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Spigelman A.D.,University of New South Wales | Pascoe S.W.,University of New South Wales | Harris M.F.,University of New South Wales | Beilby J.J.,University of Adelaide | And 4 more authors.
Australian Health Review | Year: 2013

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. © 2013 AHHA.

Batumalai V.,Liverpool Cancer Therapy Center and Ingham Institute | Batumalai V.,University of New South Wales | Quinn A.,Liverpool Cancer Therapy Center and Ingham Institute | Quinn A.,University of Wollongong | And 10 more authors.
Journal of Medical Radiation Sciences | Year: 2015

Introduction: Correct target positioning is crucial for accurate dose delivery in breast radiotherapy resulting in utilisation of daily imaging. However, the radiation dose from daily imaging is associated with increased probability of secondary induced cancer. The aim of this study was to quantify doses associated with three imaging modalities and investigate the correlation of dose and varying breast size in breast radiotherapy. Methods: Planning computed tomography (CT) data sets of 30 breast cancer patients were utilised to simulate the dose received by various organs from a megavoltage computed tomography (MV-CT), megavoltage electronic portal image (MV-EPI) and megavoltage cone-beam computed tomography (MV-CBCT). The mean dose to organs adjacent to the target volume (contralateral breast, lungs, spinal cord and heart) were analysed. Pearson correlation analysis was performed to determine the relationship between imaging dose and primary breast volume and the lifetime attributable risk (LAR) of induced secondary cancer was calculated for the contralateral breast. Results: The highest contralateral breast mean dose was from the MV-CBCT (1.79 Gy), followed by MV-EPI (0.22 Gy) and MV-CT (0.11 Gy). A similar trend was found for all organs at risk (OAR) analysed. The primary breast volume inversely correlated with the contralateral breast dose for all three imaging modalities. As the primary breast volume increases, the likelihood of a patient developing a radiation-induced secondary cancer to the contralateral breast decreases. MV-CBCT showed a stronger relationship between breast size and LAR of developing a radiation-induced contralateral breast cancer in comparison with the MV-CT and MV-EPI. Conclusions: For breast patients, imaging dose to OAR depends on imaging modality and treated breast size. When considering the use of imaging during breast radiotherapy, the patient's breast size and contralateral breast dose should be taken into account. © 2015 The Authors.

Jameson M.G.,Liverpool and Macarthur Cancer Therapy Centres | Jameson M.G.,University of Wollongong | Jameson M.G.,Ingham Institute | De Leon J.,Liverpool and Macarthur Cancer Therapy Centres | And 18 more authors.
Radiotherapy and Oncology | Year: 2013

Purpose To perform a comparative study assessing potential benefits of endorectal-balloons (ERB) in post-prostatectomy patients. Method and materials Ten retrospective post-prostatectomy patients treated without ERB and ten prospective patients treated with the ERB in situ were recruited. All patients received IMRT and IGRT using kilovoltage cone-beam computed tomography (kVCBCT). kVCBCT datasets were registered to the planning dataset, recontoured and the original plan recalculated on the kVCBCTs to recreate anatomical conditions during treatment. The imaging, structure and dose data were imported into in-house software for the assessment of geometric variation and cumulative equivalent uniform dose (EUD) in the two groups. Results The difference in location (ΔCOV) for the bladder between planning and each CBCT was similar for each group. The range of mean ΔCOV for the rectum was 0.15-0.58 cm and 0.15-0.59 cm for the non-ERB and ERB groups. For superior-CTV and inferior-CTV the difference between planned and delivered D95% (mean ± SD) for the non-ERB group was 2.1 ± 6.0 Gy and -0.04 ± 0.20 Gy. While for the ERB group the difference in D95% was 8.7 ± 12.6 Gy and 0.003 ± 0.104 Gy. Conclusions The use of ERBs in the post-prostatectomy setting did improve geometric reproducibility of the target and surrounding normal tissues, however no improvement in dosimetric stability was observed for the margins employed. © 2013 Elsevier Ireland Ltd. All rights reserved.

Quinn A.,University of Wollongong | Holloway L.,University of Wollongong | Holloway L.,University of Sydney | Koh E.-S.,Liverpool and Macarthur Cancer Therapy Centres | And 9 more authors.
Practical Radiation Oncology | Year: 2013

Purpose: To measure and compare organ doses from a standard tangential breast radiation therapy treatment (50 Gy delivered in 25 fractions) and a megavoltage cone-beam computed tomography (MV-CBCT), taken for weekly image verification, and assess the risk of radiation-induced contralateral breast cancer. Methods and Materials: Organ doses were measured with thermoluminescent dosimeters placed strategically within a female anthropomorphic phantom. The risk of radiation-induced secondary cancer of the contralateral breast was estimated from these values using excess absolute risk and excess relative risk models. Results: The effective dose from a MV-CBCT (8-monitor units) was 35.9 ± 0.2 mSv. Weekly MV-CBCT imaging verification contributes 0.5% and 17% to the total ipsilateral and contralateral breast dose, respectively. For a woman irradiated at age 50 years, the 10-year postirradiation excess relative risk was estimated to be 0.8 and 0.9 for treatment alone and treatment plus weekly MV-CBCT imaging, respectively. The 10-year postirradiation excess absolute risk was estimated to be 4.7 and 5.6 per 10,000 women-years. Conclusions: The increased dose and consequent radiation-induced second cancer risk as calculated by this study introduced by the imaging verification protocols utilizing MV-CBCT in breast radiation therapy must be weighed against the benefits of more accurate treatment. As additional image verification becomes more common, it is important that data be collected in regard to long-term malignancy risk. © 2013 American Society for Radiation Oncology.

Goldsbury D.,Cancer Research Division | Harris M.,University of New South Wales | Pascoe S.,University of New South Wales | Barton M.,Collaboration for Cancer Outcomes Research and Evaluation | And 6 more authors.
BMJ Open | Year: 2013

Objectives: To describe general practitioner (GP) involvement in the treatment referral pathway for colorectal cancer (CRC) patients. Design: A retrospective cohort analysis of linked data. Setting: A population-based sample of CRC patients diagnosed from August 2004 to December 2007 in New South Wales, Australia, using the 45 and Up Study, cancer registry diagnosis records, inpatient hospital records and Medicare claims records. Participants: 407 CRC patients who had a colonoscopy followed by surgery. Primary outcome measures: Patterns of GP consultations between colonoscopy and surgery (ie, between diagnosis and treatment). We investigated whether consulting a GP presurgery was associated with time to surgery, postsurgical GP consultations or rectal cancer cases having surgery in a centre with radiotherapy facilities. Results: Of the 407 patients, 43% (n=175) had at least one GP consultation between colonoscopy and surgery. The median time from colonoscopy to surgery was 27 days for those with an intervening GP consultation and 15 days for those without the consultation. 55% (n=223) had a GP consultation up to 30 days postsurgery; it was more common in cases of patients who consulted a GP presurgery than for those who did not (65% and 47%, respectively, adjusted OR 2.71, 95% CI 1.50 to 4.89, p=0.001). Of the 142 rectal cancer cases, 23% (n=33) had their surgery in a centre with radiotherapy facilities, with no difference between those who did and did not consult a GP presurgery (21% and 25% respectively, adjusted OR 0.84, 95% CI 0.27 to 2.63, p=0.76). Conclusions: Consulting a GP between colonoscopy and surgery was associated with a longer interval between diagnosis and treatment, and with further GP consultations postsurgery, but for rectal cancer cases it was not associated with treatment in a centre with radiotherapy facilities. GPs might require a more defined and systematic approach to CRC management.

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