119 results found
Price P, Fleurent B, Barney SE, 2021, The role of the global coalition for radiotherapy in political advocacy for radiation therapy as a cost-effective and underfunded modality around the world, International Journal of Radiation Oncology*Biology*Physics, Vol: 111, Pages: 23-26, ISSN: 0360-3016
Price P, 2021, Cancer during the COVID-19 pandemic: did we shout loudly enough and did anyone listen? A lasting legacy for nations, European Journal of Cancer, Vol: 152, Pages: 243-244, ISSN: 0959-8049
Ashcroft S, Meeking K, Price P, 2021, Flash survey on the effect of COVID-19 on radiotherapy services in the UK – the benefit of social media for rapid information gathering for the radiotherapy community and government, Clinical Oncology, Vol: 33, Pages: e88-e88, ISSN: 0936-6555
Barcellini A, Filippi AR, Dal Mas F, et al., 2020, To a new normal in radiation oncology: looking back and planning forward, Tumori Journal, Vol: 106, Pages: 440-444, ISSN: 0300-8916
Price P, Sikora K, 2020, Treatment of Cancer, Publisher: CRC Press, ISBN: 9780429649004
Treatment of Cancer is a multi-author work and comprehensive guide on modern cancer treatment that aims to give clinician and student alike the framework for an integrated approach to patient care, including radiotherapy, chemotherapy, and ...
Feng T, Zhao Y, Shi H, et al., 2020, Total-Body Quantitative Parametric Imaging of Early Kinetics of F-18-FDG, JOURNAL OF NUCLEAR MEDICINE, Vol: 62, Pages: 738-744, ISSN: 0161-5505
Price P, Barney SE, 2020, Initiation of the global coalition for radiotherapy during the COVID-19 pandemic, The Lancet Oncology, Vol: 21, Pages: 752-753, ISSN: 1470-2045
Badawi RD, Shi H, Hu P, et al., 2019, First Human Imaging Studies with the EXPLORER Total-Body PET Scanner, JOURNAL OF NUCLEAR MEDICINE, Vol: 60, Pages: 299-303, ISSN: 0161-5505
Feng T, Zhao Y, Shi H, et al., 2019, The Effects of Delay on the Input Function for Early Dynamics in Total Body Parametric Imaging, IEEE Nuclear Science Symposium / Medical Imaging Conference (NSS/MIC), Publisher: IEEE, ISSN: 1095-7863
Goldsmith C, Green MM, Middleton B, et al., 2018, Evaluation of CyberKnife ® fiducial tracking limitations to assist targeting accuracy: A phantom study with fiducial displacement, Cureus, Vol: 10, ISSN: 2168-8184
Introduction The underlying assumptions of the CyberKnife® (Accuray, Sunnyvale, CA, US) fiducial tracking system are: i) fiducial positions are accurately detected; ii) inter-fiducial geometry remains consistent (rigid); iii) inter-fiducial geometric array changes are detected and either accommodated with corrections or treatment is interrupted. However: i) soft-tissue targets are deformable & fiducial migration is possible; ii) the accuracy of the tracking system has not previously been examined with fiducial displacement; iii) treatment interruptions may occur due to inter-fiducial geometric changes, but there is little information available to assist subsequent troubleshooting. The purpose of this study was to emulate a clinical target defined with a two, three, or four-fiducial array where one fiducial is displaced to mimic a target deformation or fiducial migration scenario. The objectives: evaluate the fiducial positioning accuracy, array interpretation, & corresponding corrections of the CyberKnife system, with the aim of assisting troubleshooting following fiducial displacement.MethodsA novel solid-water phantom was constructed with three fixed fiducials (F1,F2,F3) & one moveable fiducial (F4), arranged as if placed to track an imaginary clinical target. Using either two fiducials (F1,F4), different combinations of three fiducials (F1,F2,F4; F1,F3,F4; F2,F3,F4) or four fiducials (F1,F2,F3,F4), repeat experiments were conducted where F4 was displaced inferiorly at 2-mm intervals from 0-16 mm. Data were acquired at each position of F4, including rigid body errors (RBE), fiducial x, y, & z coordinate displacements, six degrees of freedom (DOF) corrections, & robot center-of-mass (COM) translation corrections.ResultsMaximum positioning difference (mean±SD) between the reference and live x, y, & z coordinates for the three fixed fiducials was 0.08±0.30 mm, confirming good accuracy for fixed fiducial registration. For two
Goldsmith C, Plowman PN, Green MM, et al., 2018, Stereotactic ablative radiotherapy (SABR) as primary, adjuvant, consolidation and re-treatment option in pancreatic cancer: scope for dose escalation and lessons for toxicity, Radiation Oncology, Vol: 13, ISSN: 1748-717X
BackgroundStereotactic ablative radiotherapy (SABR) offers an alternative treatment for pancreatic cancer, with the potential for improved tumour control and reduced toxicity compared with conventional therapies. However, optimal dose planning and delivery strategies are unelucidated and gastro-intestinal (GI) toxicity remains a key concern.MethodsPatients with inoperable non-metastatic pancreatic cancer who received CyberKnife® SABR (18–36 Gy) in three fractions as primary, adjuvant, consolidation or re-treatment options were studied. Patient individualised planning and delivery variables were collected and their impact on patient outcome examined. Linear-quadratic (LQ) radiobiology modelling methods were applied to assess SABR parameters against a conventional fractionated radiotherapy schedule.ResultsIn total 42 patients were included, 37 (88%) of whom had stage T4 disease. SABR was used > 6 months post-primary therapy to re-treat residual disease in 11 (26.2%) patients and relapsed disease in nine (21.4%) patients. SABR was an adjuvant to other primary therapy for 14 (33.3%) patients and was the sole primary therapy for eight (19.0%) patients. The mean (95% CI) planning target volume (PTV), prescription isodose, percentage cover, minimum dose to PTV and biological effective dose (BED) were 76.3(63.8–88.7) cc, 67.3(65.2–69.5)%, 96.6(95.5–97.7)%, 22.3(21.0–23.6) Gy and 50.3(47.7–53.0) Gy, respectively. Only 3/37 (8.1%) patients experienced Grade 3 acute toxicities. Two (4.8%) patients converted to resectable status and median freedom-from-local-progression (FFLP) and overall survival (OS) were 9.8 and 8.4 months, respectively. No late toxicity was experienced in 27/32 (84.4%) patients; however, four (12.5%) patients — of whom two had particularly large PTV, two had sub-optimal number of fiducials and three breached organ-at-risk (OAR) constraints—showed Grade 4 duodenal toxicities. Longer delivery time
Wilson HP, Price PM, Ashkan K, et al., 2018, CyberKnife radiosurgery of skull-base tumors: A UK center experience, Cureus, Vol: 10, ISSN: 2168-8184
The study aim was to evaluate patient individualized Cyberknife® treatment for heterogeneous skull-base tumors. Patients treated between 2009 and 2013 at The Harley Street Clinic were studied. In total, 66 patients received 15–30 Gy in 1–5 fractions to a median planning target volume (PTV) of 6.4 cc, including patients with secondary, multiple, residual and recurrent tumors, and those with tumors of uncertain pathological type. Outcome analysis was pragmatically restricted to 35 patients who had single, primary tumors treated with curative intent, and sufficient diagnostic and outcome information. Sixteen vestibular schwannoma patients with median PTV 3.8 cc (range 0.81–19.6) received 18–25 Gy in 3–5 fractions: 81% showed no acute toxicity, 50% reported no late toxicity, 71% of symptoms were stable/improved and local control was 100% at 11.4 months median follow-up. Twelve meningioma patients with median PTV of 5.5 cc (range 0.68–22.3) received 17–30 Gy in 1–5 fractions: 83% experienced no acute toxicity, 33% reported no late toxicity, 88% of symptoms were stable/improved and local control was 100% at 22.1 months median follow-up. Seven patients with other tumor types with median PTV of 24.3 cc (range 7.6–100.5) received 15–28.5 Gy in 1–5 fractions: 57% experienced no acute toxicity, 57% reported no late toxicities, 66% of symptoms were stable and local control was 43% at 14.9 months median follow-up. When tumor types were considered together, smaller tumors (PTV < 6.4 cc) showed reduced acute toxicity (p = 0.01). Overall, smaller benign tumors showed low acute toxicity, excellent local control, and good symptom management: a focus on enhanced neurological preservation may refine outcomes. For other tumor types outcome was encouraging: a focus on optimal dose and fractionation scheduling may reduce toxicity and improve local control. Individual patient experiences are detailed where valuable le
Rice L, Goldsmith C, Green MML, et al., 2017, An effective deep-inspiration breath-hold radiotherapy technique for left-breast cancer: impact of post-mastectomy treatment, nodal coverage, and dose schedule on organs at risk, BREAST CANCER-TARGETS AND THERAPY, Vol: 9, Pages: 437-446, ISSN: 1179-1314
Background: We developed, applied, and prospectively evaluated a novel deep-inspiration breath-hold (DIBH) screening and delivery technique to optimize cardiac sparing in left-breast radiotherapy (RT) at our clinic. The impact of set-up and dose variables upon organs at risk (OAR) dose in DIBH RT was investigated.Methods and materials: All patients with left-breast cancer referred between 2011 and 2014 – of all disease stages, set-up variations, and dose prescriptions – were included. Radiographers used simple screening criteria at CT simulation, to systematically assess patients for obvious DIBH benefit and capability. Selected patients received forward-planned intensity-modulated RT (IMRT) based on a DIBH CT scan. A 3D-surface monitoring system with visual feedback assured reproducible DIBH positioning during gated radiation delivery. Patient, target set-up, and OAR dose information were collected at treatment.Results: Of 272 patients who were screened, 4 withdrew, 56 showed no obvious advantage, and 56 showed benefit but had suitability issues; 156 patients were selected and successfully completed DIBH treatment. The technique was compatible with complex set-up and optimal target coverage was maintained. Comparison of free-breathing (FB) and DIBH treatment plans in the first five patients enrolled confirmed DIBH reduced heart radiation by ~80% (p = 0.032). Low OAR doses were achieved overall: the mean (95% confidence interval [CI]) heart dose was 1.17 (1.12–1.22) Gy, and the mean ipsilateral lung dose was 5.26 (5.01–5.52) Gy. Patients who underwent a standard radiation schedule (40 Gy/15#) after breast-conserving surgery had the lowest OAR doses: post-mastectomy treatment, simultaneous supraclavicular (SCV) node coverage, and alternative dose schedule (50 Gy/25#) were interrelated variables associated with increased OAR risk and compromised ipsilateral lung dose constraints.Conclusion: The DIBH technique was successfully implemented and re
Cherry SR, Badawi RD, Karp JS, et al., 2017, Total-body imaging: Transforming the role of positron emission tomography, Science Translational Medicine, Vol: 9, Pages: eaaf6169-eaaf6169, ISSN: 1946-6234
Abel M, Ahmed H, Leen E, et al., 2015, Ultrasound-guided trans-rectal high-intensity focused ultrasound (HIFU) for advanced cervical cancer ablation is feasible: a case report., Journal of Therapeutic Ultrasound, Vol: 3, ISSN: 2050-5736
INTRODUCTION: High-intensity focused ultrasound (HIFU) is an ablative treatment undergoing assessment for the treatment of benign and malignant disease. We describe the first reported intracavitary HIFU ablation for recurrent, unresectable and symptomatic cervical cancer. CASE DESCRIPTION: A 38 year old woman receiving palliative chemotherapy for metastatic cervical adenocarcinoma was offered ablative treatment from an intracavitary trans-rectal HIFU device (Sonablate® 500). Pre-treatment symptoms included vaginal bleeding and discharge that were sufficient to impede her quality of life. No peri-procedural adverse events occurred. Symptoms resolved completely immediately post-procedure, reappeared at 7 days, increasing to pre-procedural levels by day 30. DISCUSSION AND EVALUATION: This first time experience of intracavitary cervical HIFU suggests that it is feasible for palliation of advanced cervical cancer, with no early evidence of unexpected toxicity. Ethical approval had also been granted for the use of per-vaginal access if appropriate. This route, alone or in combination with the rectal route, may provide increased accessibility in future patients with a redesigned device more suited to trans-vaginal ablations. CONCLUSION: Intracavitary HIFU is a potentially safe procedure for the treatment of cervical cancer and able to provide symptomatic improvement in the palliative setting.
Shah SIMRANA, Jin ANDI, Wilson HANNAHCP, et al., 2015, Novel Computed Tomography-based Metric Reliably Estimates bone Strength, Offering Potentially Meaningful Enhancement in Clinical Fracture Risk Prediction, European Journal of Medicine, Vol: 10, Pages: 214-220, ISSN: 2310-3434
Osteoporosis with resultant fractures is a major global health problem with huge socioeconomicimplications for patients, families and healthcare services. Areal (2D bone mineraldensity (BMD) assessment is commonly used for predicting such fracture risk, but is unreliable,estimating only about 50% of bone strength. By contrast, computed tomography (CT) basedtechniques could provide improved metrics for estimating bone strength such as bone volumefraction (BVF; a 3D volumetric measure of mineralised bone), enabling cheap, safe and reliablestrategies for clinical application, and to help divert resources to patients identified as most likelyto benefit, meeting an unmet need.Here we describe a novel method for measuring BVF at clinical-CT like low-resolution(550µm voxel size). Femoral heads (n=8) were micro-CT scanned ex-vivo. Micro-CT data weredowngraded in resolution from 30µm to 550µm voxel size and BVF calculated at high and lowresolution. Experimental mechanical testing was applied to measure ex vivo bone strength ofsamples. BVF measures collected at high-resolution showed high correlation (correlationcoefficient r2=0.95) with low-resolution data. Low-resolution BVF metrics showed high correlation(r2=0.96) with calculated sample strength. These results demonstrate that measuring BVF at lowresolution is feasible, which also predicts bone strength. Measures of BVF should be useful for clinically estimating bone strength and fracture risk. The method needs to be validated using clinical CT scans.
Rice L, Harris S, Green MML, et al., 2015, Deep inspiration breath-hold (DIBH) technique applied in right breast radiotherapy to minimize liver radiation, BJR Case Reports, Vol: 1, Pages: 1-4, ISSN: 2055-7159
A right-sided breast cancer patient (stage T1N0M0) was referred for post-surgical radiotherapy to minimize risk of local tumour recurrence. During the CT simulation and intensity-modulated radiotherapy planning process undertaken in free breathing, it was apparent that an unusually large volume of normal liver tissue (134 cc) was in the high-dose region of the tangential radiation field. This raised concern for risk of liver side effects and was considered suboptimal for this excellent prognosis patient. A deep inspiration breath-hold (DIBH) technique using three-dimensional (3D) surface monitoring—primarily developed and applied in left breast cancer to displace cardiac tissue from the target field—was investigated to determine potential benefit to optimize radiotherapy delivery. Resimulation of DIBH resulted in considerable displacement of the liver, reducing the volume of liver tissue in the target field by 63% (to 50 cc) and the mean liver dose by 46% (to 2.6 Gy). As the patient was deemed suitable for the DIBH technique, treatment was delivered according to the DIBH plan. A total of 40.05 Gy in 15 fractions was successfully delivered in the DIBH position using a technique that incorporated 3D body surface imaging with automated radiation beam hold-off when out of tolerance. Additional advantages were optimal set up without extensive immobilization and the elimination of respiratory motion. Acute mild skin erythema was the only side effect experienced—no liver sequalae were experienced by the patient up to 6 months after treatment. DIBH treatment may improve liver sparing in other similar right breast cancer patients.
Wilson HC, Shah SI, Abel PD, et al., 2015, Contemporary hormone therapy with LHRH agonists for prostate cancer: avoiding osteoporosis and fracture., Central European Journal of Urology, Vol: 68, Pages: 165-168, ISSN: 2080-4873
INTRODUCTION: Prostate cancer is a large clinical burden across Europe. It is, in fact, the most common cancer in males, accounting for more than 92,300 deaths annually throughout the continent. Prostate cancer is androgen-sensitive; thus an androgen deprivation therapy (ADT) is often used for treatment by reducing androgen to castrate levels. Several ADT agents have achieved benefits with effective palliation, but, unfortunately, severe adverse events are frequent. Contemporary ADT (Luteinising Hormone Releasing Hormone agonist - LHRHa injections) can result in side effects that include osteoporosis and fractures, compromising quality of life and survival. METHODS: In this review we analysed the associated bone toxicity consequent upon contemporary ADT and based on the literature and our own experience we present future perspectives that seek to mitigate this associated toxicity both by development of novel therapies and by better identification and prediction of fracture risk. RESULTS: Preliminary results indicate that parenteral oestrogen can mitigate associated osteoporotic risk and that CT scans could provide a more accurate indicator of overall bone quality and hence fracture risk. CONCLUSIONS: As healthcare costs increase globally, cheap and effective alternatives that achieve ADT, but mitigate or avoid such bone toxicities, will be needed. More so, innovative techniques to improve both the measurement and the extent of this toxicity, by assessing bone health and prediction of fracture risk, are also required.
Shah SIA, Abel PD, Duong T, et al., 2014, Parenteral oestrogen: Effective and safer than both oral oestrogen and contemporary androgen deprivation therapy for prostate cancer?, SCANDINAVIAN JOURNAL OF UROLOGY, Vol: 48, Pages: 411-412, ISSN: 2168-1805
Price PM, Badawi RD, Cherry SR, et al., 2014, Ultra Staging to Unmask the Prescribing of Adjuvant Therapy in Cancer Patients: The Future Opportunity to Image Micrometastases Using Total-Body F-18-FDG PET Scanning, JOURNAL OF NUCLEAR MEDICINE, Vol: 55, Pages: 696-697, ISSN: 0161-5505
Rembielak AI, Jain P, Jackson AS, et al., 2014, Phase II Trial of Cetuximab and Conformal Radiotherapy Only in Locally Advanced Pancreatic Cancer with Concurrent Tissue Sampling Feasibility Study, TRANSLATIONAL ONCOLOGY, Vol: 7, Pages: 55-64, ISSN: 1936-5233
Malietzis G, Monzon L, Hand J, et al., 2013, High-intensity focused ultrasound: advances in technology and experimental trials support enhanced utility of focused ultrasound surgery in oncology, BRITISH JOURNAL OF RADIOLOGY, Vol: 86, ISSN: 0007-1285
Whitfield G, Jain P, Green M, et al., 2012, Quantifying motion for pancreatic radiotherapy margin calculation, RADIOTHERAPY AND ONCOLOGY, Vol: 103, Pages: 360-366, ISSN: 0167-8140
Patterson DM, Zweifel M, Middleton MR, et al., 2012, Phase I Clinical and Pharmacokinetic Evaluation of the Vascular-Disrupting Agent OXi4503 in Patients with Advanced Solid Tumors, CLINICAL CANCER RESEARCH, Vol: 18, Pages: 1415-1425, ISSN: 1078-0432
Kotasidis FA, Matthews JC, Reader AJ, et al., 2012, Direct Parametric Reconstruction for Dynamic [F-18]-FDG PET/CT Imaging in the Body, IEEE Nuclear Science Symposium / Medical Imaging Conference Record (NSS/MIC) / 19th Room-Temperature Semiconductor X-ray and Gamma-ray Detector Workshop, Publisher: IEEE, Pages: 3383-3386, ISSN: 1095-7863
Price PM, Green MM, 2011, Positron emission tomography imaging approaches for external beam radiation therapies: current status and future developments, BRITISH JOURNAL OF RADIOLOGY, Vol: 84, Pages: S19-S34, ISSN: 0007-1285
Monzon L, Wasan H, Leen E, et al., 2011, Transrectal high-intensity focused ultrasonography is feasible as a new therapeutic option for advanced recurrent rectal cancer: report on the first case worldwide., Ann R Coll Surg Engl, Vol: 93, Pages: e119-e121
High-intensity focused ultrasonography is the only completely non-invasive thermal therapy. To date its applications have been limited but clinical indications are expanding with enhanced technological advances that have increased the accuracy of targeting and decreased the duration of treatment times. We report its first use for rectal cancer.
Langley RE, Cafferty FH, Pollock PA, et al., 2011, Re: Toremifene to Reduce Fracture Risk in Men Receiving Androgen Deprivation Therapy for Prostate Cancer, JOURNAL OF UROLOGY, Vol: 185, Pages: 2430-2431, ISSN: 0022-5347
Saleem A, Matthews JC, Ranson M, et al., 2011, Molecular imaging and pharmacokinetic analysis of carbon-11 labeled antisense oligonucleotide LY2181308 in cancer patients, Theranostics, Vol: 1, Pages: 290-301, ISSN: 1838-7640
Antisense oligonucleotides (ASOs) have potential as anti-cancer agents by specifically modulating genes involved in tumorigenesis. However, little is known about ASO biodistribution and tissue pharmacokinetics (PKs) in humans, including whether sufficient delivery to target tumor tissue may be achieved. In this preliminary study in human subjects, we used combined positron emission and computed tomography (PET-CT) imaging and subsequent modeling analysis of acquired dynamic data, to examine the in vivo biodistribution and PK properties of LY2181308 - a second generation ASO which targets the apoptosis inhibitor protein survivin. Following radiolabeling of LY2181308 with methylated carbon-11 ([11C]methylated-LY2181308), micro-doses (<1mg) were administered to three patients with solid tumors enrolled in a phase I trial. Moderate uptake of [11C]methylated-LY2181308 was observed in tumors (mean=32.5ng/mL per mg administered intravenously). Highest uptake was seen in kidney and liver and lowest uptake was seen in lung and muscle. One patient underwent repeat analysis on day 15 of multiple dose therapy, during administration of LY2181308 (750mg), when altered tissue PKs and a favorable change in biodistribution was seen. [11C]methylated-LY2181308 exposure increased in tumor, lung and muscle, whereas renal and hepatic exposure decreased. This suggests that biological barriers to ASO tumor uptake seen at micro-doses were overcome by therapeutic dosing. In addition, 18F-labeled fluorodeoxyglucose (FDG) scans carried out in the same patient before and after treatment showed up to 40% decreased tumor metabolism. For the development of anti-cancer ASOs, the results provide evidence of LY2181308 tumor tissue delivery and add valuable in vivo pharmacological information. For the development of novel therapeutic agents in general, the study exemplifies the merits of applying PET imaging methodology early in clinical investigations.
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