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PubMed | Ipswich Hospital NHS Trust, Peterborough City Hospital, The Clatterbridge Cancer Center Foundation Trust, University of Surrey and 3 more.
Type: Journal Article | Journal: The British journal of radiology | Year: 2016

To determine if subsets of patients may benefit from smaller or larger margins when using laser setup and bony anatomy verification of breast tumour bed (TB) boost radiotherapy (RT).Verification imaging data acquired using cone-beam CT, megavoltage CT or two-dimensional kilovoltage imaging on 218 patients were used (1574 images). TB setup errors for laser-only setup (dlaser) and for bony anatomy verification (dbone) were determined using clips implanted into the TB as a gold standard for the TB position. Cases were grouped by centre-, patient- and treatment-related factors, including breast volume, TB position, seroma visibility and surgical technique. Systematic () and random () TB setup errors were compared between groups, and TB planning target volume margins (MTB) were calculated.For the study population, laser was between 2.8 and 3.4mm, and bone was between 2.2 and 2.6mm, respectively. Females with larger breasts (p=0.03), easily visible seroma (p0.02) and open surgical technique (p0.04) had larger laser. bone was larger for females with larger breasts (p=0.02) and lateral tumours (p=0.04). Females with medial tumours (p<0.01) had smaller bone.If clips are not used, margins should be 8 and 10mm for bony anatomy verification and laser setup, respectively. Individualization of TB margins may be considered based on breast volume, TB and seroma visibility.Setup accuracy using lasers and bony anatomy is influenced by patient and treatment factors. Some patients may benefit from clip-based image guidance more than others.


Okines A.F.C.,Foundation Medicine | Langley R.E.,Clinical Trials Unit | Thompson L.C.,Clinical Trials Unit | Stenning S.P.,Clinical Trials Unit | And 18 more authors.
Annals of Oncology | Year: 2013

Background: Peri-operative chemotherapy and surgery is a standard treatment of localised oesophagogastric adenocarcinoma; however, the outcomes remain poor. Patients and methods: ST03 is a multicentre, randomised, phase II/III study comparing peri-operative ECX with or without bevacizumab (ECX-B). The primary outcome measure of phase II (n = 200) was safety, specifically gastrointestinal (GI) perforation rates and cardiotoxicity. Results: Two hundred patients were randomised between October 2007 and April 2010. Ninety-one/101 (90%) ECX and 86/99 (87%) ECX-B patients completed pre-operative chemotherapy; 7 ECX and 9 ECX-B patients stopped due to toxicity. Gastrointestinal perforations (3 ECX, 1 ECX-B), cardiac events (1 ECX, 4 ECX-B) and venous thromboembolic events (VTEs, 8 ECX, 7 ECX-B) were uncommon. Arterial thromboembolic events (ATEs, myocardial infarction (MI) or cerebrovascular accident) were more frequent with ECX-B (5 versus 1 with ECX). Delayed wound healing, anastomotic leaks and GI bleeding rates were similar. More asymptomatic left ventricular ejection fraction (LVEF) falls (≥15% and/or to <50%) occurred with ECX-B (21.2% versus 11.1% with ECX). Clinically significant falls (≥10% to below lower limit of normal, LLN) occurred in (15.3%) and (8.9%) respectively, with no associated cardiac failure (median 22 months follow-up). Conclusions: Addition of bevacizumab to peri-operative ECX chemotherapy is feasible with acceptable toxicity and no negative impact on surgical outcomes. © The Author 2012. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.


PubMed | University of Liverpool, University of Birmingham, University of Warwick, The Clatterbridge Cancer Center Foundation Trust and University of Lincoln
Type: | Journal: Nuclear instruments & methods in physics research. Section A, Accelerators, spectrometers, detectors and associated equipment | Year: 2016

For many years, silicon micro-strip detectors have been successfully used as tracking detectors for particle and nuclear physics experiments. A new application of this technology is to the field of particle therapy where radiotherapy is carried out by use of charged particles such as protons or carbon ions. Such a treatment has been shown to have advantages over standard x-ray radiotherapy and as a result of this, many new centres offering particle therapy are currently under construction around the world today. The Proton Radiotherapy, Verification and Dosimetry Applications (PRaVDA) consortium are developing instrumentation for particle therapy based upon technology from high-energy physics. The characteristics of a new silicon micro-strip tracker for particle therapy will be presented. The array uses specifically designed, large area sensors with technology choices that follow closely those taken for the ATLAS experiment at the HL-LHC. These detectors will be arranged into four units each with three layers in an


Schmidt-Hansen M.,National Collaborating Center for Cancer | Hoskin P.,Mount Vernon Cancer Center | Kirkbride P.,The Clatterbridge Cancer Center Foundation Trust | Hasler E.,National Collaborating Center for Cancer | Bromham N.,National Collaborating Center for Cancer
Clinical Oncology | Year: 2014

Aims: Radiotherapy is standard treatment for localised prostate cancer and is often combined with hormone treatment to prevent androgen stimulation of prostate cancer. Hormone therapy carries significant morbidity and can only be justified in the radical treatment of localised disease if it can be balanced against a significant gain in disease control and survival. Materials and methods: We searched Medline, Premedline, Embase, Cochrane Library, Web of Science (SCI & SSCI) and Biomed Central for randomised controlled trials published in English comparing radiotherapy or hormone therapy alone with radiotherapy and hormone therapy in combination as first-line treatment in patients with non-metastatic prostate cancer reporting overall survival, disease-free survival, distant metastases-free survival, biochemical survival, adverse events (including cardiovascular) and/or health-related quality of life. Results: Fourteen trials were included and showed that combination therapy was associated with better or similar survival and disease-free outcomes compared with single-modality treatment, and that this may particularly be the case for patients with higher risk disease. The results also suggested that combination therapy is associated with more and worse adverse events and quality of life, although this was not always the case. Some of the results are at risk of reporting bias. Conclusion: The published data support the use of combined treatment with androgen deprivation and radiotherapy for intermediate- and high-risk localised and locally advanced prostate cancer. Optimal timing, duration, formulation and the management of side-effects remain important questions for further research. © 2014 The Royal College of Radiologists.


Higgins R.,University of Salford | Higgins R.,The Clatterbridge Cancer Center Foundation Trust | Hogg P.,University of Salford | Robinson L.,University of Salford
Radiography | Year: 2013

Aim: This article discusses the level 4 (year 1) diagnostic radiography student holistic experience of the Research-informed Teaching experience (RiTe) at the University of Salford, UK. The purpose of RiTe is to expose undergraduate radiography students to more formal research, as part of their normal teaching and learning experience. Method: A grounded theory approach was adopted and a focus group with eight level 4 students was used to explore and evaluate the student experience and perception of RiTe. Results: Open coding defined categories and sub-categories, with axial and selective coding used to interrogate and explore the relationships between the focus group data. A number of insights were gained into the student holistic experience of RiTe. The issue of leadership for level 4 students was also identified. Discussion: The focus group participants found RiTe to be an extremely positive learning experience. RiTe also facilitated their translation of learnt theory into clinical skills knowledge alongside their understanding of and desire to participate in more research as undergraduates. The article also highlights areas for future research. © 2012 The College of Radiographers.


Appleton L.,The Clatterbridge Cancer Center Foundation Trust | Flynn M.,University of Liverpool
European Journal of Oncology Nursing | Year: 2014

Purpose: This qualitative exploratory study was grounded in local patient and service user experiences and was designed to investigate how the language and metaphors of cancer influence personal and social adjustment after completion of a course of treatment. Methods: The study employed a focus group design, in which eighteen people, recruited through regional networks and support groups, participated. Meetings elicited participants' stories and focused discussion on key words and common phrases in the cancer lexicon. Data from transcribed focus group recordings were analysed thematically and organised into descriptive categories concerned with the interpretations of common terms and how these influenced the management of identity and emotions. Results: The thematic categories emphasised the importance of language in the way participants managed their illness and sought to control their feelings and their interactions with others. Interpretation of findings revealed a strong central idea linking participants' accounts, which was that language, metaphor and euphemism are central to adjustment and the forging of an altered identity as a survivor of cancer diagnosis and treatment. Conclusions: The findings are consistent with what is already known about the language and metaphors of cancer, with language being an important mechanism for managing uncertainty. From participants' accounts it also appears that there may be subtle but important differences in professional and lay understandings of cancer language and metaphor. This suggests a need for oncology nurses to elaborate their broad understanding of communication skills and move toward a more detailed understanding of the language used during interactions with patients. © 2014 Elsevier Ltd.


Armoogum K.S.,Royal Derby Hospital | Thorp N.,The Clatterbridge Cancer Center Foundation Trust
Cancers | Year: 2015

Background: We compare clinical outcomes of paediatric patients with CNS tumours treated with protons or IMRT. CNS tumours form the second most common group of cancers in children. Radiotherapy plays a major role in the treatment of many of these patients but also contributes to late side effects in long term survivors. Radiation dose inevitably deposited in healthy tissues outside the clinical target has been linked to detrimental late effects such as neurocognitive, behavioural and vascular effects in addition to endocrine abnormalities and second tumours. Methods: A literature search was performed using keywords: protons, IMRT, CNS and paediatric. Of 189 papers retrieved, 10 were deemed relevant based on title and abstract screening. All papers directly compared outcomes from protons with photons, five papers included medulloblastoma, four papers each included craniopharyngioma and low grade gliomas and three papers included ependymoma. Results: This review found that while proton beam therapy offered similar clinical target coverage, there was a demonstrable reduction in integral dose to normal structures. Conclusions: This in turn suggests the potential for superior long term outcomes for paediatric patients with CNS tumours both in terms of radiogenic second cancers and out-of-field adverse effects. © 2015 by the authors; licensee MDPI, Basel, Switzerland.


PubMed | The Clatterbridge Cancer Center Foundation Trust
Type: Journal Article | Journal: Medical physics | Year: 2017

The purpose of this work was to see if the EPID is a viable alternative to other QA devices for routine FFF QA and plan dose measurements.Sensitivity measurements were made to assess response to small changes in field size and beam steering. QA plans were created where field size was varied from baseline values (5-5.5cm, 20-20.5cm). Beam steering was adjusted by altering values in service mode (Symmetry 0-3%). Plans were measured using the Varian portal imager (aS1200 DMI panel), QA3 (Sun Nuclear), and Starcheck Maxi (PTW). FFF beam parameters as stated in Fogliata et al were calculated. Constancy measurements were taken using all 3 QC devices to measure a MLC defined 2020cm field. Two clinical SABR patient plans were measured on a Varian Edge linac, using the Portal Dosimetry module in ARIA, and results compared with analysis made using Delta4 (ScandiDos).The EPID and the Starcheck performed better at detecting clinically relevant changes in field size with the QA3 performing better when detecting similar changes in beam symmetry. Consistency measurements with the EPID and Starcheck were equivalent, with comparable standard deviations. Clinical plan measurements on the EPID compared well with Delta4 results at 3%/1mm.Our results show that for FFF QA measurements such as field size and symmetry, using the EPID is a viable alternative to other QA devices. The EPID could potentially be used for QC measurements with a focus on geometric accuracy, such as MLC positional QA, due to its high resolution compared to other QA devices (EPID 0.34mm, Starcheck 3mm, QA3 5mm). Good agreement between Delta4 and portal dosimetry also indicated the EPID may be a suitable alternative for measurement of clinical plans.


PubMed | The Clatterbridge Cancer Center Foundation Trust
Type: Journal Article | Journal: Medical physics | Year: 2017

Quality assurance in radiotherapy requires the measurement of various machine parameters to ensure they remain within permitted values over time. In Truebeam release 2.0 the Machine Performance Check (MPC) was released allowing beam output and machine axis movements to be assessed in a single test. We aim to evaluate the Varian Machine Performance Check (MPC) as a tool for Statistical Process Control (SPC).Varians MPC tool was used on three Truebeam and one EDGE linac for a period of approximately one year. MPC was commissioned against independent systems. After this period the data were reviewed to determine whether or not the MPC was useful as a process control tool. Analyses on individual tests were analysed using Shewhart control plots, using Matlab for analysis. Principal component analysis was used to determine if a multivariate model was of any benefit in analysing the data.Control charts were found to be useful to detect beam output changes, worn T-nuts and jaw calibration issues. Upper and lower control limits were defined at the 95% level. Multivariate SPC was performed using Principal Component Analysis. We found little evidence of clustering beyond that which might be naively expected such as beam uniformity and beam output. Whilst this makes multivariate analysis of little use it suggests that each test is giving independent information.The variety of independent parameters tested in MPC makes it a sensitive tool for routine machine QA. We have determined that using control charts in our QA programme would rapidly detect changes in machine performance. The use of control charts allows large quantities of tests to be performed on all linacs without visual inspection of all results. The use of control limits alerts users when data are inconsistent with previous measurements before they become out of specification. A. Carver has received a speakers honorarium from Varian.


PubMed | University of Western Australia, King's College and The Clatterbridge Cancer Center Foundation Trust
Type: | Journal: Atherosclerosis | Year: 2016

Familial hypercholesterolaemia (FH) profoundly increases the risk of coronary artery disease (CAD). We investigated whether diet and a bile-acid sequestrant decrease coronary atherosclerosis in patients with FH.We identified 26 men with FH and CAD, participating in the St Thomas Atherosclerosis Regression Study, who had been randomized to receive a fat-modified diet plus cholestyramine (8g twice daily) (DC, n= 12) or usual care (UC, n=14), and investigated the relative effects of these treatments on the angiographic progression of coronary atherosclerosis over 39 months. FH was defined as probable/definite according to Dutch Lipid Clinic Network criteria; mean FH score was 8.7 (range 6-15) and mean baseline low-density lipoprotein cholesterol (LDL-Ch) concentration was 5.4 (SD 1.4) mmol/L. Coronary atherosclerosis was assessed by serial quantitative angiography as the global changes in mean and minimum absolute width of segments (MAWS and MinAWS, respectively).Mean plasma LDL-Ch concentration fell by 35% with DC and remained significantly (p<0.001) lower during the trial at 3.78 (SD 0.98)mmol/L compared with UC at 4.89 (1.04). MAWS decreased by 0.252 (SEM 0.072) mm in the UC group and by 0.001 (0.065) mm in the DC group (p=0.007), with corresponding reductions in MinAWS of 0.290 (0.087) mm and 0.013 (0.058) mm (p=0.009); these changes were significant after adjusting for baseline variables, including coronary luminal dimensions and lipoprotein(a). Progression was observed in 7 patients (50%) on UC and 3 (25%) on DC (p=0.19), with regression in no patients (0%) and 3 patients (25%) (p<0.05), respectively.This investigation, carried out in the pre-statin era, demonstrates that a prudent diet and cholestyramine could improve the course of coronary atherosclerosis in men with phenotypic FH through sustained reductions in LDL-Ch.

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