North Coast Cancer Institute

Coffs Harbour, Australia

North Coast Cancer Institute

Coffs Harbour, Australia

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McKay M.,University of Sydney | Coad R.,North Coast Cancer Institute
Annals of Translational Medicine | Year: 2017

We describe a 54-year-old man with breast cancer and a BRCA2 mutation who was also found to have bilateral supernumerary nipples. His sister, also with a BRCA2 mutation, was diagnosed with breast cancer in her late forties; she also had bilateral supernumerary nipples. We address the significance of breast cancer arising in breast tissue underlying supernumerary nipples; the known association between supernumerary nipples and genitourinary malignancies/malformations and the possible link between BRCA2 and supernumerary nipple development. We believe that this is the first described case of the latter. We then outline an approach to further management for supernumerary nipple cases. © Annals of Translational Medicine.

News Article | May 5, 2017

A man has dreamed in colour for the first time after undergoing radiotherapy to treat a tumour on his eye. The 59-year-old Australian previously dreamed exclusively in black and white. But when he received radiation therapy to the front and side of his head for four weeks, he began dreaming in vivid colour. Some of these dreams involved mentally flicking through coloured images of former girlfriends, cars, and fish he had caught. In one, he saw colourful algebraic symbols emerge from a blackboard and whizz towards him. Why he had previously dreamed only in black and white is unclear, but it may be because of the type of television he grew up with. People who saw only black-and-white film and television as children seem more likely to dream in greyscale throughout their lives. Australia didn’t fully convert to colour television until 1975. His switch to colour dreaming may have been sparked by the radiation’s effect on electrical brain activity, says radiation oncologist Michael McKay, who treated the man at the North Coast Cancer Institute in New South Wales. There is some evidence that radiation can affect electrical brain activity. People exposed to radiation during the Chernobyl disaster, for instance, showed unusual electrical brain activity on electroencephalography (EEG) tests. Over a third also reported abnormal dreams. Abnormal dreams have not previously been associated with radiotherapy treatment of the head, but this may be due to lack of reporting, says McKay. In this case, the man had an easily-curable eye tumour, whereas many others who receive radiation to the head have terminal brain tumours. This could make them less likely to notice or remark on strange dreams. The Australian man did not have EEG tests, so the effect of radiotherapy on his brain remains a mystery. “But if the radiation was affecting [EEG-detected] activity, then that could quite readily change the dream experience,” says Simon Cropper at the University of Melbourne. The man’s dreams may have become more colourful in response to altered brain activity because colour is an easily-modifiable component of perception, says Cropper. For example, hallucinogens – which also modify the patterns seen on an EEG – almost always heighten the experience of colour. But there could be a more banal explanation, says Robert Stickgold at Harvard University. The radiation may simply have caused the man to wake up more frequently in different stages of sleep, increasing the chance of noticing and remembering coloured dreams, he says. The man’s tumour was cured by radiotherapy and he reverted to black-and-white dreaming a few days after finishing treatment. McKay hopes other people will come forward if they have had similar dream-altering experiences during radiotherapy, so the phenomenon can be studied further.

Tahir A.R.M.,Peter MacCallum Cancer Center | Tahir A.R.M.,North Coast Cancer Institute | Westhuyzen J.,North Coast Cancer Institute | Dass J.,Townsville Hospital | And 6 more authors.
Asia-Pacific Journal of Clinical Oncology | Year: 2015

Aim: Chronic radiation injuries, although uncommon, are associated with poor quality of life in oncology patients. The present study assesses the efficacy and safety of hyperbaric oxygen therapy in the management of chronic radiation-induced tissue injuries. Methods: A retrospective analysis was performed in 276 consecutive patients treated with hyperbaric oxygen therapy for chronic radiation-induced tissue injuries at the Hyperbaric Medicine Unit, Townsville, Queensland, between March 1995 and March 2008. Of these patients, 189 (68%) had complete follow-up data and were assessed. Results: A total of 265 events of chronic radiation tissue injury were experienced by the 189 patients treated with hyperbaric oxygen therapy. Osteoradionecrosis prophylaxis due to radiation-induced dental disease had an overall response rate of 96% (P=0.00003; Wilcoxon matched-pairs signed-rank test). The overall response rates for established osteoradionecrosis of mandible, soft tissue necrosis of head and neck, and xerostomia were 86% (P=0.00001), 85% (P=0.002) and 64% (P=0.0001), respectively. The overall response rates for soft tissue necrosis at other sites, chronic radiation proctitis and hemorrhagic cystitis were 84% (P=0.03), 95% (P=0.0001) and 85% (P=0.03), respectively. The total complication rate after hyperbaric oxygen therapy was 15.9%, comprising reversible ear barotrauma (10.6%), reversible ocular barotrauma (4.2%), dental complications (0.5%) and myocardial infarction (0.5%). Conclusion: Our study demonstrates that hyperbaric oxygen therapy can be effectively used in a variety of chronic radiation-induced tissue injuries; its favorable risk profile suggests it should be considered for patients with radiation-induced tissue injuries. © 2014 Wiley Publishing Asia Pty Ltd.

Wilcox S.W.,North Coast Cancer Institute | Aherne N.J.,North Coast Cancer Institute | McLachlan C.S.,University of New South Wales | McKay M.J.,North Coast Cancer Institute | And 3 more authors.
Journal of Medical Imaging and Radiation Oncology | Year: 2015

Introduction We compare the results of modern external-beam radiotherapy (EBRT), using combined androgen deprivation and dose-escalated intensity-modulated radiotherapy with MRI-CT fusion and daily image guidance with fiducial markers (DE-IG-IMRT), with recently published Australian series of brachytherapy and surgery. Methods Five-year actuarial biochemical disease-free survival (bDFS), metastasis-free survival (MFS) and prostate cancer-specific survival (PCaSS) were calculated for 675 patients treated with DE-IG-IMRT and androgen deprivation therapy (ADT). Patients had intermediate-risk (IR) and high-risk (HR) disease. A search was conducted identifying Australian reports from 2005 onwards of IR and HR patients treated with surgery or brachytherapy, reporting actuarial outcomes at 3 years or later. Results With a median follow-up of 59 months, our 5-year bDFS was 93.3% overall: 95.5% for IR and 91.3% for HR disease. MFS was 96.9% overall (99.0% IR, 94.9% HR), and PCaSS was 98.8% overall (100% IR, 97.7% HR). Prevalence of Grade 2 genitourinary and gastrointestinal toxicity at 5 years was 1.3% and 1.6%, with 0.3% Grade 3 genitourinary toxicity and no Grade 3 gastrointestinal toxicity. Eight reports of brachytherapy and surgery were identified. The HDR brachytherapy series' median 5-year bDFS was 82.5%, MFS 90.0% and PCaSS 97.9%. One surgical series reported 5-year bDFS of 65.5% for HR patients. One LDR series reported 5-year bDFS of 85% for IR patients. Conclusions Modern EBRT is at least as effective as modern Australian surgical and brachytherapy techniques. All patients considering treatment for localised prostate cancer should be referred to a radiation oncologist to discuss EBRT as an equivalent option. © 2015 The Royal Australian and New Zealand College of Radiologists.

Shakespeare T.P.,North Coast Cancer Institute | Shakespeare T.P.,University of New South Wales
Radiation Oncology | Year: 2015

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.

Steer A.N.,North Coast Cancer Institute | Aherne N.J.,North Coast Cancer Institute | Aherne N.J.,University of New South Wales | Gorzynska K.,North Coast Cancer Institute | And 5 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2013

Purpose: Decision regret (DR) is a negative emotion associated with medical treatment decisions, and it is an important patient-centered outcome after therapy for localized prostate cancer. DR has been found to occur in up to 53% of patients treated for localized prostate cancer, and it may vary depending on treatment modality. DR after modern dose-escalated radiation therapy (DE-RT) has not been investigated previously, to our knowledge. Our primary aim was to evaluate DR in a cohort of patients treated with DE-RT. Methods and Materials: We surveyed 257 consecutive patients with localized prostate cancer who had previously received DE-RT, by means of a validated questionnaire. Results: There were 220 responses (85.6% response rate). Image-guided intensity modulated radiation therapy was given in 85.0% of patients and 3-dimensional conformal radiation therapy in 15.0%. Doses received included 73.8 Gy (34.5% patients), 74 Gy (53.6%), and 76 Gy (10.9%). Neoadjuvant androgen deprivation (AD) was given in 51.8% of patients and both neoadjuvant and adjuvant AD in 34.5%. The median follow-up time was 23 months (range, 12-67 months). In all, 3.8% of patients expressed DR for their choice of treatment. When asked whether they would choose DE-RT or AD again, only 0.5% probably or definitely would not choose DE-RT again, compared with 8.4% for AD (P<.01). Conclusion: Few patients treated with modern DE-RT express DR, with regret appearing to be lower than in previously published reports of patients treated with radical prostatectomy or older radiation therapy techniques. Patients experienced more regret with the AD component of treatment than with the radiation therapy component, with implications for informed consent. Further research should investigate regret associated with individual components of modern therapy, including AD, radiation therapy and surgery. © 2013 Elsevier Inc.

Min M.,North Coast Cancer Institute | Chua B.,North Coast Cancer Institute | Guttner Y.,Coffs Harbour Hospital | Abraham N.,Coffs Harbour Hospital | And 4 more authors.
Radiotherapy and Oncology | Year: 2014

Background Pelvic radiation disease (PRD) also widely known as "radiation proctopathy" is a well recognised late side-effect following conventional prostate radiotherapy. However, endoscopic evaluation and/or specialist referral for new or persistent post-prostate radiotherapy bowel symptoms is not routine and serious diagnoses may potentially be missed. Here we report a policy of endoscopic evaluation of bowel symptoms persisting >90 days post radiotherapy for prostate cancer. Methods and materials A consecutive series of 102 patients who had radical prostate intensity-modulated radiotherapy (IMRT)/image-guided radiotherapy (IGRT) and who had new or ongoing bowel symptoms or positive faecal occult blood tests (FOBT) on follow up visits more than three months after treatment, were referred for endoscopic examination. All but one (99%) had full colonoscopic investigation. Results Endoscopic findings included gastric/colonic/rectal polyps (56%), diverticular disease (49%), haemorrhoids (38%), radiation proctopathy (29%), gastritis/oesophagitis (8%) and rarer diagnoses, including bowel cancer which was found in 3%. Only four patients (4%) had radiation proctopathy without associated pathology and 65 patients (63%) had more than one diagnosis. If flexible sigmoidoscopy alone were used, 36.6% of patients and 46.6% patients with polyp(s) would have had their diagnoses missed. Conclusions Our study has shown that bowel symptoms following prostate IMRT/IGRT are due to numerous diagnoses other than PRD, including malignancy. Routine referral pathways should be developed for endoscopic evaluation/specialist review for patients with new or persistent bowel symptoms (or positive FOBT) following prostate radiotherapy. This recommendation should be considered for incorporation into national guidelines. © 2013 Elsevier Ireland Ltd. All rights reserved.

McKay M.J.,North Coast Cancer Institute | McKay M.J.,University of Sydney
Australian Family Physician | Year: 2014

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.

Norvill C.,North Coast Cancer Institute | Jenetsky G.,North Coast Cancer Institute
Australasian Physical and Engineering Sciences in Medicine | Year: 2016

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

Tyler M.K.,North Coast Cancer Institute | Tyler M.K.,Shoalhaven Cancer Care Center
Journal of Applied Clinical Medical Physics | Year: 2016

This study quantified the interplay and gradient effects on GTV dose coverage for 3D CRT, dMLC IMRT, and VMAT SABR treatments for target amplitudes of 5-30 mm using 3DVH v3.1 software incorporating 4D Respiratory MotionSim (4D RMS) module. For clinically relevant motion periods (5 s), the interplay effect was small, with deviations in the minimum dose covering the target volume (D99%) of less than ± 2.5% for target amplitudes up to 30 mm. Increasing the period to 60 s resulted in interplay effects of up to ± 15.0% on target D99% dose coverage. The gradient effect introduced by target motion resulted in deviations of up to ± 3.5% in D99% target dose coverage. VMAT treatments showed the largest deviation in dose metrics, which was attributed to the long delivery times in comparison to dMLC IMRT. Retrospective patient analysis indicated minimal interplay and gradient effects for patients treated with dMLC IMRT at the NCCI.

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