Collaborative implementation of stereotactic ablative body radiotherapy: A model for the safe implementation of complex radiotherapy techniques in Australia

Locally advanced head and neck squamous cell carcinomas (HNSCC) are often managed with surgery followed by postoperative radiochemotherapy (RCT). With the general increase in life expectancy, the proportion of elderly patients with HNSCC is expected to grow rapidly. Until now, a deeper understanding of specific management strategies for these patients in clinical routine was lacking. In the present study, we compared elderly patients (≥70 years, n = 52) and younger patients (n = 245) treated with postoperative RCT for HNSCC at our tertiary cancer center. All patients were irradiated with modern radiotherapy techniques (IMRT/VMAT). Patients ≥70 years of age had more comorbidities. Additionally, elderly patients less frequently received concomitant systemic treatment. The rates of mucositis and dermatitis were lower in patients ≥70 years. Elderly patients had significantly worse overall and progression-free survival. Locoregional and distant control were comparable in elderly and younger patients. In conclusion, postoperative RCT is a safe and effective treatment option in patients ≥70 years. In light of comorbidities and poor overall survival rates, benefits and harms of radiotherapy and concomitant systemic treatment should be weighed carefully. When exclusively applying up-to-date radiotherapy techniques with, at the same time, careful use of concomitant systemic therapy, favorable acute toxicity profiles are achieved.

Download Full-text

Vertebral compression fracture rate following stereotactic ablative body radiotherapy for spine oligometastases: a UK experience

Journal of Radiotherapy in Practice ◽

10.1017/s1460396921000224 ◽

2021 ◽

pp. 1-5

Author(s):

Sameed Hussain ◽

Anjali Zarkar ◽

Ahmed Elmodir ◽

Daniel Ford ◽

Sundus Yahya ◽

...

Keyword(s):

Vertebral Compression Fracture ◽

Demographic Data ◽

Spinal Metastases ◽

Compression Fracture ◽

Spinal Instability ◽

Fracture Rate ◽

Strict Adherence ◽

Stereotactic Ablative Body Radiotherapy ◽

Vertebral Bodies ◽

Pre Treatment

Abstract Aim: Stereotactic ablative body radiotherapy (SABR) for spine metastases is associated with a risk of vertebral compression fracture (VCF). The aim of this study was to determine the rate of VCF at one UK institution and evaluate the use of the Spinal Instability Neoplastic Score (SINS) to predict these. Materials and methods: A retrospective analysis of all patients who underwent SABR for spinal metastases between 2014 and 2018 at one UK institution was performed. Basic demographic data were collected, and SINS prior to SABR was calculated. The primary outcome was VCF rate. Secondary outcomes included time to VCF and need for surgical intervention following VCF. Results: A total of 48 oligometastases were treated with a median follow-up of 20·5 months. A maximum of two vertebral bodies were treated. The median baseline SINS was calculated as 3. The median dose was 26 Gy in three fractions. Two patients were reported to have VCF and both were successfully conservatively managed. Findings: SABR for spine oligometastases is being performed safely with low VCF rates which are comparable with those in international publications. This may be as a result of strict adherence to criteria for delivery of SABR with low pre-treatment SINS.

Download Full-text

GCT-61. CORRELATION OF PATTERNS OF DISEASE RECURRENCE WITH RADIOTHERAPY TECHNIQUES AND DOSE IN INTRACRANIAL GERM CELL TUMOURS (icGCT): LESSONS FROM THE UK COHORT OF SIOP GCT96 STUDY

Neuro-Oncology ◽

10.1093/neuonc/noaa222.278 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii340-iii340

Author(s):

Thankamma Ajithkumar ◽

Henry Mandeville ◽

Fernando Carceller ◽

Milind Ronghe ◽

Tina Foord ◽

...

Keyword(s):

Clinical Trials ◽

Disease Recurrence ◽

Germ Cell Tumours ◽

Prospective Data ◽

Data Collection And Analysis ◽

Radiotherapy Techniques ◽

The Uk ◽

A Prospective Study ◽

Patterns Of Recurrence

Abstract BACKGROUND There are global variations in radiotherapy approaches for icGCT. An understanding of patterns of disease recurrence correlated with radiation techniques and doses is important in standardising and improving the quality of radiotherapy using high-precision techniques. METHODS AND RESULTS Data from 20 patients with tumour recurrence after treatment within the SIOP GCT96 study in the UK were analysed. Seven (35%) patients had germinoma and 13 (65%) had non-germinoma. Twelve patients had local recurrence, 5 had metastatic and 3 had local and metastatic disease. Radiotherapy details were retrieved in only 8 patients (40%). Six patients had received focal radiotherapy and two craniospinal radiotherapy. Of the patients who received focal radiotherapy, 4 had recurrence within the radiation portal, one had periventricular recurrence and one had marker-positive recurrence with no radiological lesions. Both patients who received CSI recurred within the CSF space. The main reasons for poor retrieval of treatment details were difficulty in retrieving archived information and that the study was conducted during a period before PACS or electronic radiotherapy records. CONCLUSION This study highlights the importance prospective data collection and analysis to understand the patterns of recurrence in icGCT. Even within a prospective study, radiotherapy techniques varied between centres. There is therefore an urgent need for centralised radiological review and prospective radiotherapy quality assurance measures in future clinical trials.

Download Full-text

Epidemic Response: How to evaluate and respond to evolving and conflicting risk information with a focus on education and clinical environments

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/1071181320641420 ◽

2020 ◽

Vol 64 (1) ◽

pp. 1732-1735

Author(s):

Alison G. Vredenburgh ◽

Rodrigo J. Daly Guris ◽

Kevin G. Welner ◽

Sreekanth R. Cheruku

Keyword(s):

The United States ◽

Face To Face ◽

The Public ◽

Conflicting Information ◽

The Face ◽

Clinical Environments ◽

Face To Face Instruction ◽

Epidemic Response ◽

Collaborative Implementation ◽

Modern Era

By October, we will have learned a great deal about responding to an epidemic or pandemic that has proved to have a level of transmission unprecedented in the modern era. The possible and likely responses include many unknowns. Coordinated and collaborative implementation has been complicated by conflicting information from multiple governments and organizations in several languages. What will we learn about how the United States can improve its ability to respond? How do we develop consistent and accurate warnings and messaging to the public in order to increase compliance regarding a new, and not well understood, epidemic? What factors increase or decrease compliance? How are US education policymakers deciding about face-to-face instruction? How have physicians and hospitals adapted their workflows in the face of uncertainty and supply chain inconsistencies? This panel will include a warnings expert, an expert on education law and policy, and two physicians.

Download Full-text