Research Articles (Radiation Oncology)

Permanent URI for this collection

https://scholar.sun.ac.za/handle/10019.1/5131

Browse

Now showing 1 - 20 of 31

Audits of oncology units – an effective and pragmatic approach
(Health and Medical Publishing Group, 2017) Abratt, R. P.; Eedes, D.; Bailey, B.; Salmon, C.; Govender, Y.; Oelofse, I.; Burger, H.
Background. Audits of oncology units are part of all quality-assurance programmes. However, they do not always come across as pragmatic and helpful to staff. Objective. To report on the results of an online survey on the usefulness and impact of an audit process for oncology units. Methods. Staff in oncology units who were part of the audit process completed the audit self-assessment form for the unit. This was followed by a visit to each unit by an assessor, and then subsequent personal contact, usually via telephone. The audit self-assessment document listed quality-assurance measures or items in the physical and functional areas of the oncology unit. There were a total of 153 items included in the audit. The online survey took place in October 2016. The invitation to participate was sent to 59 oncology units at which staff members had completed the audit process. Results. The online survey was completed by 54 (41%) of the 132 potential respondents. The online survey found that the audit was very or extremely useful in maintaining personal professional standards in 89% of responses. The audit process and feedback was rated as very or extremely satisfactory in 80% and 81%, respectively. The self-assessment audit document was scored by survey respondents as very or extremely practical in 63% of responses. The feedback on the audit was that it was very or extremely helpful in formulating improvement plans in oncology units in 82% of responses. Major and minor changes that occurred as a result of the audit process were reported as 8% and 88%, respectively. Conclusion. The survey findings show that the audit process and its self- assessment document meet the aims of being helpful and pragmatic.
Automated radiation treatment planning for cervical cancer
(Elsevier, 2020-10) Rhee, Dong Joo; Jhingran, Anuja; Kisling, Kelly; Cardenas, Carlos; Simonds, Hannah; Court, Laurence
The radiation treatment-planning process includes contouring, planning, and reviewing the final plan, and each component requires substantial time and effort from multiple experts. Automation of treatment planning can save time and reduce the cost of radiation treatment, and potentially provides more consistent and better quality plans. With the recent breakthroughs in computer hardware and artificial intelligence technology, automation methods for radiation treatment planning have achieved a clinically acceptable level of performance in general. At the same time, the automation process should be developed and evaluated independently for different disease sites and treatment techniques as they are unique from each other. In this article, we will discuss the current status of automated radiation treatment planning for cervical cancer for simple and complex plans and corresponding automated quality assurance methods. Furthermore, we will introduce Radiation Planning Assistant, a web-based system designed to fully automate treatment planning for cervical cancer and other treatment sites.
Automated treatment planning of postmastectomy radiotherapy
(American Association of Physicists in Medicine, 2019-05-11) Kisling, Kelly; Zhang, Lifei; Shaitelman, Simona F.; Anderson, David; Thebe, Tselane; Yang, Jinzhong; Balter, Peter A.; Howell, Rebecca M.; Jhingran, Anuja; Schmeler, Kathleen; Simonds, Hannah; Du Toit, Monique; Trauernicht, Christoph; Burger, Hester; Botha, Kobus; Joubert, Nanette; Beadle, Beth M.; Court, Laurence
Purpose: Breast cancer is the most common cancer in women globally and radiation therapy is a cornerstone of its treatment. However, there is an enormous shortage of radiotherapy staff, especially in low- and middle-income countries. This shortage could be ameliorated through increased automation in the radiation treatment planning process, which may reduce the workload on radiotherapy staff and improve efficiency in preparing radiotherapy treatments for patients. To this end, we sought to create an automated treatment planning tool for postmastectomy radiotherapy (PMRT). Methods: Algorithms to automate every step of PMRT planning were developed and integrated into a commercial treatment planning system. The only required inputs for automated PMRT planning are a planning computed tomography scan, a plan directive, and selection of the inferior border of the tangential fields. With no other human input, the planning tool automatically creates a treatment plan and presents it for review. The major automated steps are (a) segmentation of relevant structures (targets, normal tissues, and other planning structures), (b) setup of the beams (tangential fields matched with a supraclavicular field), and (c) optimization of the dose distribution by using a mix of high- and low-energy photon beams and field-in-field modulation for the tangential fields. This automated PMRT planning tool was tested with ten computed tomography scans of patients with breast cancer who had received irradiation of the left chest wall. These plans were assessed quantitatively using their dose distributions and were reviewed by two physicians who rated them on a three-tiered scale: use as is, minor changes, or major changes. The accuracy of the automated segmentation of the heart and ipsilateral lung was also assessed. Finally, a plan quality verification tool was tested to alert the user to any possible deviations in the quality of the automatically created treatment plans. Results: The automatically created PMRT plans met the acceptable dose objectives, including target coverage, maximum plan dose, and dose to organs at risk, for all but one patient for whom the heart objectives were exceeded. Physicians accepted 50% of the treatment plans as is and required only minor changes for the remaining 50%, which included the one patient whose plan had a high heart dose. Furthermore, the automatically segmented contours of the heart and ipsilateral lung agreed well with manually edited contours. Finally, the automated plan quality verification tool detected 92% of the changes requested by physicians in this review. Conclusions: We developed a new tool for automatically planning PMRT for breast cancer, including irradiation of the chest wall and ipsilateral lymph nodes (supraclavicular and level III axillary). In this initial testing, we found that the plans created by this tool are clinically viable, and the tool can alert the user to possible deviations in plan quality. The next step is to subject this tool to prospective testing, in which automatically planned treatments will be compared with manually planned treatments.
Chemotherapy administration standards and guidelines : the development of a resource document
(AOSIS, 2018-08-13) Eedes, David J.; Bailey, Belinda; Burger, Henriette
There are no nationally recognised guidelines for the handling and administration of chemotherapy in South Africa. The Independent Clinical Oncology Network’s Chemotherapy Administration Standards and Guidelines Resource Documentwas developed over 2 years and first introduced at a South African international oncology conference in 2017. A working group consisting of oncologists and oncology nurses was set up to address this deficiency. Pragmatic guidelines suitable to a wide range of local chemotherapy administration practices were developed using an iterative, multidisciplinary, collaborative process. The consensus was that these guidelines should be appropriate to the South African context. Safety, standard operational procedures, recommended professional competencies and training were central to the document. Guidelines for prescribing, storing, mixing, dispensing, administering and disposing of chemotherapy were included. Patient consent and involvement, patient and staff safety, recommended professional competencies, management of accidents and errors, error reporting and local legal requirements are dealt with in detail. The hope is that these guidelines will be used as a resource document for South African chemotherapy practices, both public and private. The document is supported by standard operating procedures and action steps. These were developed to promote the use of the guidelines and to support pragmatic quality assurance measures at practice level. These standards and guidelines will be regularly updated, based on needs identified and deficiencies noted.
Establishing a multidisciplinary AIDS-associated Kaposi’s sarcoma clinic : patient characteristics, management and outcomes
(Health & Medical Publishing Group, 2018-12) Burger, H.; Ismail, Z.; Taljaard, J. J.
Background: Kaposi’s sarcoma (KS) typically occurs in the setting of immunodeficiency and specifically in the presence of HIV infection, when it is called AIDS-associated KS (AIDS-KS). In spite of impressive gains in the South African (SA) antiretroviral therapy (ART) roll-out programme since 2004, AIDS-KS still causes significant morbidity and mortality, and the treatment of advanced disease can be challenging owing to the centralisation of oncology services and the high incidence of concurrent infections. In 2014, a multidisciplinary AIDS-KS clinic (MKSC) was established at Tygerberg Hospital, Cape Town, with the goal of optimising management of AIDS-KS patients. Objectives: To report on the characteristics and outcomes of patients seen during the first 6 months after the inception of the MKSC. Methods: A retrospective observational study was performed of all new cases referred to the MKSC from February to August 2014. Results: Forty-two patients were included in the study. The median age was 34 years (range 20 - 60). Forty-one patients were on ART at time of diagnosis or were initiated by a median of 3 months after diagnosis. The median CD4+ count before diagnosis was 147 cells/µL (range 4 - 811). The HIV viral load was undetectable in 22 cases (52.4%). Thirty-eight patients (90.5%) were classified as AIDS Clinical Trials Group (ACTG) poor risk, 10 patients (23.8%) had visceral KS, 14 patients (33.3%) were on tuberculosis (TB) treatment at time of presentation, and 22 patients (52.4%) received oncological therapy in addition to ART. After median follow-up of 25.6 months, 2-year overall survival (OS) was 61.1%. On univariate analysis, factors significantly associated with poor 2-year OS included ACTG S1 stage (S = systemic illness), visceral KS, being on TB treatment, and Eastern Cooperative Oncology Group performance status score >2. In the T1 (T = tumour extent) subgroup, receiving chemotherapy was significantly associated with improved 2-year OS. Conclusions: Advanced AIDS-KS significantly affects young people in the Western Cape Province of SA despite 10 years of ART roll-out. There is a high prevalence of concomitant TB infection that could adversely affect adherence and response to treatment. Despite advanced disease at presentation and palliative treatment intent, survival outcomes are encouraging and seem to be positively affected by the increased use of chemotherapy. A multidisciplinary approach to diagnosis, staging and treatment and the exploration of prognostic indices specific to the sub-Saharan setting would be valuable in designing appropriate treatment algorithms.
Fully automatic treatment planning for external-beam radiation therapy of locally advanced cervical cancer : a tool for low-resource clinics
(American Society of Clinical Oncology, 2019) Kisling, Kelly; Zhang, Lifei; Simonds, Hannah M.; Fakie, Nazia; Yang, Jinzhong; McCarroll, Rachel; Balter, Peter; Burger, Hester; Bogler, Oliver; Howell, Rebecca; Schmeler, Kathleen; Mejia, Mike; Beadle, Beth M.; Jhingran, Anuja; Court, Laurence
PURPOSE: The purpose of this study was to validate a fully automatic treatment planning system for conventional radiotherapy of cervical cancer. This system was developed to mitigate staff shortages in low-resource clinics. METHODS: In collaboration with hospitals in South Africa and the United States, we have developed the Radiation Planning Assistant (RPA), which includes algorithms for automating every step of planning: delineating the body contour, detecting the marked isocenter, designing the treatment-beam apertures, and optimizing the beam weights to minimize dose heterogeneity. First, we validated the RPA retrospectively on 150 planning computed tomography (CT) scans. We then tested it remotely on 14 planning CT scans at two South African hospitals. Finally, automatically planned treatment beams were clinically deployed at our institution. RESULTS: The automatically and manually delineated body contours agreed well (median mean surface dis- tance, 0.6 mm; range, 0.4 to 1.9 mm). The automatically and manually detected marked isocenters agreed well (mean difference, 1.1 mm; range, 0.1 to 2.9 mm). In validating the automatically designed beam apertures, two physicians, one from our institution and one from a South African partner institution, rated 91% and 88% of plans acceptable for treatment, respectively. The use of automatically optimized beam weights reduced the maximum dose signiﬁcantly (median, −1.9%; P , .001). Of the 14 plans from South Africa, 100% were rated clinically acceptable. Automatically planned treatment beams have been used for 24 patients with cervical cancer by physicians at our institution, with edits as needed, and its use is ongoing. CONCLUSION: We found that fully automatic treatment planning is effective for cervical cancer radiotherapy and may provide a reliable option for low-resource clinics. Prospective studies are ongoing in the United States and are planned with partner clinics.
Gestational trophoblastic neoplasm and women living with HIV and/or AIDS
(AOSIS Publishing, 2015-07-03) Barnardt, Pieter; Relling, Martha
The 2011 World Health Organization global report on HIV and/or AIDS estimated that sub-Saharan Africa comprised 67% of the global HIV burden, with a current estimate of 5.9 million cases in South Africa. Since the introduction of antiretroviral therapy, there has been an increase in the incidence of non-AIDS-defining cancers. Gestational trophoblastic neoplasm (GTN) is a rare pregnancy-related disorder with an incidence ranging from 0.12–0.7/1000 pregnancies in Western nations. The overall cure rate is about 90%. Response to treatment for GTN is generally favourable; but the sequelae of HIV and/or AIDS, the resultant low CD4 counts, comorbidities, poor performance status and the extent of metastatic disease in patients receiving chemotherapy, compromise the prognosis and survival.
Hypofractionation and prostate cancer : a good option for Africa?
(AOSIS, 2017-08-29) Incrocci, Luca; Heijmen, Ben; Kupelian, Patrick; Simonds, Hannah M.
Cancer is an emerging public health problem in Africa. According to the World Health Organization, the numbers will be doubled by 2030 because of the ageing and the growth of the population. Prostate cancer is the most common cancer among men in most African countries. Radiotherapy machines are extremely limited in Africa and therefore prostate cancer in Africa is mostly managed by urologists. However, for a large proportion of prostate cancer patients, external-beam radiotherapy (EBRT) will be the treatment of choice in Africa because of limitations of surgical expertise in many countries. The disparity between the α/β ratio for late complications and the low α/β ratio for prostate cancer widens the therapeutic window when treating prostate cancer with hypofractionation. Because of the reduced number of treatment days, hypofractionation offers economic and logistic advantages, reducing the burden of the very limited radiotherapy resources in most African countries. It also increases patient convenience. A misleading assumption is that high-level radiotherapy is not feasible in low-income countries. The gold standard option for hypofractionation includes daily image-guided radiotherapy with 3–4 implanted gold fiducials. Acceptable methods for image guidance include ultrasound and cone-beam computed tomography (CT). CT-based treatment planning with magnetic resonance imaging fusion allows for accurate volume delineation. Volumetric modulated arc therapy or inversely planned intensity modulated radiotherapy is the ideal for treatment delivery. The most vital component is safe delivery, which necessitates accurate quality assurance measures and on-board imaging. We will review the evidence and potential utilisation of hypofractionated EBRT in Africa.
Long-term complications of pelvic radiotherapy
(South African Society of Gynaecologic Oncology, 2010) Simonds, Hannah
Complications following pelvic radiation are frequently under-reported and inadequately addressed. This overview examines the nature and the intensity of complications encountered by cancer survivors; it focuses specifically on gastrointestinal and vaginal complications, and the problems surrounding the methods of recording and assessing toxicities.
Malignant peripheral nerve sheath tumours and neurofibromatosis 1 : a case series and recommendations for care
(AOSIS, 2018-08-20) Burger, Henriette; Bezuidenhout, Heidre; Sher-Locketz, Candice; Baatjes, Karin; Van Wyk, Jacques; Bonthuys, Anita
Background: The incidence of malignant peripheral nerve sheath tumours (MPNST) in patients with neurofibromatosis 1 (NF1) is significantly higher than that of the general population. NF1-associated MPNST occur at a younger age and carry a worse prognosis than sporadic MPNST. Aim: This case series describes four cases of MPNST in patients with NF1. Setting: The study was performed in a public academic hospital in the Western Cape province of South Africa. Method: Demographics, disease status, histopathology, treatment and outcome data were collected retrospectively from medical charts and through review of histological slides. Results: The median age was 36.5 years. All tumours were > 5 cm at presentation and located on the trunk. One patient presented with metastatic disease. There was a mean delay of 3.5 months from presentation to initiation of treatment. Three patients underwent wide excision, with one receiving adjuvant chemotherapy and radiotherapy. At a median follow-up of 20 months from histological diagnosis only one patient was alive in clinical remission. Two patients had succumbed to progressive disease at 8 and 16 months from diagnosis and one patient with terminal metastatic disease was lost to follow-up. Conclusion: In this series the patients presented with advanced, often unresectable lesions for which single modality therapy was not curative. An adult NF1 health surveillance guideline for resource-constrained environments could lead to early diagnosis and treatment of MPNST and other complications in NF1 patients.
Managing AIDS-related Kaposi’s sarcoma and pregnancy
(AOSIS Publishing, 2013-05) Barnardt, Pieter
An estimated 30 - 40% of HIV-infected patients are likely to develop cancer during the progression of their disease. The occurrence of malignancy among these patients represents a difficult challenge in their care. Kaposi’s sarcoma (KS) – currently the most common tumour observed with an estimated incidence of 15 - 20% – represents the first manifestation of AIDS in 30 - 40% of patients. Any organ may be involved, but the gastrointestinal tract and lung remain the most frequently involved locations. The case described here presented a clinical and ethical dilemma where visceral KS, pregnancy and medical complications required multi-disciplinary management.
Managing gestational trophoblastic neoplasm (GTN) and people living with HIV (PLWH)
(MedPharm Publications, 2019) Barnardt, Pieter
The 2017 World Health Organization (WHO) global report on HIV/AIDS estimated that sub-Saharan Africa comprised 64% of the global HIV burden, with a current estimate of 19.4 million cases in Eastern and Southern Africa. Since the introduction of antiretroviral therapy (ART) there has been a 30–40% increase in the incidence of non-AIDS malignancies. Gestational trophoblastic disease comprises of a spectrum of pregnancy-related disorders with an overall cure rate of 90%. The response to treatment is generally favourable but the associated complications of HIV, comorbidities, poor performance status and extent of metastatic disease in gestational trophoblastic neoplasm patients receiving chemotherapy, compromises the outcome and survival.
Medical students' perceptions on euthanasia and physician-assisted suicide : are they fully informed?
(Health & Medical Publishing Group, 2018) Burger, H.; Gwyther, L.; Krause, R.; Ratshikana-Moloko, M.; Hellenberg, D.
No abstract available
Morphine and chronic cancer pain
(Health & Medical Publishing Group, 2001-10) Smit, B. J.
Cancer pain can be broken down into the following categories: (i),pain caused by the cancer process itself, i.e. bony invasion or nerve compression or infiltration that is likely to present with the features of acute pain; (ii) pain arising from the treatment for the cancer process and likely to present as chronic pain - this might include pain resulting from radical surgery, chemotherapy or radiation therapy; and (hi) bedsores, chronic infection or constipation, which may become part of the pain syndrome.
Morphine for cancer pain
(Health & Medical Publishing Group, 1994) Smit, B. J.
[No abstract available]
Neutron radiotherapy in South Africa : neutron radiotherapy should continue
(Health and Medical Publishing Group (HMPG), 2012-04) Sauerwein, Wolfgang; Engenhart-Cabillic, Rita; Forman, Jeffrey D.; Gueulette, John; Hachem, Sabet; Jones, Dan; Krull, Andreas; Lukas, Peter; Mandrillon, Pierre; Petry, Winfried; Rosenberg, Ivan; Venimmen, Frederik; Welsh, James S.
To the Editor: Abratt’s letter needs a response. We are currently – or have been directly – involved in treating patients with fast neutrons for decades; some with more than 20 years’ experience in proton therapy, and others working at major hospitals with modern, highend facilities for radiotherapy with photons and electrons.
Ovarian germ cell tumour and bleomycin-induced lung injury
(Medpharm Publications, 2018) Barnardt, Pieter; Griffith-Richards, Stephanie
Bleomycin, an antibiotic agent with antitumour activity, is an important drug in the management of many oncological malignancies such as lymphoma and germ cell tumours. These tumours are potentially curable and mostly affect young people. The potential side effects and long-term toxicities should be considered. The major limitation of bleomycin therapy is pulmonary toxicity and may be life threatening in about 10% of cases. This article reports a case of an ovarian mixed germ cell tumour, which presented with bleomycin-associated pulmonary toxicity.
Pentastomiasis (armillifer armillatus infestation)
(Health and Medical Publishing Group (HMPG), 2007-10) Du Plessis, Vicci; Birnie, Andrew J.; Eloff, Ivor; Reuter, Helmuth; Andronikou, Savvas
Pentastomiasis, also known as ‘tongue worm’ infestation or porocephalosis, is a parasitic zoonosis endemic to western and central Africa. In 1847, Pruner described the first human infection by a pentastomid in Cairo. The definitive hosts are snakes and other reptiles, while the intermediate hosts are carnivorous mammals and, rarely, humans. Most cases of human pentastomiasis are caused by two species of pentastomids, both of which have characteristics of arthropods and annelids, viz. Armillifer armillatus and Linguatula serrata.
A phase I trial of hypoxoside as an oral prodrug for cancer therapy : absence of toxicity
(Health & Medical Publishing Group, 1995) Smit, B. J.; Albrecht, C. F.; Liebenberg, R. W.; Kruger, P. B.; Freestone, M.; Gouws, L.; Theron, E.; Bouic, P. J. D.; Etsebeth, S.; Van Jaarsveld, P. P.
Objective. To assess the toxicity of hypoxoside taken orally by 24 patients with lung cancer. Design. Open study with patients taking 1 200 - 3 200 mg standardised Hypoxis plant extract (200 mg capsules) per day divided in 3 doses in order to maintain metabolite blood levels near 100 μg/ml. Participants and setting. Patients with histologically proven squamous, large-cell or adenocarcinoma were hospitalised initially at the radiation oncology ward, Karl Bremer Hospital, Bellville, W. Cape. Thereafter they returned every 2 weeks for full clinical examinations. Methods. Routine biochemical and haematological measurements were done. Patients underwent regular full clinical examinations including radiographs and computed tomography scanning according to the discretion of the principal investigator. Results. Nineteen patients on hypoxoside therapy survived for an average of 4 months with progression of their primary tumours and metastases, while 5 survived for more than a year. One of them survived for 5 years and histological examination of the primary lesion showed absence of cancer. No toxic effects, in clinical examinations or biochemical or haematological measurements, were found that could be ascribed to the ingestion of hypoxoside. Only one occasion of possible drug intolerance, with anxiety, nausea, vomiting and diarrhoea, was noted. Conclusion. The absence of toxicity warrants further investigation of hypoxoside as an oral prodrug, especially in patients with slow-growing necrotising tumours that are inoperable and have high concentrations of β-glucuronidase and sulphatase as high sensitivity for rooperol.
Photosensitizers and radiosensitizers in dermatology and oncology
(HMPG, 1979-09) Bruckner, V.
Two therapeutic modalities are currently of great interest, namely photo- and radiosensitization. Whereas photosensitizers only function in combination with ultraviolet (UV) light, radiosensitizers act only in combination with ionizing radiation. Because of the small UV penetration, up to a maximum of 0,5 mm, photosensitization can take place only at the surface of the body, i.e. the skin. Photosensitizers are applied in dermatology in order to optimize and improve the UV therapy of certain diseases (mainly psoriasis, mycosis fungoides and vitiligo). Radiosensitizers lead to an increase in sensitivity of the hypoxic and therefore radioresistant parts of tumours against X- and gamma-radiation. With sufficient concentration within the tumor, they can act where the radiation can reach, even in the deeper parts of the body. They represent a modern and useful aid to radiation oncology. Because of neurotoxic effects, however, their practical use is limited. A short review of the history, mechanisms of action, application and side-effects of these photo- and radiosensitizers is presented.

Browse

Browsing Research Articles (Radiation Oncology) by Title

Results Per Page

Sort Options