RESUMO
INTRODUCTION: Cancer Australia guidelines recommend that hypofractionation should be considered for women over the age of 50 years with early breast cancer. GenesisCare is the largest provider of radiation therapy services in Australia. This study aimed to investigate variation in hypofractionation across 4 states encompassing the period when the most recent guidelines had been released. METHODS: Patients with T1 N0 and T2 N0 breast cancer who received radiation therapy as adjuvant therapy after breast conservation surgery between 2014 and 2016 were reviewed. Patient, treatment and disease-related variables were included in the univariate and multivariate models together with other potential explanatory variables such as the state, in which the patient was treated, radiation oncologist and distance from the treatment centre. RESULTS: Of 3374 patients included, 44% received a hypofractionated schedule. There was an increase in the use of hypofractionation from 32% in 2014 to 56% in 2016. Older patients were more likely to receive a hypofractionated treatment schedule - 75% for patients 80 years and over. Multivariate modelling revealed older age, year of treatment, higher T stage and grade, chemotherapy and the individual radiation oncologist (and state) as independent predictors of the use of hypofractionation. There was no difference in hypofractionation based on laterality. CONCLUSIONS: Guidelines from Cancer Australia may impact clinician behaviour. The influence of the individual radiation oncologist remains paramount, and their practice is affected by their immediate colleagues. Subsequent analysis of hypofractionation rates after presentation of these data has resulted in a significant increase in its use.
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Neoplasias da Mama/radioterapia , Padrões de Prática Médica/estatística & dados numéricos , Prática Privada , Hipofracionamento da Dose de Radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
We describe the use of radiotherapy for parotid IgG4-related disease (IgG4-RD), initially misdiagnosed as Kimura's disease, with sustained good partial response in a 37-year-old male. To the best of our knowledge, this is the first reported case of radiation for extra-orbital IgG4-RD, albeit inadvertently.
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Doença Relacionada a Imunoglobulina G4/radioterapia , Glândula Parótida/efeitos da radiação , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Resultado do TratamentoRESUMO
Three large randomised controlled trials have been published in the last year demonstrating the non-inferiority of moderate hypofractionation compared to conventional fractionation for localised prostate cancer with respect to both disease control and late toxicity at 5 years. Furthermore, no clinically significant differences in patient-reported outcomes have emerged. More mature follow-up data are now also available from phase 2 studies confirming that moderate hypofractionation is associated with low rates of significant toxicity at 10 years. Moving forward it is likely that appropriate patient selection, integration of androgen deprivation and attention to optimising technique will play a more important role than modest differences in dose-fractionation schedules. Here we briefly review the evidence, discuss issues of patient selection and provide an approach to implementing moderately hypofractionated radiation therapy for prostate cancer in clinical practice.
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Neoplasias da Próstata/radioterapia , Hipofracionamento da Dose de Radiação , Humanos , Masculino , Fatores de RiscoRESUMO
INTRODUCTION: Recent studies have suggested reducing the dose submandibular glands receive when patients undergo head and neck radiotherapy can play a crucial role in preventing xerostomia. However, they are traditionally not spared due to concern that target coverage may be compromised. We investigated the possibility of sparing the contralateral submandibular gland (cSM) by utilising modern planning techniques. METHODS: 10 head and neck patients previously treated with conformal therapy at our centre were retrospectively planned using intensity modulated radiation therapy (IMRT), and volumetric modulated arc therapy (VMAT). Each patient was prescribed 70 Gy in 35 fractions to the primary volume, with 56 Gy delivered to the elective nodal areas. The primary objective was to spare the cSM gland using appropriate dose constraints. RESULTS: Mean dose to the cSM gland was reduced to an acceptable dose level (39 Gy) for all patients replanned using an IMRT or VMAT technique, without compromising planned target volume (PTV) coverage or other critical structures. VMAT was able to reduce the mean dose to 31.5 ± 5.5 Gy compared to 34.5 ± 4.8 Gy of IMRT and offered improved plan conformity. CONCLUSION: Sparing the cSM gland is possible using IMRT and VMAT planning, whilst preserving coverage on the elective PTV. This has produced a change in protocol in our department, more focus placed on sparing the SM glands. VMAT is a viable alternative method of delivering treatment and will be utilised when required.
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Órgãos em Risco/efeitos da radiação , Doses de Radiação , Radioterapia de Intensidade Modulada/efeitos adversos , Glândula Submandibular/efeitos da radiação , Neoplasias de Cabeça e Pescoço/radioterapia , Humanos , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador , Estudos Retrospectivos , Xerostomia/etiologia , Xerostomia/prevenção & controleRESUMO
INTRODUCTION: This patterns of practice study was conducted on behalf of the RANZCR Breast Interest Group in order to document current radiotherapy practices for breast cancer in Australia and New Zealand. The survey identifies variations and highlights potential contentious aspects of radiotherapy management of breast cancer. METHODS: A fifty-eight question survey was disseminated via the Survey Monkey digital platform to 388 Radiation Oncologists in Australia and New Zealand. RESULTS: In total, 156 responses were received and collated. Areas of notable consensus among respondents included hypofractionation (77.3% of respondents would 'always' or 'sometimes' consider hypofractionation in the management of ductal carcinoma in-situ and 99.3% in early invasive breast cancer); margin status in early breast cancer (73.8% believe a clear inked margin is sufficient and does not require further surgery) and use of bolus in post-mastectomy radiotherapy (PMRT) (91.1% of participants use bolus in PMRT). Areas with a wider degree of variability amongst respondents included regional nodal irradiation and components of radiotherapy planning and delivery (examples include the technique used for delivery of boost and frequency of bolus application for PMRT). CONCLUSION: The results of these patterns of practice survey informs radiation oncologists in Australia and New Zealand of the current clinical practices being implemented by their peers. The survey identifies areas of consensus and contention, the latter of which may lead to a development of research trials and/or educational activities to address these areas of uncertainty.