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Hayden A.J.,Westmead Cancer Care Center | Martin J.M.,Radiation Oncology Queensland | Kneebone A.B.,Northern Sydney Cancer Center | Lehman M.,Princess Alexandra Hospital | And 4 more authors.
Journal of Medical Imaging and Radiation Oncology | Year: 2010

Summary: External beam radiotherapy for prostate cancer has undergone substantial technological and clinical advances in the recent years. The Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group undertook a process to develop consensus clinical practice guidelines for external beam radiotherapy for prostate carcinoma delivered with curative intent, aiming to provide guidance for clinicians on the appropriate integration of clinical evidence and newer technologies. Draft guidelines were presented and discussed at a consensus workshop in May 2009 attended by radiation oncologists, radiation therapists and medical physicists. Amended guidelines were distributed to radiation oncologists in Australia, New Zealand and Singapore for comment, and modifications were incorporated where appropriate. Evidence based recommendations for risk stratification, the role of image-guided and intensity-modulated radiation therapy, prescribed dose, simulation and treatment planning, the role and duration of neo-adjuvant/adjuvant androgen deprivation therapy and outcome reporting are presented. Central to the guidelines is the recommendation that image-guided radiation therapy should be used when definitive external beam radiotherapy for prostate cancer is prescribed. The consensus guidelines provide a co-operatively developed, evidence-based framework for contemporary treatment of prostate cancer with external beam radiotherapy. © 2010 The Authors. Journal of Medical Imaging and Radiation Oncology © 2010 The Royal Australian and New Zealand College of Radiologists.


Finnigan R.,Radiation Oncology Queensland | Burmeister B.,University of Queensland | Barry T.,Princess Alexandra Hospital | Jones K.,University of Queensland | And 4 more authors.
Journal of Clinical Neuroscience | Year: 2015

We report technique and early clinical results of stereotactic body radiotherapy (SBRT) from Princess Alexandra Hospital. SBRT involves the precise delivery of highly conformal and image-guided external beam radiotherapy with high doses per fraction. It is increasingly being applied in management of spinal tumours. Thirty-six courses of spine SBRT in 34 patients were delivered between May 2010 and December 2013. Mean patient age was 58 years. Treatment was predominantly for metastatic disease, applied in de novo (n = 22), retreatment (n = 14) and postoperative (n = 8) settings. Prescribed doses included 18-30 Gy in 1-5 fractions. SBRT technique evolved during the study period, resulting in a relative dose escalation. No severe acute toxicities were observed. At median follow-up of 7.4 months (range: 1.7-22.2), no late radiation myelopathy was observed. Risk of new/worsening vertebral compression fractures was 22% (n = 8) and was significantly associated with increasing Spinal Instability Neoplastic Scores (p = 0.0002). In-field control was 86% with relapse occurring at a median interval of 2.8 months (range: 1.9-4.7). Thirteen patients (36%) died and median overall survival has not been reached. SBRT is an evolving technology with promising early efficacy and safety results. The outcomes of this series are comparable with international literature, and await longer follow-up. © 2015 Elsevier Ltd. All rights reserved.


Biggs S.,Riverina Cancer Care Center | Sobolewski M.,Riverina Cancer Care Center | Murry R.,Radiation Oncology Queensland | Kenny J.,Epworth Radiation Oncology
Physica Medica | Year: 2015

There are many methods available to predict electron output factors; however, many centres still measure the factors for each irregular electron field. Creating an electron output factor prediction model that approaches measurement accuracy - but uses already available data and is simple to implement - would be advantageous in the clinical setting. This work presents an empirical spline model for output factor prediction that requires only the measured factors for arbitrary insert shapes. Equivalent ellipses of the insert shapes are determined and then parameterised by width and ratio of perimeter to area. This takes into account changes in lateral scatter, bremsstrahlung produced in the insert material, and scatter from the edge of the insert. Agreement between prediction and measurement for the 12 MeV validation data had an uncertainty of 0.4% (1SD). The maximum recorded deviation between measurement and prediction over the range of energies was 1.0%. The validation methodology showed that one may expect an approximate uncertainty of 0.5% (1SD) when as little as eight data points are used. The level of accuracy combined with the ease with which this model can be generated demonstrates its suitability for clinical use. Implementation of this method is freely available for download at https://github.com/SimonBiggs/electronfactors. © 2015 Associazione Italiana di Fisica Medica.


Ratnayake G.,Royal Brisbane and Womens Hospital | Martin J.,University of Newcastle | Plank A.,Oncology Research Australia | Wong W.,Radiation Oncology Queensland
Journal of Medical Imaging and Radiation Oncology | Year: 2014

Introduction Both intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) have been shown to independently reduce late rectal toxicity for men with prostate cancer (PC) treated with radiotherapy. We explore whether IMRT offers further reductions in late rectal toxicity for men already being managed with IGRT and compare this with more gradual changes over time. Methods Between 2007 and 2009, 103 patients with PC were treated with three-dimensional conformal radiotherapy (3D-CRT n = 52) or IMRT (n = 51) with doses of 74-78 Gy at 2 Gy per fraction. All men had daily IGRT using intra-prostatic gold fiducials. The primary endpoint was incidence of grade ≥2 late rectal toxicity as graded by the Radiation Therapy Oncology Group scale. Results The relative risk of late grade ≥2 rectal toxicity in patients treated with IMRT was 68% less than seen with image-guided 3D-CRT at 36 months post-treatment (7% versus 22%; hazard ratio = 0.32, P = 0.03). IMRT remained a significant protective factor in a multivariate analysis. A discriminant analysis showed that the relative volume of rectal wall exposed to doses over 50 Gy was most strongly associated with late rectal toxicity. Controlling for duration of follow-up, a later year of treatment was the strongest clinical predictor of late rectal toxicity in multivariate modelling (P = 0.03). Conclusion For men with PC managed to doses of 74-78 Gy with IGRT, IMRT leads to reduced rectal toxicity compared with 3D-CRT. Incremental improvements in treatment delivery over time also appear to have an independently strong beneficial effect. © 2014 The Royal Australian and New Zealand College of Radiologists.


Gorayski P.,Radiation Oncology Queensland | Gorayski P.,University of Queensland | Pinkham M.B.,University of Queensland | Lehman M.,University of Queensland
Australian Family Physician | Year: 2015

Background One in five Australian men are diagnosed with prostate cancer. External beam radiation therapy (EBRT) is an effective treatment for men suitable for definitive therapy. Objectives This article outlines the processes involved in EBRT for prostate cancer, with particular emphasis on recent technological advances that have had a positive impact on patient outcomes. The patient's experience is explained and comparisons are made with surgery. Discussion Patients diagnosed with localised prostate cancer may have multiple treatment options. General practitioners have an important role in helping patients navigate their way through the information needed to make this decision. Radiotherapy technologies, including image guidance, intensitymodulated radiation therapy and stereotactic (ablative) radiation therapy are discussed in this article. © The Royal Australian College of General practitioners 2015.

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