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Coffs Harbour, Australia

McKay M.J.,University of Sydney | McKay M.J.,North Coast Cancer Institute | McKay C.,Royal Newcastle Hospital
Australasian Journal of Dermatology

Simple clinical observations can give useful insights into biological processes in humans. Here we present a temporal series of pictures addressing the tissue response of a basal cell carcinoma to radiotherapy, where re-epithelialisation (RE) after radiotherapy appeared to occur by clonal regrowth, rather than the usually described sheet-like RE. © 2015 The Australasian College of Dermatologists. Source

McKay M.J.,North Coast Cancer Institute | McKay M.J.,University of Sydney
Australian Family Physician

Background: We present the case of an elderly man who was referred with a neglected, highly advanced skin squamous cell carcinoma on his posterior chest wall. The cancer was causing difficult-to-control pain and malodour. Objective: The treatment and outcomes of local hypofractionated (6 Gray fractions) radiotherapeutic management of an advanced lesion are shown. Discussion: The treatment could not, for reasons of the radiation tolerance of the lungs, cover the entirety of the bulky cancer; ie. the radiotherapy was a balance between not exceeding lung tolerance and achieving adequate tumour coverage. Keeping the treatment simple was also important, as the aim of therapy was palliation, and the patient's ability to lie reproducibly still was compromised. Hence, he was treated with large, weekly fractions - such treatment is useful in the palliative setting, as it minimises patient discomfort and inconvenience. The treatment achieved significant tumour regression, complete relief of pain, arm lymphoedema and a large reduction in malodour. Source

Shakespeare T.P.,North Coast Cancer Institute | Shakespeare T.P.,University of New South Wales
Radiation Oncology

Background: Positron emission tomography (PET) imaging is routinely used in many cancer types, although is not yet a standard modality for prostate carcinoma. Prostate-specific membrane antigen (PSMA) PET is a promising new modality for staging prostate cancer, with recent studies showing potential advantages over traditional computed tomography (CT), magnetic resonance imaging (MRI) and nuclear medicine bone scan imaging. However, the impact of PSMA PET on the decision-making of radiation oncologists and outcomes after radiotherapy is yet to be determined. Our aim was to determine the impact of PSMA PET on a radiation oncologist's clinical practice. Findings: Patients in a radiation oncology clinic who underwent PSMA PET were prospectively recorded in an electronic oncology record. Patient demographics, outcomes of imaging, and impact on decision-making were evaluated. Fifty-four patients underwent PSMA PET between January and May 2015. The major reasons for undergoing PET included staging before definitive (14.8 %) or post-prostatectomy (33.3 %) radiotherapy, and investigation of PSA failures following definitive (16.7 %) or post-prostatectomy (33.3 %) radiotherapy. In 46.3 % of patients PSMA was positive after negative traditional imaging, in 9.3 % PSMA was positive after equivocal imaging, and in 13.0 % PSMA was negative after equivocal imaging. PSMA PET changed radiotherapy management in 46.3 % of cases, and hormone therapy in 33.3 % of patients, with an overall change in decision-making in 53.7 % of patients. Conclusions: PSMA PET has the potential to significantly alter the decision-making of radiation oncologists, and may become a valuable imaging tool in the future. © 2015 Shakespeare. Source

Forrester H.B.,Monash Institute of Medical Research | Ivashkevich A.,Monash Institute of Medical Research | McKay M.J.,North Coast Cancer Institute | Leong T.,Peter MacCallum Cancer Center | And 3 more authors.

Follistatin is a potent regulator of the inflammatory response and binds to and inhibits activin A action. Activin A is a member of the TGFβ protein superfamily which has regulatory roles in the inflammatory response and in the fibrotic process. Fibrosis can occur following cell injury and cell death induced by agents such as ionizing radiation (IR). IR is used to treat cancer and marked fibrotic response is a normal tissue (non-tumour) consequence in a fraction of patients under the current dose regimes. The discovery and development of a therapeutic to abate fibrosis in these radiosensitive patients would be a major advance for cancer radiotherapy. Likewise, prediction of which patients are susceptible to fibrosis would enable individualization of treatment and provide an opportunity for pre-emptive fibrosis control and better tumour treatment outcomes. The levels of activin A and follistatin were measured in fibroblasts derived from patients who developed severe radiation-induced fibrosis following radiotherapy and compared to fibroblasts from patients who did not. Both follistatin and activin A gene expression levels were increased following IR and the follistatin gene expression level was lower in the fibroblasts from fibrosis patients compared to controls at both basal levels and after IR. The major follistatin transcript variants were found to have a similar response to IR and both were reduced in fibrosis patients. Levels of follistatin and activin A secreted in the fibroblast culture medium also increased in response to IR and the relative follistatin protein levels were significantly lower in the samples derived from fibrosis patients. The decrease in the follistatin levels can lead to an increased bioactivity of activin A and hence may provide a useful measurement to identify patients at risk of a severe fibrotic response to IR. Additionally, follistatin, by its ability to neutralise the actions of activin A may be of value as an anti-fibrotic for radiation induced fibrosis. © 2013 Forrester et al. Source

Norvill C.,North Coast Cancer Institute | Jenetsky G.,North Coast Cancer Institute
Australasian Physical and Engineering Sciences in Medicine

This planning study investigates the clinical impact of multi-leaf collimator (MLC) calibration errors on three common treatment sites; head and neck (H&N), prostate and stereotactic body radiotherapy (SBRT) for lung. All plans used using either volumetric modulated adaptive therapy or dynamic MLC techniques. Five patient plans were retrospectively selected from each treatment site, and MLC errors intentionally introduced. MLC errors of 0.7, 0.4 and 0.2 mm were sufficient to cause major violations in the PTV planning criteria for the H&N, prostate and SBRT lung plans. Mean PTV dose followed a linear trend with MLC error, increasing at rates of 3.2–5.9 % per millimeter depending on treatment site. The results indicate that an MLC quality assurance program that provides sub-millimeter accuracy is an important component of intensity modulated radiotherapy delivery techniques. © 2016 Australasian College of Physical Scientists and Engineers in Medicine Source

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