The aim of this study was to investigate the inter-fraction variations, patient comfort and knowledge at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The differences in set-up that occurred between treatme...The aim of this study was to investigate the inter-fraction variations, patient comfort and knowledge at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The differences in set-up that occurred between treatment sessions for the left sided breast patients were observed and recorded. Measurements of routine set-up variation for 24 patients were performed by matching the cone beam computed tomography (CBCT) and the planning computed tomography (CT). Scans of all five fractions per patient were used to quantify the setup variations with standard deviation (SD) in all the three directions (anterior posterior, left right, and superior inferior). The patients DIBH comfort and knowledge was also evaluated. The average translational errors for the anterior posterior (AP, z), left-right (LR, x), and Superior-inferior (SI, y) directions were 0.40 cm, 0.40 cm, and 0.40 cm, respectively. The translation variation of the three directions showed statistical significance (P < 0.05). On comfort and knowledge investigation, among all participants, 80% moderately agreed that the therapist’s instructions for operating the deep inspiration breath hold (DIBH) technique were easy to understand, and 63.33% indicated that their comfort with the DIBH technique was neutral or average. The inter-fraction variations in patients with left-sided breast cancer were qualitatively analyzed. Significant shifts between CBCT and planning CT images were observed. The daily treatment verification could assist accurate dose delivery.展开更多
Purpose: To assess clinical outcomes after using IG-IMRT for palliation among patients with advanced cancers. Methods: Patients with advanced and/or metastatic cancers were treated on our Tomo-PAL (Tomotherapy?-Planni...Purpose: To assess clinical outcomes after using IG-IMRT for palliation among patients with advanced cancers. Methods: Patients with advanced and/or metastatic cancers were treated on our Tomo-PAL (Tomotherapy?-Planning and Administration Linked) protocol using helical TomoTherapy? and evaluated to assess clinical efficacy of treatment as well as to assess side effects. Results: A total of 40 patients were treated to 40 sites from Feb 2007 to May 2009. There were 25 men and 15 women with a median age of 70 years (range 16 - 94). Pain and bleeding were the most common symptoms being palliated (80% and 12.5% respectively). The dose prescribed ranged from 5 - 25 Gy in 1 - 5 fractions. A qualitative improvement in symptoms was documented in 82% of patients (75% partial relief and 7% complete relief) and major side effects were not encountered. Conclusions: IG-IMRT can be used for palliation and produces response rates that compare favourably with those reported in the published literature.展开更多
Identification of extrahepatic metastases(EHM) of hepatocellular carcinoma(HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle t...Identification of extrahepatic metastases(EHM) of hepatocellular carcinoma(HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle tissue is extremely rare. We describe a unique case of HCC metastasizing to the paravertebral muscle. A 55-year-old man with a history of hepatitis B cirrhosis underwent partial liver resection with complete removal of HCC. Three months later, a computed tomography(CT) scan showed intrahepatic recurrence. The tumors were treated with yttrium-90 microspheres, transcatheter arterial chemoembolization, and sorafenib. Six months later, a CT scan showed an enhancing lesion of the left paravertebral muscle that on biopsy were consistent with metastatic HCC. The tumor was treated with stereotactic hypo-fractionated imageguided radiation therapy(SHFRT). A follow-up scan 3 mo post-radiotherapy revealed a stable appearance of the paravertebral muscle metastasis. Because of the progression in the intrahepatic tumors, the patient was treated with capecitabine, which was changed to dasatinib 6 mo later. The patient passed away three years after the primary surgical resection. Management of EHM poses an extreme challenge. This is the first case of HCC with EHM to the paravertebral muscle in which stability of disease was achieved using SHFRT. This case highlights the importance of early detection of hepatitis B viral infection and initiation of anti-viral therapy to decrease recurrence of HCC and prevent EHM.展开更多
Objectives: In 1997, a study was launched to investigate the treatment of early prostate cancer. Using a patient preference design, health-related quality-of-life (HRQOL) and disease specific HRQOL was assessed prospe...Objectives: In 1997, a study was launched to investigate the treatment of early prostate cancer. Using a patient preference design, health-related quality-of-life (HRQOL) and disease specific HRQOL was assessed prospectively to compare men undergoing radical prostatectomy (RP), hypo-fractionated conformal radiotherapy (CRT) or brachytherapy (BT). Methods: Patients with localised prostate cancer were counselled by a urological surgeon, clinical oncologist and specialist uro-oncology nurse. Patients received treatment according to individual preference. 430 men chose and received RP (n = 217), CRT (n = 161) and BT (n = 52). 354 (82%) completed pre-treatment RAND 36-Item Short-Form Health survey version-2 (SF36v2) and University of California, Los Angeles Prostate cancer index (UCLA-PCI) questionnaires. HRQOL score changes from baseline to 24 months were compared using Kruskall-Wallis test. Results: Pre-treatment, the CRT cohort scored lower for physical function (p = 0.0029) and general health perception (p = 0.0021). The BT cohort reported better baseline scores for urinary function (p = 0.0291), urinary bother (p = 0.0030), sexual function (p = 0.0009) and bowel bother (p = 0.0063). At 24 months, bowel function was similar for CRT and BT but both modalities were worse than RP (p = 0.0010). Urinary continence deteriorated most following RP (p < 0.0001) but BT had worse urinary bother (p = 0.0153). Sexual function deteriorated most following RP and BT (p < 0.0005). Percentages of patients achieving erections adequate for sexual activity (from baseline to 24 months) were 66% to 29% for RP, 62% to 49% for CRT and 88% to 65% for BT. Conclusion: This data demonstrates significant differences in disease specific quality-of-life between RP, CRT and BT and should be available for men with early prostate cancer making treatment decisions.展开更多
Background Metastatic lung cancer is one of the most common oncologic problems. This study aimed to evaluate the long-term clinical outcome of stereotactic body radiation therapy （SBRT） for metastatic lung tumors. M...Background Metastatic lung cancer is one of the most common oncologic problems. This study aimed to evaluate the long-term clinical outcome of stereotactic body radiation therapy （SBRT） for metastatic lung tumors. Methods We retrospectively reviewed the 71 patients with lung metastases, who had 172 lesions treated with SBRT from January 2000 to December 2006. All patients were unfit or failed after surgery and/or chemotherapy. The median total dose was 48 Gy （range, 30-60） in 4 （range, 2-12） fractions. The median size of the irradiated lesions was 2.1 cm （range, 0.9-7.9 cm）. Results All but two patients received follow up. The median follow-up time was 24.7 months （range, 2.9-114.4 months）. The median follow-up time for living patients was 86.8 months （range, 58.1-114.4 months）. The 1-, 3-, 5-year local control and overall survival rates were 88.8%, 75.4%, 75.4% and 78.9%, 40.8%, 25.2%. Multivariate analysis showed that the absence of extrapulmonary metastases （P=-0.024; hazard ratio （HR）, 1.894; 95% confidence interval （C/）, 1.086-3.303） and disease-free interval 〈12 months （P=0.014; HR, 0.511; 95% Cl, 0.299-0.873） were independent prognostic factors. No grade 3 or more acute and late toxicities occurred. Only one patient developed a non-symptomatic rib fracture. Conclusion SBRT could be an alternative treatment to surgery for subsets of patients with lung metastases with favorable long-term survival and tolerable complications.展开更多
文摘The aim of this study was to investigate the inter-fraction variations, patient comfort and knowledge at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The differences in set-up that occurred between treatment sessions for the left sided breast patients were observed and recorded. Measurements of routine set-up variation for 24 patients were performed by matching the cone beam computed tomography (CBCT) and the planning computed tomography (CT). Scans of all five fractions per patient were used to quantify the setup variations with standard deviation (SD) in all the three directions (anterior posterior, left right, and superior inferior). The patients DIBH comfort and knowledge was also evaluated. The average translational errors for the anterior posterior (AP, z), left-right (LR, x), and Superior-inferior (SI, y) directions were 0.40 cm, 0.40 cm, and 0.40 cm, respectively. The translation variation of the three directions showed statistical significance (P < 0.05). On comfort and knowledge investigation, among all participants, 80% moderately agreed that the therapist’s instructions for operating the deep inspiration breath hold (DIBH) technique were easy to understand, and 63.33% indicated that their comfort with the DIBH technique was neutral or average. The inter-fraction variations in patients with left-sided breast cancer were qualitatively analyzed. Significant shifts between CBCT and planning CT images were observed. The daily treatment verification could assist accurate dose delivery.
文摘Purpose: To assess clinical outcomes after using IG-IMRT for palliation among patients with advanced cancers. Methods: Patients with advanced and/or metastatic cancers were treated on our Tomo-PAL (Tomotherapy?-Planning and Administration Linked) protocol using helical TomoTherapy? and evaluated to assess clinical efficacy of treatment as well as to assess side effects. Results: A total of 40 patients were treated to 40 sites from Feb 2007 to May 2009. There were 25 men and 15 women with a median age of 70 years (range 16 - 94). Pain and bleeding were the most common symptoms being palliated (80% and 12.5% respectively). The dose prescribed ranged from 5 - 25 Gy in 1 - 5 fractions. A qualitative improvement in symptoms was documented in 82% of patients (75% partial relief and 7% complete relief) and major side effects were not encountered. Conclusions: IG-IMRT can be used for palliation and produces response rates that compare favourably with those reported in the published literature.
文摘Identification of extrahepatic metastases(EHM) of hepatocellular carcinoma(HCC) has been paradoxically increasing due to an increase in the survival of HCC patients. However, metastasis of HCC to the skeletal muscle tissue is extremely rare. We describe a unique case of HCC metastasizing to the paravertebral muscle. A 55-year-old man with a history of hepatitis B cirrhosis underwent partial liver resection with complete removal of HCC. Three months later, a computed tomography(CT) scan showed intrahepatic recurrence. The tumors were treated with yttrium-90 microspheres, transcatheter arterial chemoembolization, and sorafenib. Six months later, a CT scan showed an enhancing lesion of the left paravertebral muscle that on biopsy were consistent with metastatic HCC. The tumor was treated with stereotactic hypo-fractionated imageguided radiation therapy(SHFRT). A follow-up scan 3 mo post-radiotherapy revealed a stable appearance of the paravertebral muscle metastasis. Because of the progression in the intrahepatic tumors, the patient was treated with capecitabine, which was changed to dasatinib 6 mo later. The patient passed away three years after the primary surgical resection. Management of EHM poses an extreme challenge. This is the first case of HCC with EHM to the paravertebral muscle in which stability of disease was achieved using SHFRT. This case highlights the importance of early detection of hepatitis B viral infection and initiation of anti-viral therapy to decrease recurrence of HCC and prevent EHM.
文摘Objectives: In 1997, a study was launched to investigate the treatment of early prostate cancer. Using a patient preference design, health-related quality-of-life (HRQOL) and disease specific HRQOL was assessed prospectively to compare men undergoing radical prostatectomy (RP), hypo-fractionated conformal radiotherapy (CRT) or brachytherapy (BT). Methods: Patients with localised prostate cancer were counselled by a urological surgeon, clinical oncologist and specialist uro-oncology nurse. Patients received treatment according to individual preference. 430 men chose and received RP (n = 217), CRT (n = 161) and BT (n = 52). 354 (82%) completed pre-treatment RAND 36-Item Short-Form Health survey version-2 (SF36v2) and University of California, Los Angeles Prostate cancer index (UCLA-PCI) questionnaires. HRQOL score changes from baseline to 24 months were compared using Kruskall-Wallis test. Results: Pre-treatment, the CRT cohort scored lower for physical function (p = 0.0029) and general health perception (p = 0.0021). The BT cohort reported better baseline scores for urinary function (p = 0.0291), urinary bother (p = 0.0030), sexual function (p = 0.0009) and bowel bother (p = 0.0063). At 24 months, bowel function was similar for CRT and BT but both modalities were worse than RP (p = 0.0010). Urinary continence deteriorated most following RP (p < 0.0001) but BT had worse urinary bother (p = 0.0153). Sexual function deteriorated most following RP and BT (p < 0.0005). Percentages of patients achieving erections adequate for sexual activity (from baseline to 24 months) were 66% to 29% for RP, 62% to 49% for CRT and 88% to 65% for BT. Conclusion: This data demonstrates significant differences in disease specific quality-of-life between RP, CRT and BT and should be available for men with early prostate cancer making treatment decisions.
文摘Background Metastatic lung cancer is one of the most common oncologic problems. This study aimed to evaluate the long-term clinical outcome of stereotactic body radiation therapy （SBRT） for metastatic lung tumors. Methods We retrospectively reviewed the 71 patients with lung metastases, who had 172 lesions treated with SBRT from January 2000 to December 2006. All patients were unfit or failed after surgery and/or chemotherapy. The median total dose was 48 Gy （range, 30-60） in 4 （range, 2-12） fractions. The median size of the irradiated lesions was 2.1 cm （range, 0.9-7.9 cm）. Results All but two patients received follow up. The median follow-up time was 24.7 months （range, 2.9-114.4 months）. The median follow-up time for living patients was 86.8 months （range, 58.1-114.4 months）. The 1-, 3-, 5-year local control and overall survival rates were 88.8%, 75.4%, 75.4% and 78.9%, 40.8%, 25.2%. Multivariate analysis showed that the absence of extrapulmonary metastases （P=-0.024; hazard ratio （HR）, 1.894; 95% confidence interval （C/）, 1.086-3.303） and disease-free interval 〈12 months （P=0.014; HR, 0.511; 95% Cl, 0.299-0.873） were independent prognostic factors. No grade 3 or more acute and late toxicities occurred. Only one patient developed a non-symptomatic rib fracture. Conclusion SBRT could be an alternative treatment to surgery for subsets of patients with lung metastases with favorable long-term survival and tolerable complications.
