Riverina Cancer Care Center

Wagga Wagga, Australia

Riverina Cancer Care Center

Wagga Wagga, Australia
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Galimberti V.,Italian National Cancer Institute | Cole B.F.,University of Vermont | Cole B.F.,Dana-Farber Cancer Institute | Zurrida S.,Italian National Cancer Institute | And 30 more authors.
The Lancet Oncology | Year: 2013

Background: For patients with breast cancer and metastases in the sentinel nodes, axillary dissection has been standard treatment. However, for patients with limited sentinel-node involvement, axillary dissection might be overtreatment. We designed IBCSG trial 23-01 to determine whether no axillary dissection was non-inferior to axillary dissection in patients with one or more micrometastatic (≤2 mm) sentinel nodes and tumour of maximum 5 cm. Methods: In this multicentre, randomised, non-inferiority, phase 3 trial, patients were eligible if they had clinically non-palpable axillary lymph node(s) and a primary tumour of 5 cm or less and who, after sentinel-node biopsy, had one or more micrometastatic (≤2 mm) sentinel lymph nodes with no extracapsular extension. Patients were randomly assigned (in a 1:1 ratio) to either undergo axillary dissection or not to undergo axillary dissection. Randomisation was stratified by centre and menopausal status. Treatment assignment was not masked. The primary endpoint was disease-free survival. Non-inferiority was defined as a hazard ratio (HR) of less than 1·25 for no axillary dissection versus axillary dissection. The analysis was by intention to treat. Per protocol, disease and survival information continues to be collected yearly. This trial is registered with ClinicalTrials.gov, NCT00072293. Findings: Between April 1, 2001, and Feb 28, 2010, 465 patients were randomly assigned to axillary dissection and 469 to no axillary dissection. After the exclusion of three patients, 464 patients were in the axillary dissection group and 467 patients were in the no axillary dissection group. After a median follow-up of 5·0 (IQR 3·6-7·3) years, we recorded 69 disease-free survival events in the axillary dissection group and 55 events in the no axillary dissection group. Breast-cancer-related events were recorded in 48 patients in the axillary dissection group and 47 in the no axillary dissection group (ten local recurrences in the axillary dissection group and eight in the no axillary dissection group; three and nine contralateral breast cancers; one and nine regional recurrences; and 34 and 25 distant relapses). Other non-breast cancer events were recorded in 21 patients in the axillary dissection group and eight in the no axillary dissection group (20 and six second non-breast malignancies; and one and two deaths not due to a cancer event). 5-year disease-free survival was 87·8% (95% CI 84·4-91·2) in the group without axillary dissection and 84·4% (80·7-88·1) in the group with axillary dissection (log-rank p=0·16; HR for no axillary dissection vs axillary dissection was 0·78, 95% CI 0·55-1·11, non-inferiority p=0·0042). Patients with reported long-term surgical events (grade 3-4) included one sensory neuropathy (grade 3), three lymphoedema (two grade 3 and one grade 4), and three motor neuropathy (grade 3), all in the group that underwent axillary dissection, and one grade 3 motor neuropathy in the group without axillary dissection. One serious adverse event was reported, a postoperative infection in the axilla in the group with axillary dissection. Interpretation: Axillary dissection could be avoided in patients with early breast cancer and limited sentinel-node involvement, thus eliminating complications of axillary surgery with no adverse effect on survival. © 2013 Elsevier Ltd.


Wilkinson J.M.,Charles Sturt University | Stevens M.J.,Riverina Cancer Care Center
Journal of Complementary and Integrative Medicine | Year: 2014

Background: This study determined the prevalence, types, and attitudes towards complementary and alternative medicines (CAMs) and therapies in cancer patients actively undergoing conventional cancer treatment at a regional cancer centre. Methods: Data were collected using a self-administered questionnaire provided to adult cancer patients attending a comprehensive cancer care centre in regional Australia over a 3-month period. Results: A participation rate of 89% was recorded over the 3-month period with 285 of 320 cancer patients providing completed data. Mean age was 64 years and slightly more females responded (56%). CAM types used by patients were classified according to US National Centre for Complementary and Alternative Medicine (NCCAM) domains. Overall prevalence of CAM use was 49% (140/285). The NCCAM domains of biologicallybased treatments (mainly herbal and vitamin/mineral supplements) and manipulative/body-based methods (chiropractic and massage) were the most popular. Most patients (61%) who used CAM prior to cancer diagnosis continued complementary practices afterwards, and 33% of participants became first-time CAM users only after diagnosis. CAM use appeared to be associated with high patient acceptance and satisfaction which was not related to either cancer diagnosis or prognosis. Patients who used CAM were mainly willing to disclose (77%) this practice to their conventional health care providers. Conclusions: CAM use is prevalent in regional Australia. Collaborative integration of some CAM practices into conventional cancer care pathways (a process known as integrative oncology) is likely to have substantial patient support.


Brown T.E.,Royal Brisbane and Womens Hospital | Spurgin A.-L.,Royal Brisbane and Womens Hospital | Ross L.,Royal Brisbane and Womens Hospital | Tripcony L.,Royal Brisbane and Womens Hospital | And 7 more authors.
Head and Neck | Year: 2013

Background: The "Swallowing and Nutrition Guidelines for Patients with Head and Neck Cancer" were developed to guide early identification and management of dysphagia and nutritional risk before, during, and after cancer treatment. The purpose of this study was to validate these guidelines. Methods: Patients attending a Combined Head and Neck Clinic at a major tertiary hospital in 2007 to 2008 were assessed using the guidelines, with high-risk category patients recommended for proactive gastrostomy. Data were collected on guideline adherence, gastrostomy tube insertion, and weight. Sensitivity, specificity, and positive predictive value were calculated for validation. Results: Proactive gastrostomy tubes were inserted in 173 of 501 patients (25%). Overall guideline adherence was 87%. High-risk category adherence was 75%. Validation outcomes were sensitivity 54%, specificity 93%, and positive predictive value 82%. Conclusion: The risk categories in the guidelines are valid to assist early identification of swallowing and nutritional risk and guide decision-making on proactive gastrostomy tube insertion. © 2012 Wiley Periodicals, Inc.


Wang D.,University of Sydney | Sobolewski M.,Riverina Cancer Care Center | Sobolewski M.,Royal Prince Alfred Hospital | Hill R.,University of Sydney | Hill R.,Royal Prince Alfred Hospital
Australasian Physical and Engineering Sciences in Medicine | Year: 2012

The objective of this work was to evaluate the dosimetry of tungsten eye shields for use with kilovoltage X-ray beam treatments. The eye shields, originally designed for megavoltage electron beams, were made of 2 mm tungsten thickness and inside diameters of 11.6 and 15.0 mm with optional aluminium caps of 0.5 and 1 mm thickness. The relative dosimetry of the eye shields were examined by measurement of transmission doses with full scatter conditions, central axis depth doses and beam profiles underneath the eye shield. The X-ray beams used in this study ranged in energy from 50 to 280 kVp. Transmission measurements were performed using an Advanced Markus ionisation chamber located at the surface of an RMI457 Solid Water phantom with a 3 cm diameter applicator flush against the phantom surface. Depth doses and profiles measurements were performed in a PTW MP3 scanning water tank with a PTW diamond detector. Results for transmission doses for the medium size eye shield increased from 1 to 22 % for 50-280 kVp while for the smaller eye shield the percentage dose increased from 3.5 to 30 % for the same energy range. There were minimal differences between using the 0.5 and 1 mm aluminium caps. Central axis depth doses measured with and without the eye shields demonstrated the 125 and 180 kVp beams had higher peak doses behind the eye shields. These results show that these tungsten eye shields are suitable for use with kilovoltage X-ray beams. However, the clinical impact needs to be considered for the higher X-ray beam energies. © 2012 Australasian College of Physical Scientists and Engineers in Medicine.


Biggs S.,Riverina Cancer Care Center | Sobolewski M.,Riverina Cancer Care Center | Murry R.,Radiation Oncology Queensland | Kenny J.,Epworth HealthCare
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.


PubMed | Epworth HealthCare, Radiation Oncology Queensland and Riverina Cancer Care Center
Type: Journal Article | Journal: Physica medica : PM : an international journal devoted to the applications of physics to medicine and biology : official journal of the Italian Association of Biomedical Physics (AIFB) | Year: 2016

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 12MeV 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.


PubMed | St George Hospital, Wagga Wagga Base Hospital, University of New South Wales, Concord Repatriation General Hospital and Riverina Cancer Care Center
Type: | Journal: Case reports in oncological medicine | Year: 2013

Takotsubo cardiomyopathy is a rare but increasingly recognized phenomenon, which can occur as a side-effect of chemotherapeutic agents, in particular, the antimetabolite 5-fluorouracil. We describe a case of delayed Takotsubo cardiomyopathy after 3 weeks of adjuvant 5-fluorouracil for resected rectal adenocarcinoma in a 66-year-old female, supported by angiographic, electrocardiographic, and echocardiographic features. As a complication, she developed an apical mural thrombus with subsequent cerebral thromboembolic events and was successfully anticoagulated to make a full recovery. We present a review of the literature on Takotsubo cardiomyopathy secondary to 5-fluorouracil and the rare occurrence of thromboembolic complications. As this is a significant clinical phenomenon which involves a multispeciality approach to management, oncologists and cardiologists need to recognize it as a potential toxicity of a widely administered chemotherapeutic drug.


Cho M.,Royal Adelaide Hospital | Gordon L.,Flinders Medical Center | Rembielak A.,Christie at Oldham | Woo T.C.S.,Riverina Cancer Care Center
British Journal of Dermatology | Year: 2014

Summary Radiotherapy is an available treatment for management of basal cell carcinoma (BCC). This study aims to analyse the published literature about radiotherapy in treatment of BCC. A focus of this study will be to compare the dosing regimens adopted in these studies. A search of the Medline database was conducted from 1984 to August 2013. Search terms used were 'basal cell carcinoma', 'radiotherapy', 'epithelial skin cancer' and 'external irradiation'. Fourteen studies on the use of radiotherapy for BCC were included. Seven studies included only cases of BCC, while six studies also included patients treated for squamous cell carcinoma. The overall cure rates ranged from 79·2% to 100%. More than 90% of the patients reported good or excellent aesthetic outcome from radiotherapy (three studies). There was a wide variation in the total dose and dose per fraction of radiotherapy used. Nine studies utilized dosing regimens within the recommended guidelines of the National Comprehensive Cancer Network. There are a limited number of high-quality prospective studies of radiotherapy for BCC. Based on the available evidence, radiotherapy provides a high rate of local control with low rates of complications that are comparable with surgery. What's already known about this topic? Radiotherapy is a treatment modality that is approved for basal cell carcinoma (BCC). What does this study add? This literature review provides a summary of the latest evidence for the use of radiotherapy for BCC and analysis of the different dosing regimens used.


Sobolewski M.,Riverina Cancer Care Center | Haque M.,University of Sydney
Australasian Physical and Engineering Sciences in Medicine | Year: 2014

The purpose of this study was to quantify the effect of treatment area and treatment distance on dose distributions for geometrically optimised surface mould plans in order to provide guidance in choosing treatment parameters and constructing moulds for individual patients. Geometrically optimised plans were generated with a typical brachytherapy planning system and measurements were taken with radiochromic film over depths of 5–32 mm with an 192Ir high dose rate source. Films were calibrated with a cylindrical geometry technique utilising the 192Ir source and readout was performed with a flatbed scanner. The rate of dose fall-off about the prescription plane, as well as the magnitude and extent of local dose maxima superficial to the prescription plane, increased with decreasing treatment areas when inter-catheter spacing and treatment distance were kept constant. The dose fall-off was highly dependent on treatment distance, with a 16 % reduction in dose 4 mm superficial to the treatment depth occurring when the distance was increased from 10 to 20 mm while maintaining a 10 mm inter-catheter spacing. The table generated using the measured planar geometry data, can be used as an initial guide for mould construction and planning. The properties of high dose regions near to the catheter plane are highly dependent on the treatment area, which must be considered when normal tissue dose tolerances are a concern. Treatment distance is a key variable influencing the overall dose distribution and should be adjusted as a function of the desired tumour to skin dose ratio, controlled by mould thickness. © 2014, Australasian College of Physical Scientists and Engineers in Medicine.


PubMed | Riverina Cancer Care Center
Type: Journal Article | Journal: Australasian physical & engineering sciences in medicine | Year: 2015

The purpose of this study was to quantify the effect of treatment area and treatment distance on dose distributions for geometrically optimised surface mould plans in order to provide guidance in choosing treatment parameters and constructing moulds for individual patients. Geometrically optimised plans were generated with a typical brachytherapy planning system and measurements were taken with radiochromic film over depths of 5-32mm with an (192)Ir high dose rate source. Films were calibrated with a cylindrical geometry technique utilising the (192)Ir source and readout was performed with a flatbed scanner. The rate of dose fall-off about the prescription plane, as well as the magnitude and extent of local dose maxima superficial to the prescription plane, increased with decreasing treatment areas when inter-catheter spacing and treatment distance were kept constant. The dose fall-off was highly dependent on treatment distance, with a 16% reduction in dose 4mm superficial to the treatment depth occurring when the distance was increased from 10 to 20mm while maintaining a 10mm inter-catheter spacing. The table generated using the measured planar geometry data, can be used as an initial guide for mould construction and planning. The properties of high dose regions near to the catheter plane are highly dependent on the treatment area, which must be considered when normal tissue dose tolerances are a concern. Treatment distance is a key variable influencing the overall dose distribution and should be adjusted as a function of the desired tumour to skin dose ratio, controlled by mould thickness.

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