Objective decision-making following a portal film: the results of a pilot study.

PURPOSE: To discriminate between random and systematic treatment setup errors using portal films. METHODS AND MATERIALS: A bi-dimensional analytic techniques using multiple analyses of variance based on Hotelling's T2 statistics to derive numerical and graphical measures of daily portal film accuracy and precision has been trialed using 88 daily portal films from seven patients' treatment. RESULTS: A demonstration is provided of how a reasonable approximation of random variation from the intended (Simulator) field center, and systematic displacement of the mean position of the portal film centers may be derived from a minimum number of portal films. If a random error as great as 10 mm exists, at least six or seven portal films are considered necessary to reliably detect and quantify the size of a systematic error. CONCLUSION: Our results suggest that a modest systematic error could go undetected until the end of a 5 or 6 week course of treatment if only one portal film is obtained each week. A greater number of portal films should be performed during the first week of treatment to reduce the frequency of such errors. Efforts to separate and quantify both random and systematic errors in setup are worthwhile and will lead to improvements in outcome at the individual patient level and at a departmental level in the development of quality assurance programs.

A double exposed portal image comparison between electronic portal imaging hard copies and port films in radiation therapy treatment setup confirmation to determine its clinical application in a radiotherapy center.

PURPOSE: At the William Buckland Radiotherapy Center (WBRC), field-only electronic portal image (EPI) hard copies are used for radiation treatment field verification for whole brain, breast, chest, spine, and large pelvic fields, as determined by a previous study. A subsequent research project, addressing the quality of double exposed EPI hard copies for sites where field only EPI was not considered adequate to determine field placement, has been undertaken. The double exposed EPI hard copies were compared to conventional double exposed port films for small pelvic, partial brain, and head and neck fields and for a miscellaneous group. METHODS AND MATERIALS: All double exposed EPIs were captured during routine clinical procedures using liquid ion chamber cassettes. EPI hard copies were generated using a Visiplex multi-format camera. In sites where port film remained the preferred verification format, the port films were generated as per department protocol. In addition EPIs were collected specifically for this project. Four radiation oncologists performed the evaluation of EPI and port film images independently with a questionnaire completed at each stage of the evaluation process to assess the following: Adequacy of information in the image to assess field placement. Adequacy of information for determining field placement correction. Clinician's preferred choice of imaging for field placement assessment RESULTS: The results indicate that double exposed EPI hard copies generally do containsufficient information to permit evaluation of field placement and can replace conventionaldouble exposed port films in a significant number of sites. These include the following:pelvis fields < 12 X 12 cm, partial brain fields, and a miscellaneous group. However forradical head and neck fields, the preferred verification image format remained port film dueto the image hard copy size and improved contrast for this media. Thus in this departmenthard copy EPI is the preferred modality of field verification for all sites except radical headand neck treatments. This should result in an increase in efficiency of workloadmanagement and patient care.

Accelerated fractionation radiotherapy for advanced head and neck cancer.

Between 1981 and 1986, 89 patients with advanced head and neck squamous cancer were treated with a continuous accelerated fractionation radiotherapy (AFRT) regimen. Three fractions of 1.80 Gy, 4 h apart, were given on three treatment days per week (Monday, Wednesday, Friday), and the tumour dose was taken to 59.40 Gy in 33 fractions in 24-25 days. Acute mucosal reactions were generally quite severe, but a split was avoided by providing the patient with intensive support, often as an in-patient, until the reactions settled. Late radiation effects have been comparable to those obtained with conventional fractionation. The probability of local-regional control was 47% at 3 years for 69 previously untreated patients, whereas it was only 12% at one year for 20 patients treated for recurrence after radical surgery. Fifty-eight previously untreated patients with tumours arising in the upper aero-digestive tract were analysed in greater detail. The probability of local-regional control at 3 years was 78% for 17 Stage III patients and 15% for 31 Stage IV patients. This schedule of continuous AFRT is feasible and merits further investigation.

Factors associated with symptom-specific psychological and functional impact among acoustic neuroma patients.

INTRODUCTION: The main purpose of this study was to investigate the psychological and functional impact attributed to acoustic neuroma symptoms. MATERIALS AND METHODS: A sample of 207 acoustic neuroma patients completed a study-specific questionnaire about the severity, frequency, and psychological and functional impact of 9 acoustic neuroma symptoms. RESULTS: The survey response rate was 56.4 per cent. All symptoms had some degree of psychological impact for the majority of participants; hearing loss was the symptom most often reported to have a severe psychological impact. The majority of respondents reported functional impact attributed to hearing loss, balance disturbance, dizziness, eye problems, headache and fatigue; balance disturbance was the symptom most often reported to have a severe functional impact. For most symptoms, psychological and functional impact were related to severity and frequency. CONCLUSION: Of the acoustic neuroma symptoms investigated, hearing loss and balance disturbance were the most likely to have a severe psychological and functional impact, respectively.

Factors associated with anxiety and depression in the management of acoustic neuroma patients.

The objectives of this study were to describe anxiety and depression levels among acoustic neuroma patients; examine differences in anxiety and depression across the acoustic neuroma management options of microsurgery, radiation and observation; and to investigate management, medical and demographic factors that might predict anxiety and depression in this patient group. A cross-sectional questionnaire was completed by 205 adults diagnosed with, or treated for, a unilateral acoustic neuroma within five years of questionnaire distribution. Median age of participants was 57.0 years, and 120 (58.5%) were female. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Clinically significant anxiety was reported by 29.8% of participants and 10.2% were depressed. Mean anxiety and depression scores did not differ from general population norms. No significant differences in anxiety and depression were found across management options. Time since management, number of symptoms and comorbid medical conditions predicted anxiety, while depression was predicted by number of symptoms. This appears to be the first study among acoustic neuroma patients in which anxiety and depression were compared across management options. Treating physicians should be aware that as the number of acoustic neuroma symptoms increases, so may the likelihood of clinically significant anxiety and depression.

Heterotopic bone formation affecting the hip joint is preventable in high risk patients by post-operative radiation.

Between 1984 and 1993, 40 high risk patients (45 hips) received postoperative irradiation as prophylaxis against heterotopic ossification (HO). Radiotherapy was commenced within 5 days of the surgery in 43 of 45 hips. The development of HO was assessed by comparison of radiographic films prior to irradiation and at least 2 months after treatment (median interval 12 months). Progression of HO was observed in only two of 45 hips (4.3%) and of clinical significance in one (2.2%). Treatment was well tolerated with no acute complications or loosening of prosthetic components attributable to irradiation. During the study period, the treatment programme changed from 20 Gy in 10 fractions to 6-8 Gy in a single fraction, without loss of treatment efficacy. As well as improving resource utilization, single fraction techniques allow fewer patient transfers thereby reducing patient discomfort and risk of hip dislocation. This procedure is uncomplicated and should be considered more widely in the management of this disabling non-malignant condition.