Verity Ahern - Academia.edu (original) (raw)

Papers by Verity Ahern

Research paper thumbnail of Absence of adverse early quality of life outcomes of radiation therapy in breast conservation therapy for early breast cancer

Journal of medical imaging and radiation oncology, Feb 1, 2005

The New South Wales Breast Radiation Oncology Group has completed a prospective multicentre study... more The New South Wales Breast Radiation Oncology Group has completed a prospective multicentre study of the impact of radiation therapy (RT) on acute toxicity and quality of life (QoL) in women with early breast cancer treated with breast conservation therapy. The patient group received adjuvant breast tangential RT after wide local excision of breast cancer. Acute toxicity and cosmesis was assessed quantitatively and qualitatively. European Organization of Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30) and Perceived Adjustment to Chronic Illness Scale (PACIS) were the QoL instruments used. Of 175 women, 34.3% described lethargy leading to a significant disruption to normal activity during RT. At week 6, this had reduced to 7.5% reporting significant lethargy. No negative effects on QoL were noted over the time period of RT; EORTC demonstrated no difference (P = 0.79). PACIS recorded a significant improvement in functioning (P < 0.001) from baseline to week 6. Univariate analysis on potential predictive patient, tumour and treatment factors demonstrated an association of baseline pre-RT breast discomfort with worse lethargy (P = 0.03), EORTC (P < 0.01) and PACIS (P < 0.01) measures. This study confirms the minimal impact of RT on patient functioning at 6 weeks post-treatment.

Research paper thumbnail of Dr. Colin Alexander Bull

Journal of Medical Imaging and Radiation Oncology

Research paper thumbnail of Outcomes of Patients Treated in the UK Proton Overseas Programme: Non-central Nervous System Group

Research paper thumbnail of RADT-38. Incidence of Hearing Impairment After Definitive Proton Beam Therapy for Malignancies of the Brain and Base of Skull

Neuro-Oncology

AIM Aim of the project is to report the incidence of moderate/severe (G ≥ 3) long-term hearing im... more AIM Aim of the project is to report the incidence of moderate/severe (G ≥ 3) long-term hearing impairment (HI) and to identify risk factors in patients treated for malignancies of the brain and base of skull with definitive Proton Beam Therapy (PBT) within the Proton Overseas Programme (POP). METHODS Clinical and treatment-related data from patients’ files stored in a national database and curated by a dedicated outcomes unit were extracted and analysed. Clinical toxicity data from the POP were graded as per Common Terminology Criteria for Adverse Events (CTCAE 4.0). Dosimetric data (Dmean to the cochlear structures) were extracted from the Treatment Planning System Proknow. For the purpose of this analysis, patients with radical definitive PBT only were selected. RESULTS Between 2008 - 2018, 229 UK patients received radical PBT overseas for Craniopharyngioma (104 patients;45.4%), Chordoma (60; 26.2%), Chondrosarcoma (53;23.1%), Meningioma (7;3%), Pituitary Adenoma (5;2.1%). Median ...

Research paper thumbnail of A rare case of delayed radiation necrosis following adjuvant radiotherapy for recurrent breast cancer

British Journal of Hospital Medicine

Research paper thumbnail of Radiation doses and fractionation schedules in non-low-risk ductal carcinoma in situ in the breast (BIG 3–07/TROG 07.01): a randomised, factorial, multicentre, open-label, phase 3 study

Research paper thumbnail of Patient-Specific Heart Constraint: A Tool for Optimization and Evaluation of Mean Heart Dose in Breast Cancer Patients

Practical Radiation Oncology, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Feasibility of arm‐draining lymph node‐sparing radiotherapy of breast cancer: A pilot planning study

Journal of Medical Imaging and Radiation Oncology, 2021

IntroductionLymphoedema following axillary radiotherapy for breast cancer causes significant morb... more IntroductionLymphoedema following axillary radiotherapy for breast cancer causes significant morbidity. Our goal was to evaluate the feasibility of sparing the lymph node that drains the arm’s lymphatics (ARM node) while achieving standard dose constraints for whole breast and comprehensive lymph node irradiation.MethodsSix patients underwent lymphoscintigraphy and SPECT CT to identify the breast sentinel node (SN) and ARM node. The ARM node was contoured on the SPECT CT and deformably registered to the radiotherapy treatment planning CT. Radiotherapy plans (50 Gy in 25 fractions) with VMAT technique were generated, with the aim to spare the ARM node (Mean dose <25 Gy) and achieve adequate coverage to the remaining axilla. The plan required the breast SN site (clip + 10 mm surrounding the clip) to achieve D98% > 47.5 Gy, and axillary nodal CTV excluding ARM node to achieve D90% > 45 Gy.ResultsIn one patient, the ARM node was within the volume of breast SN site and sparing w...

Research paper thumbnail of Pediatric Radiotherapy in Low and Middle Income Countries

Communicable diseases are still the leading cause of childhood mortality in third world countries... more Communicable diseases are still the leading cause of childhood mortality in third world countries. However, as prevention and treatment of malnutrition and infectious diseases improves, global health challenges are shifting towards combating non-communicable diseases including cancer which has high rates of mortality in children (Wilimas and Ribeiro 2001). More than two-thirds of the world’s pediatric cancers are currently diagnosed in low- and middle income countries (LMIC) (Kellie and Howard 2008). The patterns of occurrence of childhood cancer in LMIC compared to high income countries (HIC) and the lack of population-based cancer registries suggest that many patients die from undiagnosed cancer and the burden of childhood cancer is under-estimated. Children diagnosed with cancer in low-income countries (LIC) continue to have a much poorer chance of survival compared to those in HIC (Fig. 21.1).

Research paper thumbnail of Impact of the EndoPredict genomic assay on treatment decisions for oestrogen receptor-positive early breast cancer patients: benefits of physician selective testing

Breast Cancer Research and Treatment, 2021

Genomic tests improve accuracy of risk prediction for early breast cancers but these are expensiv... more Genomic tests improve accuracy of risk prediction for early breast cancers but these are expensive. This study evaluated the clinical utility of EndoPredict®, in terms of impact on adjuvant therapy recommendations and identification of parameters to guide selective application. Patients with ER-positive, HER2-negative, and early-stage invasive breast cancer were tested with EndoPredict®. Two cohorts were recruited: one consecutively and another at clinical team discretion. Systemic treatment recommendations were recorded before and after EndoPredict® results were revealed to the multidisciplinary team. 233 patients were recruited across five sites: 123 consecutive and 110 at clinical team discretion. In the consecutive cohort 50.6% (62/123) cases were classified high risk of recurrence by EndoPredict®, compared with 62.7% (69/110) in the selective cohort. A change in treatment recommendation was significantly more likely (p < 0.0001) in the selective cohort (43/110, 39.1%) compared to the consecutive group (11/123, 8.9%). The strongest driver of selective recruitment was intermediate grade histology, whilst logistic regression modelling demonstrated that nodal status (p < 0.001), proliferative rate (p = 0.001), and progesterone receptor positivity (p < 0.001) were the strongest discriminators of risk. Whilst molecular risk can be predicted by traditional variables in a high proportion of cases, EndoPredict® had a greater impact on treatment decisions in those cases selected for testing at team discretion. This is indicative of the robust ability of the clinical team to identify cases most likely to benefit from testing, underscoring the value of genomic tests in the oncologists’ tool kit.

Research paper thumbnail of Achieving Local Control

Rhabdomyosarcoma is a chemotherapy-responsive tumour, and all patients are treated with chemother... more Rhabdomyosarcoma is a chemotherapy-responsive tumour, and all patients are treated with chemotherapy because this is a systemic disease. 1 The principle North American chemotherapy regimen is vincristine, actinomycin-D and cyclophosphamide (VAC). In European studies, ifosfamide has been substituted for cyclophosphamide (IVA). The role of anthracycline drugs remains controversial; in randomised studies, the addition of doxorubicin or epirubicin did not lead to improved outcomes. However, these drugs do have activity against rhabdomyosarcoma, and some units routinely incorporate them into treatment protocols. A current European study is re-examining the role of doxorubicin, while a recent rhabdomyosarcoma trial within the Children’s Oncology Group for patients with ‘high risk disease’ incorporated doxorubicin in a single arm trial. This latter trial also added irinotecan, ifosfamide and etoposide; early outcome data appear promising. 2 Irinotecan had earlier been shown to be active in...

Research paper thumbnail of PH-0225 TROG 14.04: Multicentre study of feasibility and impact on anxiety of DIBH in breast cancer patients

Radiotherapy and Oncology, 2021

Research paper thumbnail of PO-1475 Systematic prospective data mining in everyday practice – the NHS approach for proton beam therapy

Radiotherapy and Oncology, 2021

Research paper thumbnail of PO-0262 Brachytherapy for paediatric pelvic tumours – sole local therapy modality and combined with surgery

Radiotherapy and Oncology, 2021

Research paper thumbnail of Particle therapy tumour outcomes: An updated systematic review

Journal of Medical Imaging and Radiation Oncology, 2020

SummaryParticle therapy (PT) offers the potential for reduced normal tissue damage as well as esc... more SummaryParticle therapy (PT) offers the potential for reduced normal tissue damage as well as escalation of target dose, thereby enhancing the therapeutic ratio in radiation therapy. Reflecting the building momentum of PT use worldwide, construction has recently commenced for The Australian Bragg Centre for Proton Therapy and Research in Adelaide – the first PT centre in Australia. This systematic review aims to update the clinical evidence base for PT, both proton beam and carbon ion therapy. The purpose is to inform clinical decision‐making for referral of patients to PT centres in Australia as they become operational and overseas in the interim. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and thirty‐six studies were included, two‐thirds related to proton beam therapy alone. PT at the very least provides equivalent tumour outcome...

Research paper thumbnail of Practice patterns and recommendations for pediatric image‐guided radiotherapy: A Children's Oncology Group report

Pediatric Blood & Cancer, 2020

This report by the Radiation Oncology Discipline of Children's Oncology Group (COG) describes... more This report by the Radiation Oncology Discipline of Children's Oncology Group (COG) describes the practice patterns of pediatric image‐guided radiotherapy (IGRT) based on a member survey and provides practice recommendations accordingly. The survey comprised of 11 vignettes asking clinicians about their recommended treatment modalities, IGRT preferences, and frequency of in‐room verification. Technical questions asked physicists about imaging protocols, dose reduction, setup correction, and adaptive therapy. In this report, the COG Radiation Oncology Discipline provides an IGRT modality/frequency decision tree and the expert guidelines for the practice of ionizing image guidance in pediatric radiotherapy patients.

Research paper thumbnail of EP-1404: Non-linear radiomic signatures characterizing overall survival from non-small cell lung cancer

Radiotherapy and Oncology, 2018

was a significant predictor for OS (median, 55.6 vs 24.5 months, p=0.04). Low PLR (≤ 153.1) was a... more was a significant predictor for OS (median, 55.6 vs 24.5 months, p=0.04). Low PLR (≤ 153.1) was associated with longer PFS (45.2 vs 9.8 months, p=0.009). Low NLR (≤ 2.97) showed a trend toward better OS (45.5 vs 24.5 months) and PFS (18.7 vs 10.4 months) with no statistical difference (p=0.19, 0.28). Conclusion Pretreatment PLR and LMR could be prognostic markers for OS and PFS in patients with non-small cell lung cancer treated with chemoradiotherapy. EP-1403 Clinical outcome and toxicity of stereotactic ablative radiotherapy to centrally located tumors.

Research paper thumbnail of EP-1305: Location of arm draining lymph node in relation to breast cancer radiotherapy field and volume

Radiotherapy and Oncology, 2018

significantly long overall survival in comparison with the patients with RLNR. However, multivari... more significantly long overall survival in comparison with the patients with RLNR. However, multivariate Cox regression analysis showed the recurrences site had no significant impact on the overall survival (P=0.14). Conclusion The presented results are excellent in terms of LR rate. Further careful follow-up and careful registration of the recurrences is needed to improve their understanding.

Research paper thumbnail of PO-0757: Non-small cell lung cancer decision support based on distributed learning over multi-center data

Radiotherapy and Oncology, 2018

Research paper thumbnail of Quality of life after breast-conserving therapy and adjuvant radiotherapy for non-low-risk ductal carcinoma in situ (BIG 3-07/TROG 07.01): 2-year results of a randomised, controlled, phase 3 trial

The Lancet Oncology, 2020

Background BIG 3-07/TROG 07.01 is an international, multicentre, randomised, controlled, phase 3 ... more Background BIG 3-07/TROG 07.01 is an international, multicentre, randomised, controlled, phase 3 trial evaluating tumour bed boost and hypofractionation in patients with non-low-risk ductal carcinoma in situ following breastconserving surgery and whole breast radiotherapy. Here, we report the effects of diagnosis and treatment on health-related quality of life (HRQOL) at 2 years. Methods The BIG 3-07/TROG 07.01 trial is ongoing at 118 hospitals in 11 countries. Women aged 18 years or older with completely excised non-low-risk ductal carcinoma in situ were randomly assigned, by use of a minimisation algorithm, to tumour bed boost or no tumour bed boost, following conventional whole breast radiotherapy or hypofractionated whole breast radiotherapy using one of three randomisation categories. Category A was a 4-arm randomisation of tumour bed boost versus no boost following conventional whole breast radiotherapy (50 Gy in 25 fractions over 5 weeks) versus hypofractionated whole breast radiotherapy (42•5 Gy in 16 fractions over 3•5 weeks). Category B was a 2-arm randomisation between tumour bed boost versus no boost following conventional whole breast radiotherapy, and category C was a 2-arm randomisation between tumour bed boost versus no boost following hypofractionated whole breast radiotherapy. Stratification factors were age at diagnosis, planned endocrine therapy, and treating centre. The primary endpoint, time to local recurrence, will be reported when participants have completed 5 years of follow-up. The HRQOL statistical analysis plan prespecified eight aspects of HRQOL, assessed by four questionnaires at baseline, end of treatment, and at 6, 12, and 24 months after radiotherapy: fatigue and physical functioning (EORTC QLQ-C30); cosmetic status, breast-specific symptoms, arm and shoulder functional status (Breast Cancer Treatment Outcome Scale); body image and sexuality (Body Image Scale); and perceived risk of invasive breast cancer (Cancer Worry Scale and a study-specific question). For each of these measures, tumour bed boost was compared with no boost, and conventional whole breast radiotherapy compared with hypofractionated whole breast radiotherapy, by use of generalised estimating equation models. Analyses were by intention to treat, with Hochberg adjustment for multiple testing. This trial is registered with ClinicalTrials.gov, NCT00470236.

Research paper thumbnail of Absence of adverse early quality of life outcomes of radiation therapy in breast conservation therapy for early breast cancer

Journal of medical imaging and radiation oncology, Feb 1, 2005

The New South Wales Breast Radiation Oncology Group has completed a prospective multicentre study... more The New South Wales Breast Radiation Oncology Group has completed a prospective multicentre study of the impact of radiation therapy (RT) on acute toxicity and quality of life (QoL) in women with early breast cancer treated with breast conservation therapy. The patient group received adjuvant breast tangential RT after wide local excision of breast cancer. Acute toxicity and cosmesis was assessed quantitatively and qualitatively. European Organization of Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30) and Perceived Adjustment to Chronic Illness Scale (PACIS) were the QoL instruments used. Of 175 women, 34.3% described lethargy leading to a significant disruption to normal activity during RT. At week 6, this had reduced to 7.5% reporting significant lethargy. No negative effects on QoL were noted over the time period of RT; EORTC demonstrated no difference (P = 0.79). PACIS recorded a significant improvement in functioning (P < 0.001) from baseline to week 6. Univariate analysis on potential predictive patient, tumour and treatment factors demonstrated an association of baseline pre-RT breast discomfort with worse lethargy (P = 0.03), EORTC (P < 0.01) and PACIS (P < 0.01) measures. This study confirms the minimal impact of RT on patient functioning at 6 weeks post-treatment.

Research paper thumbnail of Dr. Colin Alexander Bull

Journal of Medical Imaging and Radiation Oncology

Research paper thumbnail of Outcomes of Patients Treated in the UK Proton Overseas Programme: Non-central Nervous System Group

Research paper thumbnail of RADT-38. Incidence of Hearing Impairment After Definitive Proton Beam Therapy for Malignancies of the Brain and Base of Skull

Neuro-Oncology

AIM Aim of the project is to report the incidence of moderate/severe (G ≥ 3) long-term hearing im... more AIM Aim of the project is to report the incidence of moderate/severe (G ≥ 3) long-term hearing impairment (HI) and to identify risk factors in patients treated for malignancies of the brain and base of skull with definitive Proton Beam Therapy (PBT) within the Proton Overseas Programme (POP). METHODS Clinical and treatment-related data from patients’ files stored in a national database and curated by a dedicated outcomes unit were extracted and analysed. Clinical toxicity data from the POP were graded as per Common Terminology Criteria for Adverse Events (CTCAE 4.0). Dosimetric data (Dmean to the cochlear structures) were extracted from the Treatment Planning System Proknow. For the purpose of this analysis, patients with radical definitive PBT only were selected. RESULTS Between 2008 - 2018, 229 UK patients received radical PBT overseas for Craniopharyngioma (104 patients;45.4%), Chordoma (60; 26.2%), Chondrosarcoma (53;23.1%), Meningioma (7;3%), Pituitary Adenoma (5;2.1%). Median ...

Research paper thumbnail of A rare case of delayed radiation necrosis following adjuvant radiotherapy for recurrent breast cancer

British Journal of Hospital Medicine

Research paper thumbnail of Radiation doses and fractionation schedules in non-low-risk ductal carcinoma in situ in the breast (BIG 3–07/TROG 07.01): a randomised, factorial, multicentre, open-label, phase 3 study

Research paper thumbnail of Patient-Specific Heart Constraint: A Tool for Optimization and Evaluation of Mean Heart Dose in Breast Cancer Patients

Practical Radiation Oncology, 2021

This is a PDF file of an article that has undergone enhancements after acceptance, such as the ad... more This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Research paper thumbnail of Feasibility of arm‐draining lymph node‐sparing radiotherapy of breast cancer: A pilot planning study

Journal of Medical Imaging and Radiation Oncology, 2021

IntroductionLymphoedema following axillary radiotherapy for breast cancer causes significant morb... more IntroductionLymphoedema following axillary radiotherapy for breast cancer causes significant morbidity. Our goal was to evaluate the feasibility of sparing the lymph node that drains the arm’s lymphatics (ARM node) while achieving standard dose constraints for whole breast and comprehensive lymph node irradiation.MethodsSix patients underwent lymphoscintigraphy and SPECT CT to identify the breast sentinel node (SN) and ARM node. The ARM node was contoured on the SPECT CT and deformably registered to the radiotherapy treatment planning CT. Radiotherapy plans (50 Gy in 25 fractions) with VMAT technique were generated, with the aim to spare the ARM node (Mean dose <25 Gy) and achieve adequate coverage to the remaining axilla. The plan required the breast SN site (clip + 10 mm surrounding the clip) to achieve D98% > 47.5 Gy, and axillary nodal CTV excluding ARM node to achieve D90% > 45 Gy.ResultsIn one patient, the ARM node was within the volume of breast SN site and sparing w...

Research paper thumbnail of Pediatric Radiotherapy in Low and Middle Income Countries

Communicable diseases are still the leading cause of childhood mortality in third world countries... more Communicable diseases are still the leading cause of childhood mortality in third world countries. However, as prevention and treatment of malnutrition and infectious diseases improves, global health challenges are shifting towards combating non-communicable diseases including cancer which has high rates of mortality in children (Wilimas and Ribeiro 2001). More than two-thirds of the world’s pediatric cancers are currently diagnosed in low- and middle income countries (LMIC) (Kellie and Howard 2008). The patterns of occurrence of childhood cancer in LMIC compared to high income countries (HIC) and the lack of population-based cancer registries suggest that many patients die from undiagnosed cancer and the burden of childhood cancer is under-estimated. Children diagnosed with cancer in low-income countries (LIC) continue to have a much poorer chance of survival compared to those in HIC (Fig. 21.1).

Research paper thumbnail of Impact of the EndoPredict genomic assay on treatment decisions for oestrogen receptor-positive early breast cancer patients: benefits of physician selective testing

Breast Cancer Research and Treatment, 2021

Genomic tests improve accuracy of risk prediction for early breast cancers but these are expensiv... more Genomic tests improve accuracy of risk prediction for early breast cancers but these are expensive. This study evaluated the clinical utility of EndoPredict®, in terms of impact on adjuvant therapy recommendations and identification of parameters to guide selective application. Patients with ER-positive, HER2-negative, and early-stage invasive breast cancer were tested with EndoPredict®. Two cohorts were recruited: one consecutively and another at clinical team discretion. Systemic treatment recommendations were recorded before and after EndoPredict® results were revealed to the multidisciplinary team. 233 patients were recruited across five sites: 123 consecutive and 110 at clinical team discretion. In the consecutive cohort 50.6% (62/123) cases were classified high risk of recurrence by EndoPredict®, compared with 62.7% (69/110) in the selective cohort. A change in treatment recommendation was significantly more likely (p < 0.0001) in the selective cohort (43/110, 39.1%) compared to the consecutive group (11/123, 8.9%). The strongest driver of selective recruitment was intermediate grade histology, whilst logistic regression modelling demonstrated that nodal status (p < 0.001), proliferative rate (p = 0.001), and progesterone receptor positivity (p < 0.001) were the strongest discriminators of risk. Whilst molecular risk can be predicted by traditional variables in a high proportion of cases, EndoPredict® had a greater impact on treatment decisions in those cases selected for testing at team discretion. This is indicative of the robust ability of the clinical team to identify cases most likely to benefit from testing, underscoring the value of genomic tests in the oncologists’ tool kit.

Research paper thumbnail of Achieving Local Control

Rhabdomyosarcoma is a chemotherapy-responsive tumour, and all patients are treated with chemother... more Rhabdomyosarcoma is a chemotherapy-responsive tumour, and all patients are treated with chemotherapy because this is a systemic disease. 1 The principle North American chemotherapy regimen is vincristine, actinomycin-D and cyclophosphamide (VAC). In European studies, ifosfamide has been substituted for cyclophosphamide (IVA). The role of anthracycline drugs remains controversial; in randomised studies, the addition of doxorubicin or epirubicin did not lead to improved outcomes. However, these drugs do have activity against rhabdomyosarcoma, and some units routinely incorporate them into treatment protocols. A current European study is re-examining the role of doxorubicin, while a recent rhabdomyosarcoma trial within the Children’s Oncology Group for patients with ‘high risk disease’ incorporated doxorubicin in a single arm trial. This latter trial also added irinotecan, ifosfamide and etoposide; early outcome data appear promising. 2 Irinotecan had earlier been shown to be active in...

Research paper thumbnail of PH-0225 TROG 14.04: Multicentre study of feasibility and impact on anxiety of DIBH in breast cancer patients

Radiotherapy and Oncology, 2021

Research paper thumbnail of PO-1475 Systematic prospective data mining in everyday practice – the NHS approach for proton beam therapy

Radiotherapy and Oncology, 2021

Research paper thumbnail of PO-0262 Brachytherapy for paediatric pelvic tumours – sole local therapy modality and combined with surgery

Radiotherapy and Oncology, 2021

Research paper thumbnail of Particle therapy tumour outcomes: An updated systematic review

Journal of Medical Imaging and Radiation Oncology, 2020

SummaryParticle therapy (PT) offers the potential for reduced normal tissue damage as well as esc... more SummaryParticle therapy (PT) offers the potential for reduced normal tissue damage as well as escalation of target dose, thereby enhancing the therapeutic ratio in radiation therapy. Reflecting the building momentum of PT use worldwide, construction has recently commenced for The Australian Bragg Centre for Proton Therapy and Research in Adelaide – the first PT centre in Australia. This systematic review aims to update the clinical evidence base for PT, both proton beam and carbon ion therapy. The purpose is to inform clinical decision‐making for referral of patients to PT centres in Australia as they become operational and overseas in the interim. Three major databases were searched by two independent researchers, and evidence quality was classified according to the National Health and Medical Research Council evidence hierarchy. One hundred and thirty‐six studies were included, two‐thirds related to proton beam therapy alone. PT at the very least provides equivalent tumour outcome...

Research paper thumbnail of Practice patterns and recommendations for pediatric image‐guided radiotherapy: A Children's Oncology Group report

Pediatric Blood & Cancer, 2020

This report by the Radiation Oncology Discipline of Children's Oncology Group (COG) describes... more This report by the Radiation Oncology Discipline of Children's Oncology Group (COG) describes the practice patterns of pediatric image‐guided radiotherapy (IGRT) based on a member survey and provides practice recommendations accordingly. The survey comprised of 11 vignettes asking clinicians about their recommended treatment modalities, IGRT preferences, and frequency of in‐room verification. Technical questions asked physicists about imaging protocols, dose reduction, setup correction, and adaptive therapy. In this report, the COG Radiation Oncology Discipline provides an IGRT modality/frequency decision tree and the expert guidelines for the practice of ionizing image guidance in pediatric radiotherapy patients.

Research paper thumbnail of EP-1404: Non-linear radiomic signatures characterizing overall survival from non-small cell lung cancer

Radiotherapy and Oncology, 2018

was a significant predictor for OS (median, 55.6 vs 24.5 months, p=0.04). Low PLR (≤ 153.1) was a... more was a significant predictor for OS (median, 55.6 vs 24.5 months, p=0.04). Low PLR (≤ 153.1) was associated with longer PFS (45.2 vs 9.8 months, p=0.009). Low NLR (≤ 2.97) showed a trend toward better OS (45.5 vs 24.5 months) and PFS (18.7 vs 10.4 months) with no statistical difference (p=0.19, 0.28). Conclusion Pretreatment PLR and LMR could be prognostic markers for OS and PFS in patients with non-small cell lung cancer treated with chemoradiotherapy. EP-1403 Clinical outcome and toxicity of stereotactic ablative radiotherapy to centrally located tumors.

Research paper thumbnail of EP-1305: Location of arm draining lymph node in relation to breast cancer radiotherapy field and volume

Radiotherapy and Oncology, 2018

significantly long overall survival in comparison with the patients with RLNR. However, multivari... more significantly long overall survival in comparison with the patients with RLNR. However, multivariate Cox regression analysis showed the recurrences site had no significant impact on the overall survival (P=0.14). Conclusion The presented results are excellent in terms of LR rate. Further careful follow-up and careful registration of the recurrences is needed to improve their understanding.

Research paper thumbnail of PO-0757: Non-small cell lung cancer decision support based on distributed learning over multi-center data

Radiotherapy and Oncology, 2018

Research paper thumbnail of Quality of life after breast-conserving therapy and adjuvant radiotherapy for non-low-risk ductal carcinoma in situ (BIG 3-07/TROG 07.01): 2-year results of a randomised, controlled, phase 3 trial

The Lancet Oncology, 2020

Background BIG 3-07/TROG 07.01 is an international, multicentre, randomised, controlled, phase 3 ... more Background BIG 3-07/TROG 07.01 is an international, multicentre, randomised, controlled, phase 3 trial evaluating tumour bed boost and hypofractionation in patients with non-low-risk ductal carcinoma in situ following breastconserving surgery and whole breast radiotherapy. Here, we report the effects of diagnosis and treatment on health-related quality of life (HRQOL) at 2 years. Methods The BIG 3-07/TROG 07.01 trial is ongoing at 118 hospitals in 11 countries. Women aged 18 years or older with completely excised non-low-risk ductal carcinoma in situ were randomly assigned, by use of a minimisation algorithm, to tumour bed boost or no tumour bed boost, following conventional whole breast radiotherapy or hypofractionated whole breast radiotherapy using one of three randomisation categories. Category A was a 4-arm randomisation of tumour bed boost versus no boost following conventional whole breast radiotherapy (50 Gy in 25 fractions over 5 weeks) versus hypofractionated whole breast radiotherapy (42•5 Gy in 16 fractions over 3•5 weeks). Category B was a 2-arm randomisation between tumour bed boost versus no boost following conventional whole breast radiotherapy, and category C was a 2-arm randomisation between tumour bed boost versus no boost following hypofractionated whole breast radiotherapy. Stratification factors were age at diagnosis, planned endocrine therapy, and treating centre. The primary endpoint, time to local recurrence, will be reported when participants have completed 5 years of follow-up. The HRQOL statistical analysis plan prespecified eight aspects of HRQOL, assessed by four questionnaires at baseline, end of treatment, and at 6, 12, and 24 months after radiotherapy: fatigue and physical functioning (EORTC QLQ-C30); cosmetic status, breast-specific symptoms, arm and shoulder functional status (Breast Cancer Treatment Outcome Scale); body image and sexuality (Body Image Scale); and perceived risk of invasive breast cancer (Cancer Worry Scale and a study-specific question). For each of these measures, tumour bed boost was compared with no boost, and conventional whole breast radiotherapy compared with hypofractionated whole breast radiotherapy, by use of generalised estimating equation models. Analyses were by intention to treat, with Hochberg adjustment for multiple testing. This trial is registered with ClinicalTrials.gov, NCT00470236.