the factors that were predictive of high-dose-rate (HDR) gynaecological brachytherapy duration and to model them using previously described Basic Treatment Equivalent (BTE) methodology. This was a prospective single arm pilot study that aimed to enrol 20 patients from two centres. Patient, tumour and treatment factors were recorded. The duration of each component of brachytherapy was recorded. Univariate and bivariate analyses were conducted to identify factors that predicted overall brachytherapy duration. The generalized estimating equations method was used to derive an equation that predicted the duration of brachytherapy. Data were collected for 20 patients who underwent 53 episodes of brachytherapy, either as part of definitive radiotherapy (tandem and ovoids) or post-operatively (vaginal cylinder). Factors that were predictive of overall duration were technique (tandem and ovoids vs vaginal cylinder, P = 0.0007), treatment intention (definitive vs post-operative, P = 0.0001), type of plan (in idual vs standard, P = 0.0001), hospital (1 vs 2, P = 0.0001) and body mass index (P = 0.0001). This study demonstrates the feasibility of examining factors that influence the duration of gynaecological brachytherapy using BTE methodology. To develop a reliable model, a larger multicentre study is needed. Such a model will allow comparisons of efficiency and more accurate assessment of treatment capacity between centres.
Distance learning in the Applied Sciences of Oncology
Publisher: Elsevier BV
Date: 04-2010
DOI: 10.1016/J.RADONC.2010.02.011
Abstract: The major impediment to the expansion of oncology services is a shortage of personnel. To develop a distance learning course for radiation oncology trainees. Under the sponsorship of the Asia Pacific Regional Cooperative Agreement administered by the International Atomic Energy Agency (IAEA), a CD ROM-based Applied Sciences of Oncology (ASOC) distance learning course of 71 modules was created. The course covers communications, critical appraisal, functional anatomy, molecular biology, pathology. The materials include interactive text and illustrations that require students to answer questions before they can progress. The course aims to supplement existing oncology curricula and does not provide a qualification. It aims to assist students in acquiring their own profession's qualification. The course was piloted in seven countries in Asia, Africa and Latin America during 2004. After feedback from the pilot course, a further nine modules were added to cover imaging physics (three modules), informed consent, burnout and coping with death and dying, Economic analysis and cancer care, Nutrition, cachexia and fatigue, radiation-induced second cancers and mathematical tools and background for radiation oncology. The course was widely distributed and can be downloaded from www.iaea.org/Publications/Training/Aso/register.html. ASOC has been downloaded over 1100 times in the first year after it was posted. There is a huge demand for educational materials but the interactive approach is labour-intensive and expensive to compile. The course must be maintained to remain relevant.
Patterns of Radiotherapy Re-Treatment in Patients with Lung Cancer: A Retrospective, Longitudinal Study
Publisher: Elsevier BV
Date: 06-2007
The ideal oncology curriculum for medical students
Publisher: American Society of Clinical Oncology (ASCO)
Date: 20-11-2006
The shortage of medical oncologists: the Australian Medical Oncologist Workforce Study
Publisher: AMPCo
Date: 2012
DOI: 10.5694/MJA11.10363
Abstract: To determine current and projected supply, demand and shortfall of medical oncologists (MOs) and the Australian chemotherapy utilisation rate. A 2009 cross-sectional observational study of Australian adult medical oncology practice work patterns. Electronic or paper self-administered questionnaire. The 2009 and projected (2014) supply, demand and shortfall of full-time equivalent (FTE) MOs, and the chemotherapy utilisation rate. 476 medical oncology positions comprising 234 FTE MOs were identified. Of the 150 medical oncology practices, 117 (78%) were in metropolitan locations and 33 (22%) were in rural locations. The average number of new patients seen per FTE MO was 270 patients (ranging by state from 191 to 343). The demand for FTE MOs was estimated at 326 to 391 in 2009 and 361 to 432 in 2014. The shortfall of FTE MOs was estimated at 92 to 157 in 2009 and 84 to 156 in 2014. The chemotherapy utilisation rate was 19%. The current shortage of MOs is expected to persist in the future. National strategies are needed to increase the capacity of the medical oncology workforce and the chemotherapy utilisation rate.
Estimation of an optimal utilisation rate for palliative radiotherapy in newly diagnosed cancer patients.
Publisher: Elsevier BV
Date: 02-2010
Radiotherapy utilization in New South Wales from 1996 to 1998
Publisher: Wiley
Date: 08-2000
DOI: 10.1046/J.1440-1673.2000.00833.X
Abstract: The purpose of the present study was to examine utilization rates of radiotherapy by newly diagnosed cancer patients in New South Wales (NSW) from 1996 to 1998. The 1989 report of the Australian Health Ministers' Advisory Council (AHMAC) recommended that 50% of all newly diagnosed cancer patients should receive radiotherapy. Previous reports showed that the true rate was between 30 and 36%. In 1991 and 1995 the NSW Department of Health developed strategic plans that were intended to implement the AHMAC recommendation. An analysis was carried out of activity reports of radiation oncology departments in NSW and its component Area Health Services (AHS). All NSW patients newly diagnosed with cancer between 1996 and 1998 and treated by radiotherapy were included in the study. A total of 37% of newly diagnosed cancer patients received radiotherapy in NSW in 1998. This has increased from 30% since 1990-91. Rural AHS in 1998 had an identical average rate of 37% (range: 23-54%) when compared to urban AHS (average: 37% range: 26-49%). Rural AHS have increased utilization from 19% in 1990-91. Area health services with a radiation oncology department had a slightly higher rate of utilization than those AHS without a radiation oncology department (39 and 36%, respectively). The rates of utilization of radiotherapy in NSW in 1998 continued to be well below the benchmark set by AHMAC and varied widely between AHS. Attention to and expansion of services should be focused on both rural and urban areas of need.
Chemotherapy in rectal cancer: variation in utilization and development of an evidence-based benchmark rate of optimal chemotherapy utilization.
Publisher: Elsevier BV
Date: 06-2011
Estimation of the optimal brachytherapy utilization rate in the treatment of gynecological cancers and comparison with patterns of care.
Publisher: Elsevier BV
Date: 02-2013
Estimation of an optimal radiotherapy utilization rate for melanoma: a review of the evidence.
Publisher: Wiley
Date: 15-03-2004
DOI: 10.1002/CNCR.20092
Abstract: Radiotherapy is not used commonly in the treatment of patients with malignant melanoma. The benchmark optimal radiotherapy utilization rates for melanoma are largely unknown, despite the fact that melanoma is a very common cancer. To develop an evidence-based benchmark for the optimal proportion of patients with melanoma who should receive radiotherapy, the authors reviewed major treatment guidelines for melanoma. A radiotherapy decision tree was constructed showing the clinical features of melanoma patients for whom radiotherapy was indicated based on evidence. The proportions of melanoma patients with indications for radiotherapy were obtained from epidemiologic data and were used to calculate the optimal proportion of melanoma patients who should receive radiotherapy. The proportion of patients with melanoma for whom radiotherapy is indicated at some point in their illness, according to the best available evidence, was calculated at 23% of all melanoma patients. The utilization rates of radiotherapy for melanoma recorded in actual practice were 13% in New South Wales, 6% in data from the American College of Surgeons, and 1% according to Surveillance, Epidemiology, and End Results data. Strategies for implementing the evidence-based guidelines are recommended to overcome the shortfall in the use of radiotherapy in the treatment of patients with melanoma.
Advances in cancer management: At what cost to medical student education?
Publisher: Springer Science and Business Media LLC
Date: 07-2009
DOI: 10.1080/08858190902924849
Abstract: Several studies have demonstrated concern over medical student exposure to cancer patients. Aim. To examine this concern and explore possible explanations. Surveys of Australian and New Zealand interns in 1990 and 2001 were compared to surveys of University of Western Australia graduates from 2002-2006. Significant decreases in the number of interns who had examined cancer patients from 1990 to 2006 were evident, despite spending more time in oncology clinics. Advances in patient management has resulted in a shift to ambulatory care reducing patient accessibility. Medical schools must identify means to provide students with adequate patent exposure.
The population benefit of evidence-based radiotherapy: 5-Year local control and overall survival benefits.
Publisher: Elsevier BV
Date: 02-2017
Estimating the number of fractions by tumour site for European countries in 2012 and 2025: An ESTRO-HERO analysis
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.RADONC.2017.11.009
Abstract: The optimal number of radiotherapy fractions is a relevant input for planning resource needs. An estimation of the total number of fractions by country and tumour site is assessed for 2012 and 2025. European cancer incidence data by tumour site and country for 2012 and 2025 were extracted from the GLOBOCAN database. Incidence and stage data were introduced in the Australian Collaboration for Cancer Outcomes Research and Evaluation (CCORE) model, producing an evidence-based proportion of incident cases with an indication for radiotherapy and fractions by indication. An indication was defined as a clinical situation in which radiotherapy was the treatment of choice. The total number of fractions if radiotherapy was given according to guidelines to all patients with an indication in Europe was estimated to be 30 million for 2012 with a forecasted increase of 16.1% by 2025, yet with differences by country and tumour. The average number of fractions per course was 17.6 with a small range of differences following stage at diagnosis. Among the treatments with radical intent the average was 24 fractions, while it decreased to 2.5 among palliative treatments. An increase in the total number of fractions is expected in many European countries in the coming years following the trends in cancer incidence. In planning radiotherapy resources, these increases should be balanced to the evolution towards hypofractionation, along with increased complexity and quality assurance.
Influence of radiotherapy treatment time on control of laryngeal cancer: comparisons between centres in Manchester, UK and Toronto, Canada
Publisher: Elsevier BV
Date: 04-1994
Radiotherapy in Low- and Middle-income Countries. What Can We Do Differently?
Publisher: Elsevier BV
Date: 02-2017
Optimal uptake rates for initial treatments for cervical cancer in concordance with guidelines in Australia and Canada: Results from two large cancer facilities.
Publisher: Elsevier BV
Date: 08-2015
An international review of patient safety measures in radiotherapy practice
Publisher: Elsevier BV
Date: 07-2009
DOI: 10.1016/J.RADONC.2009.03.007
Abstract: Errors from radiotherapy machine or software malfunction usually are well documented as they affect hundreds of patients, whereas random errors affecting in idual patients are more difficult to be discovered and prevented. Although major clinical radiotherapy incidents have been reported, many more have remained unrecognised or have not been reported. The literature in this field is limited as it is mostly published as a result of investigation of major errors. We present a review of radiotherapy incidents internationally with the aim of identifying the domains where most errors occur through extensive review and synthesis of published reports, unpublished 'Grey literature' and departmental incident data. Our review of radiotherapy-related events in the last three decades (1976-2007) identified more than seven thousand (N=7741) incidents and near misses. Three thousand one hundred and twenty-five incidents reported patient harm of variable intensity ranging from underdose increasing the risk of recurrence, to overdose causing toxicity, and even death for 1% (N=38) 4616 events were near misses with no recognisable patient harm. Based on our review, a radiotherapy risk profile has been published by the WHO World Alliance for Patient Safety that highlights the role of communication, training and strict adherence to guidelines rotocols in improving the safety of radiotherapy process.
Estimation of the optimal brachytherapy utilisation rate in the treatment of vaginal cancer and comparison with patterns of care.
Publisher: Wiley
Date: 28-05-2012
Tables of equivalent dose in 2 gy fractions: A simple application of the linear quadratic formula
Publisher: Elsevier BV
Date: 1995
Adjuvant therapy for rectal cancer can no longer be ignored.
Publisher: Wiley
Date: 09-1999
Evidence-based optimal number of radiotherapy fractions for cancer: A useful tool to estimate radiotherapy demand.
Publisher: Elsevier BV
Date: 04-2015
Related Organisations
Royal Australian And New Zealand College Of Radiologists
Location: Australia
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The Australian MRI-Linac Program: Transforming The Science And Clinical Practice Of Cancer Radiotherapy
Start Date: 2017
End Date: 2022
Funder: National Health and Medical Research Council
View Funded ActivityLinkage Infrastructure, Equipment And Facilities - Grant ID: LE120100006
Start Date: 2012
End Date: 12-2017
Amount: $600,000.00
Funder: Australian Research Council
View Funded ActivityLinkage Infrastructure, Equipment And Facilities - Grant ID: LE140100009
Start Date: 05-2014
End Date: 05-2015
Amount: $1,064,000.00
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