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Knight G.,Grand River Regional Cancer Center | Earle C.C.,Odette Cancer Center | Cosby R.,McMaster University | Coburn N.,Odette Cancer Center | And 3 more authors.
Gastric Cancer | Year: 2013

Background: Gastric cancer is a global health problem accounting for 10% of all new cancer cases and 12% of all cancer deaths worldwide. Many clinical trials and meta-analyses have explored the value of neoadjuvant or adjuvant chemotherapy and radiation therapy in gastric cancer; however, these studies have produced conflicting results. The purpose of this guidance document was to determine whether patients with resectable gastric cancer should receive neoadjuvant or adjuvant therapy in addition to surgery. Outcomes of interest were overall survival, disease-free survival, and adverse events. Methods: A systematic review was undertaken to inform recommendations regarding neoadjuvant and adjuvant therapy in resectable gastric cancer in Ontario, Canada. MEDLINE and EMBASE databases, as well as American Society of Clinical Oncology (ASCO) annual meeting proceedings and American Society for Therapeutic Radiology and Oncology (ASTRO) proceedings were systematically searched from 2002 to 2010. Oral fluoropyrimidine trials were excluded owing to the unavailability of these agents in North America. Results: Overall, 22 randomized controlled trials (RCTs), 13 meta-analyses, and two secondary analyses were included. The systematic review informed the development of a clinical practice guideline with the following recommendations. Postoperative 5-fluorouracil-based chemoradiotherapy based on the Macdonald approach or perioperative ECF (epirubicin, cisplatin, fluorouracil) chemotherapy based on the Cunningham/MAGIC (Medical Research Council Adjuvant Gastric Infusional Chemotherapy) approach are both acceptable standards of care in North America. Choice of treatment should be made on a case-by-case basis. Adjuvant chemotherapy is a reasonable option for those patients for whom the Macdonald and MAGIC protocols are contraindicated. All patients with resectable gastric cancer should undergo a pretreatment multidisciplinary assessment to determine the best plan of care. Conclusions: Overall survival in patients with resectable gastric cancer is significantly improved with the use of either postoperative chemoradiation (Macdonald approach) or perioperative ECF (MAGIC protocol). © 2012 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.


Chow J.C.L.,University of Toronto | Chow J.C.L.,Ryerson University | Jiang R.,Grand River Regional Cancer Center | Jiang R.,University of Waterloo
Physics in Medicine and Biology | Year: 2012

This study examines variations of bone and mucosal doses with variable soft tissue and bone thicknesses, mimicking the oral or nasal cavity in skin radiation therapy. Monte Carlo simulations (EGSnrc-based codes) using the clinical kilovoltage (kVp) photon and megavoltage (MeV) electron beams, and the pencil-beam algorithm (Pinnacle 3treatment planning system) using the MeV electron beams were performed in dose calculations. Phase-space files for the 105 and 220 kVp beams (Gulmay D3225 x-ray machine), and the 4 and 6MeV electron beams (Varian 21 EX linear accelerator) with a field size of 5cm diameter were generated using the BEAMnrc code, and verified using measurements. Inhomogeneous phantoms containing uniform water, bone and air layers were irradiated by the kVp photon and MeV electron beams. Relative depth, bone and mucosal doses were calculated for the uniform water and bone layers which were varied in thickness in the ranges of 0.52cm and 0.21cm. A uniform water layer of bolus with thickness equal to the depth of maximum dose (d max) of the electron beams (0.7cm for 4 MeV and 1.5cm for 6 MeV) was added on top of the phantom to ensure that the maximum dose was at the phantom surface. From our Monte Carlo results, the 4 and 6 MeV electron beams were found to produce insignificant bone and mucosal dose (<1%), when the uniform water layer at the phantom surface was thicker than 1.5cm. When considering the 0.5cm thin uniform water and bone layers, the 4 MeV electron beam deposited less bone and mucosal dose than the 6 MeV beam. Moreover, it was found that the 105 kVp beam produced more than twice the dose to bone than the 220 kVp beam when the uniform water thickness at the phantom surface was small (0.5cm). However, the difference in bone dose enhancement between the 105 and 220 kVp beams became smaller when the thicknesses of the uniform water and bone layers in the phantom increased. Dose in the second bone layer interfacing with air was found to be higher for the 220 kVp beam than that of the 105 kVp beam, when the bone thickness was 1cm. In this study, dose deviations of bone and mucosal layers of 18% and 17% were found between our results from Monte Carlo simulation and the pencil-beam algorithm, which overestimated the doses. Relative depth, bone and mucosal doses were studied by varying the beam nature, beam energy and thicknesses of the bone and uniform water using an inhomogeneous phantom to model the oral or nasal cavity. While the dose distribution in the pharynx region is unavailable due to the lack of a commercial treatment planning system commissioned for kVp beam planning in skin radiation therapy, our study provided an essential insight into the radiation staff to justify and estimate bone and mucosal dose. © 2012 Institute of Physics and Engineering in Medicine.


Moulton C.-A.,A+ Network | Gu C.-S.,Hamilton Health Sciences | Law C.H.,Sunnybrook Health science Center and Odette Cancer Center | Tandan V.R.,Hamilton Health Sciences | And 13 more authors.
JAMA - Journal of the American Medical Association | Year: 2014

IMPORTANCE: Patients with colorectal cancer with liver metastases undergo hepatic resection with curative intent. Positron emission tomography combined with computed tomography (PET-CT) could help avoid noncurative surgery by identifying patients with occult metastases. OBJECTIVES: To determine the effect of preoperative PET-CT vs no PET-CT (control) on the surgical management of patients with resectable metastases and to investigate the effect of PET-CT on survival and the association between the standardized uptake value (ratio of tissue radioactivity to injected radioactivity adjusted by weight) and survival. DESIGN, SETTING, AND PARTICIPANTS: A randomized trial of patients older than 18 years with colorectal cancer treated by surgery, with resectable metastases based on CT scans of the chest, abdomen, and pelvis within the previous 30 days, and with a clear colonoscopy within the previous 18 months was conducted between 2005 and 2013, involving 21 surgeons at 9 hospitals in Ontario, Canada, with PET-CT scanners at 5 academic institutions. INTERVENTIONS: Patients were randomized using a 2 to 1 ratio to PET-CT or control. MAIN OUTCOMES AND MEASURES: The primary outcomewas a change in surgical management defined as canceled hepatic surgery, more extensive hepatic surgery, or additional organ surgery based on the PET-CT. Survival was a secondary outcome. RESULTS: Of the 263 patients who underwent PET-CT, 21 had a change in surgical management (8.0%; 95% CI, 5.0%-11.9%). Specifically, 7 patients (2.7%) did not undergo laparotomy, 4 (1.5%) had more extensive hepatic surgery, 9 (3.4%) had additional organ surgery (8 of whom had hepatic resection), and the abdominal cavity was opened in 1 patient but hepatic surgery was not performed and the cavity was closed. Liver resection was performed in 91% of patients in the PET-CT group and 92%of the control group. After a median follow-up of 36 months, the estimated mortality rate was 11.13 (95% CI, 8.95-13.68) events/1000 person-months for the PET-CT group and 12.71 (95% CI, 9.40-16.80) events/1000 person-months for the control group. Survival did not differ between the 2 groups (hazard ratio, 0.86 [95% CI, 0.60-1.21]; P = .38). The standardized uptake value was associated with survival (hazard ratio, 1.11 [90% CI, 1.07-1.15] per unit increase; P < .001). The C statistic for the model including the standardized uptake value was 0.62 (95% CI, 0.56-0.68) and without it was 0.50 (95% CI, 0.44-0.56). The difference in C statistics is 0.12 (95% CI, 0.04-0.21). The low C statistic suggests that the standard uptake value is not a strong predictor of overall survival. CONCLUSIONS AND RELEVANCE: Among patients with potentially resectable hepatic metastases of colorectal adenocarcinoma, the use of PET-CT compared with CT alone did not result in frequent change in surgical management. These findings raise questions about the value of PET-CT scans in this setting. Copyright 2014 American Medical Association. All rights reserved.


Gao X.,University of Waterloo | Kang Q.S.,University of Waterloo | Yeow J.T.W.,University of Waterloo | Barnett R.,University of Waterloo | Barnett R.,Grand River Regional Cancer Center
Nanotechnology | Year: 2010

The extraordinary physical properties of quantum dot (QD) materials such as high radiation sensitivity and good radiation resistivity indicate their potential for use in the fabrication of radiation sensors. This paper reports the design and fabrication of two kinds of radiation sensors based on ZnO and CdTe QDs. Both sensors are characterized using a Gulmay Medical D3000DXR unit for superficial x-ray irradiation with source photon energies that range from 36.9 to 64.9keV. The QD radiation sensors exhibit excellent linearity with respect to different photon energy doses, radiation source to device surface distances, and field sizes. The effects of the electrode separation and the area density of the QD layer are also investigated. All sensors characterized show an outstanding repeatability under photon irradiation, with a signal variation less than 1%. © 2010 IOP Publishing Ltd.


Crump M.,University of Toronto | Herst J.,Northeastern Ontario Regional Cancer Center | Baldassarre F.,McMaster University | Sussman J.,Juravinski Cancer Center | And 3 more authors.
Blood | Year: 2015

Case 1. Anne is a 23-year-old nursing student who presents with bilateral cervical, left supraclavicular, and left axillary adenopathy. Computed tomography (CT) scan of the thorax reveals a 6-cm anterior mediastinal mass. Biopsy of the left supraclavicular lymph node reveals classical nodular sclerosis Hodgkin lymphoma. A complete blood count is normal and the erythrocyte sedimentation rate (ESR) is 25 mm/h. CT scan of the abdomen/pelvis show normal liver and spleen and no evidence of abdominal lymphadenopathy. You are asked to advise her on the role of radiation therapy in her treatment plan. Case 2. John is a 48-year-old teacher who presents with chest pain following a hockey game. A chest radiograph reveals mediastinal widening, and a contrast-enhancedCT scan shows a 7.5-cm anterior mediastinalmass, with enlarged paratracheal and right hilar lymph nodes. Image-guided core biopsy of the mediastinal mass is diagnostic for classical Hodgkin lymphoma. The hemoglobin is 130 g/L, white blood cell count and platelets are normal, and the ESR is 35 mm/h. John asks you about the role of radiotherapy in the management of his lymphoma. © 2015 by The American Society of Hematology.

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