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Connolly Hospital Dublin
St. Luke’s Radiation Oncology Network Dublin (25)
Author
Armstrong, John, G
(20)
Holmberg, Ola
(1)
Kelleher, F.C
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Mydin, A.R
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O'Shea, Evelyn
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Adjuvant radiotherapy in Stage I endometrial cancer. Where do we stand? (1)
Aims: The treatment of prostate cancer is frequently influenced by the Partin Tables. This predictive model has been internally and externally validated since it was conceived, and has proved to be remarkably reliable andconsistent. This paper proposes that, by using the statistical programme for the social sciences (SPSS) and receiver-operator characteristic curves, it is possible to detect institutions that apply this model sub-optimally. Materials and methods: This theory was supported by a PUBMED search using relevant search words. Results: This is a novel technique with the potential to allow retrospective and prospective accrual of results. Conclusions: A systematic institutional review of how accurately a hospital assesses the clinical stage, Gleason score and PSA has the potential to increase an institution's predictive accuracy when it uses the Partin Tables. The proposed method allows for quantitation of the level of error and comparison of predictive accuracy between institutions. It also may be used as an internal outcome measure to assess improvement in a hospital's investigative procedures over time (1)
Analysis of the results of treatment of localised prostate cancer with radiation and surgery has identified patients who are at high risk of developing metastatic dissemination. High histologic grade, serum prostate specific antigen above 20 ng/ml, extension beyond the capsule of the prostate, and involvement of lymph nodes are highly predictive of metastatic risk. Antiandrogen therapy has high rates of activity in the treatment of overt metastatic disease prompting its assessment as an adjuvant treatment added to radiation therapy. There are now major prospective randomized trials which have been completed. The current evidence indicates that a large survival benefit ensues when antiandrogen therapy is added to radiation for appropriately selected patients. This adjuvant approach is likely to become the standard of care. Strategies for further enhancement of adjuvant therapy are discussed (1)
BACKGROUND: Patient immobilisation and position are important contributors to the reproducibility and accuracy of radiation therapy. In addition the choice of position can alter the external contour of the treated area and has the potential to alter the spatial relationship between internal organs. The published literature demonstrates variation in the use of the prone and supine position for prostate cancer radiation therapy. Previous investigators using different protocols for patient preparation, imaging and target volume definition have demonstrated changes in the calculated therapeutic ratio comparing the two positions. We did not use rigid immobilisation, laxatives, rectal catheters or bladder voiding and assessed if in the prone position would cause a reduction of the dose to the rectum. We performed a prospective comparison of the two positions in 26 patients to determine if the differences in the spatial relation between the rectum and the planning target volume (PTV) would impact on dose-volume histograms to organs at risk (OAR). We also determined if any such improvement might permit dose escalation (1)
PURPOSE: Local failure is a major obstacle to the cure of locally advanced non-small-cell lung cancer. 3-Dimensional conformal radiation therapy (3-DCRT) selects optimal treatment parameters to increase dose to tumor and reduce normal tissue dose, potentially permitting dose escalation. There are several ongoing trials of dose escalation using 3-dimensional conformal radiation therapy for non-small-cell lung cancer. We performed this analysis to determine if data derived from dose volume histograms could be used as the basis for designing the method of dose escalation in these trials. ""METHODS AND MATERIALS: Between 1990 and 1993, 31 patients were treated with 3-DCRT and had complete normal tissue dose volume histograms created as part of the planning process. The stage distribution was stage I/TI 13, stage IHa in 45, and stage Illb in 42. The median radiation dose to gross disease was 70.2 Gy (52.2�;72 Gy). Elective mediastinal irradiation (50.4 Gy) was administered to 52 (16/31) of patients. RESULTS: Thr toxicity encountered in this experience was pulmonary. Dose-volume-histogram data were used to analyze the predictors of toxicity and showed a correlation between risk of pulmonary toxicity and indices of dose to lung parenchyma. Grade 3 or higher pulmonary toxicityoccurred in 38 (3/8) of pts with (1)
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PURPOSE: Non-small cell lung cancer (NSCLC) patients with locally advanced unresectable disease have a grim prognosis. Radiotherapeutic strategies are necessary to improve the permanent eradication of thoracic disease. The poor results achieved with conventional external beam radiation therapy reflect in part, the inadequacy of such therapy in achieving its primary objective of achieving local control. The impact of three-dimensional conformal radiation therapy (3-DCRT) on local disease eradication and its potential role in improving survival is assessed. DESIGN: This review addresses aspects of the software and hardware technology of 3-DCRT, the clinical and technical aspects of target volume definition, the use of 3-DCRT to predict radiation pneumonitis, strategies for dose escalation in NSCLC, and analyses the clinical results to date. RESULTS: Initially investigators compared the best treatment techniques devised with conventional planning techniques to those devised with 3-DCRT (1)
Three-dimensional conformal radiation therapy (3DCRT) is a mode of high precision radiotherapy which has the potential to improve the therapeutic ratio of radiation therapy for locally advanced non-small cell lung cancer. The preliminary clinical experience with 3DCRT has been promising and justifies further endeavour to refine its clinical application and ultimately test its role in randomized trials. There are several steps to be taken before 3DCRT evolves into an effective single modality for the treatment of lung cancer and before it is effectively integrated with chemotherapy. This article addresses core issues in the process of target volume definition for the application of 3DCRT technology to lung cancer. The International Commission on Radiation Units and Measurements Report no. 50 definitions of target volumes are used to identify the factors influencing target volumes in lung cancer. The rationale for applying 3DCRT to lung cancer is based on the frequency of failure to eradicate gross tumour with conventional approaches. It may therefore be appropriate to ignore subclinical or microscopic extensions when designing a clinical target volume, thereby restricting target volume size and allowing dose escalation. When the clinical target volume is expanded to a planning target volume, an optimized margin would result in homogeneous irradiation to the highest dose feasible within normal tissue constraints. To arrive at such optimized margins, multiple factors, including data acquisition, data transfer, patient movement, treatment reproducibility, and internal organ and target volume motion, must be considered. These factors may vary significantly depending on technology and techniques, and published quantitative analyses are no substitute for meticulous attention to detail and audit of performance (1)
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1)
The current status of adjuvant hormonal therapy combined with radiation therapy for localised prostate cancer
Author
Armstrong, John, G
Pub. Date
1998
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Further interpretation of the PORT meta-analysis
Author
Armstrong, John, G
Pub. Date
2002
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3)
Careers in radiotherapy - clinical oncology
Author
Armstrong, John, G
Pub. Date
1997
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4)
A phase II trial for the optimisation of treatment position in the radiation therapy of prostate cancer
Author
Armstrong, John, G
Publisher
Staff Publications- Mairin Cannon
Pub. Date
2008
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5)
Stereotactic techniques for primary tumours and metastatic cancer
Author
Armstrong, John, G
Pub. Date
2008
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6)
Three-dimensional conformal radiotherapy: precision treatment of lung cancer
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Armstrong, John, G
Pub. Date
1994
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7)
Advances in radiation technology can improve survival and quality of life for cancer patients
Author
Armstrong, John, G
Pub. Date
2001
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8)
Advanced in radiation technology can improve survival and quality of life for cancer patients
Author
Armstrong, John, G
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9)
Adjuvant hormonal therapy for cancer of the prostate
Author
Armstrong, John, G
Pub. Date
1996
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10)
Target volume definition for three-dimensional conformal radiation therapy of lung cancer
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Armstrong, John, G
Pub. Date
June 1998
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11)
Breast conservation; role of radiation therapy
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Armstrong, John, G
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12)
Pilomatrix carcinoma presenting as an extra axial mass: clinicopathological features
Author
Armstrong, John, G
Publisher
Staff Publications- Aherne, Noel J
Pub. Date
2008
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13)
Radiotherapy for prostate cancer: recent advances
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Armstrong, John, G
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14)
Strategy for dose escalation using 3-dimensional conformal radiation therapy for lung cancer
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Armstrong, John, G
Pub. Date
1995
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15)
Comparison of conformity index in 3D-CRT, IMRT, and proton therapy in lung cancer
Author
Armstrong, John, G
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16)
Three-dimensional conformal radiation therapy at the Memorial Sloan-Kettering Cancer Center
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Armstrong, John, G
Pub. Date
1992
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17)
The impact of three-dimensional radiation on the treatment of non-small cell lung cancer
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Armstrong, John, G
Pub. Date
2000
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18)
The management of prostate cancer
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Armstrong, John, G
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19)
Strategies to enhance the benefits of increasing local control of cancer with radiation
Author
Armstrong, John, G
Pub. Date
1999
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20)
The diagnosis and management of prostate cancer
Author
Armstrong, John, G
Pub. Date
1998
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