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Biomedical subjects

Val Gebski

Publications and source records attributed to Val Gebski.

At least 19 recordsLinked to original sources
PubMed2006

The prognostic value of pimonidazole and tumour pO2 in human cervix carcinomas after radiation therapy: a prospective international multi-center study.

BACKGROUND AND PURPOSE: Hypoxia adversely affects treatment outcome in human uterine cervical cancer. Here, we present the results of a prospective international multi-centre study evaluating the prognostic value of pre-treatment tumour oxygen partial pressure (pO(2)) and the hypoxia marker pimonidazole (pimo). MATERIALS AND METHODS: One hundred and twenty-seven patients with primary cervix cancer were entered. Pre-treatment tumour pO(2) measurements were obtained, and reported by the median tumour pO(2), the fraction of pO(2) values <or=10 mmHg (HP(10)), <or=5 mmHg (HP(5)) and <or=2.5 mmHg (HP(2.5)). Following intravenous pimonidazole administration, biopsies were taken, stained for pimonidazole adducts, and scored for the area of labelled tumour cells on a scale from 0 to 4. Treatment modalities were surgery (11%), radiotherapy (98%), chemotherapy (33%) and carbogen (14%). RESULTS: None of the hypoxia descriptors were statistically significant prognostic factors for loco-regional tumour control or overall survival when analyzed as continuous variables or divided by the sample median. By univariate analysis only tumour size and nodal status were significant prognostic factors for local control. Tumour size and FIGO stage were significant for overall survival. In a multivariate analysis stratified by centre, only tumour size above 5 cm and lower pre-treatment haemoglobin predicted poorer overall survival among FIGO stage, nodal involvement, tumour size, pre-treatment haemoglobin dichotomized at 12 g/dl and pimo 1, pimo 4 and HP(5) as continuous variables. CONCLUSION: Neither Eppendorf nor pimonidazole should be dismissed based on the current results. However, further investigations are needed to readdress the hypotheses of the current study having optimized statistical designs, and a population of sufficient size treated more homogenously following rigorous protocols.

Adult↗
PubMed2006

Survival effects of postmastectomy adjuvant radiation therapy using biologically equivalent doses: a clinical perspective.

BACKGROUND: Postmastectomy radiation therapy reduces locoregional recurrence among women with operable breast cancer, but whether it improves survival has been controversial. We reanalyzed the results from 36 unconfounded trials (i.e., addition of radiation therapy was the sole discriminant between treatments being compared) that were identified in previous meta-analyses, which provided 38 comparisons. METHODS: We used three predefined treatment categories for individual patient data: 1) a biologically equivalent dose (BED) of 40-60 Gy in 2-Gy fractions with an appropriate target volume, 2) an inadequate or excessive dose of radiation therapy, and 3) an inappropriate target volume. Effects of radiation therapy on 5-year and 10-year survival in each of the treatment categories were estimated from a cohort of 13 199 patients from the published rates or, if these were unavailable, from the published survival curves. We also used this categorization to reanalyze data from Early Breast Cancer Trialists' Collaborative Group (EBCTCG) postmastectomy studies. At 10 years, 16 (84%) of the 19 comparisons in our study coincided with those reported by the EBCTCG. All statistical tests were two-sided. RESULTS: Twenty-five of the 38 available comparisons had used optimal and complete radiotherapy (i.e., category 1). Of these 25 comparisons, 17 had 5-year data, and these data showed that adjuvant radiation therapy was associated with a 2.9% absolute increase in survival (odds ratio [OR] of death = 0.87, 95% confidence interval [CI] = 0.79 to 0.96; P = .006). Thirteen category 1 trials had data at 10 years, and these data showed that adjuvant radiation therapy was associated with a statistically significant 6.4% absolute increase in survival (OR of death = 0.78, 95% CI = 0.70 to 0.85; P < .001). No statistically significant change in survival was observed among category 2 (OR of death = 0.91, 95% CI = 0.75 to 1.11) or 3 (OR of death = 0.97, 95% CI = 0.61 to 1.55) trials. Among the 33 EBCTCG studies, odds of local recurrence were reduced more among category 1 trials (80% lower) than among category 2 (70% lower) or 3 (64% lower) trials (P(heterogeneity) < .001). Odds of all-cause death were also lower among category 1 trials (13% lower) than among category 2 (3% lower) or 3 (26% higher) trials (P(heterogeneity) = .01). CONCLUSIONS: Adjuvant radiation therapy with an optimal BED and target volume was statistically significantly associated with improved survival for up to 10 years.

Breast Neoplasms↗
PubMed2005

Dynamic balancing randomization in controlled clinical trials.

In the design of randomized clinical trials, balancing of treatment allocation across important prognostic factors (strata) improves the efficiency of the final comparisons. Whilst randomization methods exist which attempt to balance treatments across the strata (permuted blocks, minimization, biased coin), these approaches assign equal importance for all the strata. Dynamic balancing randomization (DBR) is a tree-based method proposed by Signorini et al. allowing different levels of imbalance in different strata which ensures a balance for each level of prognostic risk factors (conditional balance) whilst at the same time preserving randomness. We present a simple modification to the original approach to maintain a marginal balance over important strata and examine the properties of this modification. Two important measures of performance are used to provide comparisons between the approaches: a loss function, which can be interpreted as the squared norm of the imbalance vector, and a forcing index which conveys the degree of randomness. A comparison of DBR with minimization and a biased coin design is carried out by simulation on two simulated trials.

Humans↗
PubMed2005

Randomised controlled trial of the Lidcombe programme of early stuttering intervention.

OBJECTIVES: To evaluate the efficacy of the Lidcombe programme of early stuttering intervention by comparison to a control group. DESIGN: A pragmatic, open plan, parallel group, randomised controlled trial with blinded outcome assessment. SETTING: Two public speech clinics in New Zealand. PARTICIPANTS: Stuttering preschool children who presented to the speech clinics for treatment. Inclusion criteria were age 3-6 years and frequency of stuttering of at least 2% syllables stuttered. Exclusion criteria were onset of stuttering during the six months before recruitment and treatment for stuttering during the previous 12 months. 54 participants were randomised: 29 to the Lidcombe programme arm and 25 to the control arm. 12 of the participants were girls. INTERVENTION: Lidcombe programme of early stuttering intervention. MAIN OUTCOME MEASURES: Frequency of stuttering was measured as the proportion of syllables stuttered, from audiotaped recordings of participants' conversational speech outside the clinic. Parents in both arms of the trial collected speech samples in three different speaking situations before randomisation and at three, six, and nine months after randomisation. RESULTS: Analysis showed a highly significant difference (P = 0.003) at nine months after randomisation. The mean proportion of syllables stuttered at nine months after randomisation was 1.5% (SD 1.4) for the treatment arm and 3.9% (SD 3.5) for the control arm, giving an effect size of 2.3% of syllables stuttered (95% confidence interval 0.8 to 3.9). This effect size was more than double the minimum clinically worthwhile difference specified in the trial protocol. CONCLUSIONS: The results provide evidence from a randomised controlled trial to support early intervention for stuttering. The Lidcombe programme is an efficacious treatment for stuttering in children of preschool age.

Child↗
PubMed2005

Evaluation of the quality of radiotherapy randomized trials for painful bone metastases.

BACKGROUND: The quality of randomized radiotherapy studies investigating the palliation of painful bone metastases has been questioned, with some authors recognizing the potential impact of bias on result interpretation. However, there has been no published comprehensive evaluation of quality assessment. The goals of the current study were to evaluate the quality of randomized studies using a validated checklist and to discuss implications and future directions. METHODS: The authors performed a search for studies that could be reliably assessed using the validated quality assessment instrument. Independent assessors scored study quality using the instrument. RESULTS: The median quality score of the 17 identified randomized studies was 1 of 5 (range, 0-3). The majority (71%) of points were awarded for the authors describing the study as "randomized." The method of randomization and description of withdrawals and dropouts were scored poorly for most studies. None of the studies were awarded points for allocation concealment (blinding). The overall quality was deemed poor (a score of 0-2) for 16 of 17 (94%) studies. CONCLUSIONS: The quality of published randomized evidence comparing efficacy of fractionation schedules for the palliation of bone metastases was suboptimal. As a result of the potential biases present, subjective end points (e.g., retreatment rates) cannot be reliably evaluated. Greater efforts are required by radiation oncology trial groups to improve quality, with a particular focus on developing methods of allocation concealment and comprehensively reporting results.

Bone Neoplasms↗
PubMed2005

Adjuvant locoregional radiotherapy as best practice in patients with Merkel cell carcinoma of the head and neck.

BACKGROUND: Australians have the highest rate of skin cancer in the world. Merkel cell carcinoma (MCC) is the most aggressive skin cancer reported, with a high propensity for relapse. The purpose of this study was to report the patterns of recurrence after initial treatment, the outcomes, and any predictors for survival. METHODS: We identified 37 patients who were diagnosed with MCC of the head and neck between 1980 and 2002. In this retrospective analysis, multivariate analysis was performed by use of Cox regression analysis. Disease-free survival (DFS) and overall survival (OS) were calculated with Kaplan-Meier survival curves. RESULTS: The median age at diagnosis was 75 years (range, 46-89 years), with 24 men and 13 women. The median duration of follow-up was 26 months (range, 7-104 months). Twenty-nine patients (78%) initially were seen with a primary lesion, and eight (22%) had a primary lesion and clinical nodal disease. A total of 24 (65%) of 37 patients had a relapse, with regional relapse the most common site of the first relapse (12 of 37). The rates of local relapse were similar for patients undergoing local surgery (three of 17; 18%) or surgery and adjuvant radiotherapy (two of 19; 11%). Nodal relapse developed in seven (50%) of 14 patients not receiving regional treatment compared with six (26%) of 23 patients receiving regional treatment of some type. Patients treated with surgery and adjuvant radiotherapy experienced a significantly longer median DFS than did those undergoing surgery alone (23 months vs 6 months; p < .01). The 3-year OS and DFS rates for the entire study population were 66% and 25%, respectively. CONCLUSION: MCC is an aggressive skin cancer. There is a sufficient body of evidence, including this study, to consider the addition of adjuvant locoregional radiotherapy as best practice in markedly improving freedom from relapse.

Aged↗
PubMed2005

Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial.

BACKGROUND: Resection remains the best treatment for carcinoma of the oesophagus in terms of local control, but local recurrence and distant metastasis remain an issue after surgery. We aimed to assess whether a short preoperative chemoradiotherapy regimen improves outcomes for patients with resectable oesophageal cancer. METHODS: 128 patients were randomly assigned to surgery alone and 128 patients to surgery after 80 mg/m(2) cisplatin on day 1, 800 mg/m(2) fluorouracil on days 1-4, with concurrent radiotherapy of 35 Gy given in 15 fractions. The primary endpoint was progression-free survival. Secondary endpoints were overall survival, tumour response, toxic effects, patterns of failure, and quality of life. Analysis was done by intention to treat. FINDINGS: Neither progression-free survival nor overall survival differed between groups (hazard ratio [HR] 0.82 [95% CI 0.61-1.10] and 0.89 [0.67-1.19], respectively). The chemoradiotherapy-and-surgery group had more complete resections with clear margins than did the surgery-alone group (103 of 128 [80%] vs 76 of 128 [59%], p=0.0002), and had fewer positive lymph nodes (44 of 103 [43%] vs 69 of 103 [67%], p=0.003). Subgroup analysis showed that patients with squamous-cell tumours had better progression-free survival with chemoradiotherapy than did those with non-squamous tumours (HR 0.47 [0.25-0.86] vs 1.02 [0.72-1.44]). However, the trial was underpowered to determine the real magnitude of benefit in this subgroup. INTERPRETATION: Preoperative chemoradiotherapy with cisplatin and fluorouracil does not significantly improve progression-free or overall survival for patients with resectable oesophageal cancer compared with surgery alone. However, further assessment is warranted of the role of chemoradiotherapy in patients with squamous-cell tumours.

Adult↗
PubMed2005

Surgery and adjuvant radiotherapy in patients with cutaneous head and neck squamous cell carcinoma metastatic to lymph nodes: combined treatment should be considered best practice.

OBJECTIVE: Patients with cutaneous squamous cell carcinoma (SCC) may develop metastatic SCC to nodes in the head and neck. Recent data support best outcome with the addition of adjuvant radiotherapy. This study aims to present further supportive evidence. STUDY DESIGN: Retrospective chart review. METHODS: Patients were identified with metastatic cutaneous SCC to nodes of the head and neck treated with surgery or surgery and adjuvant radiotherapy. Relapse and outcome were analyzed using Cox regression analysis. Disease-free survival and overall survival rates were calculated using Kaplan-Meier survival curves. RESULTS: Between 1980 to 2000, 167 patients were treated with curative intent at Westmead Hospital, Sydney. Median age was 67 years (range, 34-95) in 143 men and 24 women with a minimum follow-up of 24 months. Patients underwent surgery (21/167; 13%), or surgery and adjuvant radiotherapy (146/167; 87%). The majority (98/167; 59%) of metastatic nodes were located in the parotid and/or cervical nodes. The remaining 69 (41%) had metastatic cervical nodes (levels I-V). Forty-seven patients (28%) had recurrences, with the majority (35/47; 74%) as locoregional failures. On multivariate analysis, spread to multiple nodes and single-modality treatment significantly predicted worse survival. Patients undergoing combined treatment had a lower rate of locoregional recurrence (20% vs. 43%) and a significantly better 5-year disease-free survival rate (73% vs. 54%; P = .004) compared to surgery alone. CONCLUSIONS: In patients with metastatic cutaneous head and neck SCC, surgery and adjuvant radiotherapy provide the best chance of achieving locoregional control and should be considered best practice.

Adult↗
PubMed2005

Anterior tongue cancer and the incidence of cervical lymph node metastases with increasing tumour thickness: should elective treatment to the neck be standard practice in all patients?

BACKGROUND: There is an increasing risk of cervical lymph node metastases as tumour thickness increases in patients with anterior tongue squamous cell carcinoma (SCC). The role of elective neck treatment in early anterior tongue cancer in unclear. METHODS: Patients diagnosed with anterior tongue cancer and treated with glossectomy +/- neck dissection were identified. The aim was to document the incidence of pathological lymph node metastases and outcome with increasing tumour thickness. The Cox proportional hazards model was used to identify prognostic factors. Survival curves were calculated using the Kaplan-Meier method. RESULTS: Between 1980 and 2002 99 patients (63 male and 36 female) with anterior tongue SCC were treated at Westmead Hospital, Sydney, and had a documented tumour thickness. Median age at diagnosis was 63 years (23-89 years). Median follow up was 37 months (6-205 months). Sixty-three patients underwent partial glossectomy and neck dissection. Thirty-six underwent partial glossectomy only. At the time of presentation 45/63 (71%) were clinically node negative. Using tumour thickness < or = 5 mm versus > 5 mm the incidence of nodal metastases was 8% versus 51% (P = 0.007). On multivariate analysis pathological nodal involvement and advanced stage both significantly predicted survival. The 2-year disease-free survival difference based on tumour thickness (< or = 5 mm vs > 5 mm) was 76% versus 65% (P = 0.47). CONCLUSIONS: Elective treatment to the ipsilateral neck is not indicated in all patients with anterior tongue cancer. However, for patients with a tumour thickness > 5 mm it is recommended that they undergo treatment to the ipsilateral neck in the form of a supraomohyoid neck dissection.

Adult↗
PubMed2005

Participation in the RACS sentinel node biopsy versus axillary clearance trial.

BACKGROUND: The Royal Australasian College of Surgeons (RACS) SNAC trial is a randomized controlled trial of sentinel node biopsy (SNB) versus axillary clearance (AC). It opened in May 2001 and is recruiting rapidly with good acceptance by consumers. METHODS: A study of eligibility and treatment choices was conducted between November 2001 and September 2002 for women presenting with early breast cancer to 10 centres participating in the trial. RESULTS: More than half of the 622 women (54%) were ineligible for trial entry because they had large (> 3 cm) or multicentric cancers. Participation was offered to 92% of eligible women and was taken up by 63%. The commonest reason for not participating was the desire to choose treatment rather than have it randomly allocated. Despite this there is a great acceptance of clinical trials because very few women (4% of those eligible) gave 'lack of interest in clinical trials' as the reason for non-participation. Few women who declined trial participation chose to have SNB alone (4.5% of those eligible). CONCLUSION: Sentinel node biopsy may become the standard of care for managing small breast cancers, but a significant number of patients will still require or choose axillary dissection. Results from large randomized trials are needed to determine the relative benefits and harms of SNB compared with AC. Surgeons must carefully discuss options for management with their patients.

Axilla↗
PubMed2005

Merkel cell carcinoma: improved outcome with adjuvant radiotherapy.

BACKGROUND: Merkel cell carcinoma is an aggressive primary cutaneous neuroendocrine carcinoma. Patients remain at high risk of locoregional and distant relapse despite treatment. Most studies support the incorporation of locoregional adjuvant radiotherapy in reducing the risk of relapse. METHODS: Between 1980 and 2002, 86 patients diagnosed with Merkel cell carcinoma were treated with curative intent at Westmead Hospital, Sydney. Multivariate analysis was performed using Cox regression analysis. Disease-free survival and overall survival was calculated using Kaplan-Meier survival curves. RESULTS: Median age at diagnosis was 75 years (range 46-89 years) in 49 men and 37 women. Median duration of follow up was 31 months (range 6-153 months). Fifty-one (59%) patients presented with a primary lesion, 19 (22%) with a primary lesion and clinical nodal disease and 16 (19%) with lymph node metastases from an unknown primary. A total of 47 of 86 (55%) relapsed with regional nodal relapse, the commonest site of first relapse. Local relapse was similar for patients undergoing surgery (5/37; 14%) compared with surgery and adjuvant radiotherapy (3/25; 12%). Nodal relapse occurred in 14 of 36 (37%) treated with surgery compared with 7 of 38 (18%) patients treated with surgery and adjuvant radiotherapy. Patients treated with surgery and adjuvant radiotherapy experienced a better median disease free survival compared to those undergoing surgery alone (10.5 months vs 4 months; P < 0.01). The 5-year overall and disease-free survival rate for the entire study population was 47% and 25%, respectively. Twenty-six patients (30%) died as a result of Merkel cell carcinoma. CONCLUSION: Merkel cell carcinoma is an aggressive skin cancer. The addition of adjuvant radiotherapy markedly improves regional control rates and should be considered best practice.

Aged↗
PubMed2005

Presenting symptoms of epithelial ovarian cancer.

OBJECTIVES: Epithelial ovarian cancer is a common disease with a high mortality, the latter being frequently attributed to late diagnosis due to failure to recognise symptoms of early disease. This study was designed to determine any differences in symptomatology between patients with early and advanced stage disease. DESIGN: A retrospective cohort study of 100 patients with stage 1 disease and 100 with stage 3 disease. Ten consecutive patients with stage 1 disease and 10 with stage 3 disease were identified from the database of patients treated each year from 1990 to 1999. SETTING: A tertiary referral centre for gynecological malignancy. OUTCOME MEASURES: The nature and duration of symptoms, age at presentation, and the size, histologic type and grade of tumour were determined by chart review, and the findings compared using logistic regression analysis. RESULTS: Ninety percent of women with early, and 100% with advanced disease reported at least one symptom. With early disease, abdominal pain was reported by 51% and abdominal swelling by 32%, and with advanced disease abdominal swelling by 62% and abdominal pain by 44%. Seventy percent of the early stage and 69% of the advanced stage cohorts reported symptoms of less than 3 months duration. Tumours less than 5 cm diameter were three times more likely to have advanced disease (P = 0.02). Grade 1 tumours were 40 times more likely to be early stage than grade 3 tumours. Serous tumours occurred in 25% of patients with early disease, and 45% with advanced disease (P = 0.01). CONCLUSION: Patients with early stage ovarian cancer are likely to be younger and to have larger, better differentiated tumours that are more often non-serous histologically. Advanced disease is not invariably due to delayed diagnosis.

Adenocarcinoma, Mucinous↗
PubMed2005

The effects of iodine on intelligence in children: a meta-analysis of studies conducted in China.

This study quantifies the effects of iodine on the intellectual development of children using a systematic manual literature search of Chinese publications related to iodine deficiency disorders. The Chinese Medical Reference Database, Medline, and Cochrane library were searched electronically in Chinese and English. Inclusion criteria included: studies conducted in China, comparing children (<16 ys) living in naturally iodine sufficient (IS) with those in severely iodine deficient (ID) areas, or children in ID areas born before and after the introduction of iodine supplementation. Intelligent Quotient (IQ) was measured using Binet or Raven Scales. The iodine sufficient control groups were comparable socially, economically, and educationally with the study groups. Random effects models were used in the meta-analysis. Effect size was the standard deviation IQ point (SIQP), which is equivalent to 15 IQ. Thirty-seven reported studies, total 12,291 children, were analysed. The effect size was an increase of 0.83, 0.82, and 0.32 SIQP respectively, for the children living in IS communities compared with those living in ID areas with no iodine supplementation, with inadequate iodine supplementation, or children who had received iodine during their mothers' pregnancy and after birth. These equal to 12.45, 12.3, 4.8 IQ points. Compared with that of children whose mothers were persistently exposed to ID, the total effect size of the 21 entries was an increase of 0.58 SIQP (8.7 IQ points) in the group receiving iodine supplementation during pregnancy. Furthermore, there was an increase on 1.15 SIQP of Binet or 0.8 SIQP on Raven Scale (17.25 or 12 IQ points) for children born more than 3.5 years after iodine supplementation program was introduced. The level of iodine nutrition plays a crucial role in the intellectual development of children. The intelligence damage of children exposed to severe ID was profound, demonstrated by 12.45 IQ points loss and they recovered 8.7 IQ points with iodine supplementation or IS before and during pregnancy. Iodine supplementation before and during pregnancy to women living in severe ID areas could prevent their children from intelligence deficit. This effect becomes evident in children born 3.5 years after the iodine supplementation program was introduced.

Adolescent↗
PubMed2004

Factorial designs: a graphical aid for choosing study designs accounting for interaction.

The presence of possible treatment interaction when designing a factorial study can be either greeted with dismay (for an antagonistic or negative interaction) or can be welcome (in the case of a synergistic effect). The type of potential interaction may greatly influence the choice of study design. Depending on the magnitude of an expected additive or multiplicative interaction, a three-arm study, instead of a 2 x 2 factorial, may yield greater statistical power. A graphical aid for examining the loss of power due to the presence of such interaction is developed. The technique can also be applied to designing studies where prespecified subgroup analyses are of particular interest. Tests for interaction effects between subgroups are usually underpowered, even if the subgroups have been prespecified in the protocol. The technique can be used to determine the appropriate sample sizes in the subgroups to ensure adequate power to detect potential interaction effects. The method is illustrated with respect to a published 2 x 2 factorial study. In this study, interaction reduced the power of the final analysis to detect significant main effects.

Clinical Trials as Topic↗
PubMed2003

A randomized trial evaluating rigid immobilization for pelvic irradiation.

BACKGROUND: Accuracy and reproducibility of the patient's position is fundamental to the successful delivery of radiation therapy. In recent years, a number of pelvic immobilization techniques have been developed. Few have been evaluated in randomized trials, and many of these studies have produced contradictory and inconclusive results. PURPOSE: To assess whether the use of rigid immobilization devices improve the accuracy and reproducibility of prostate irradiation to a clinically useful degree. METHODS AND MATERIALS: A total of 100 patients receiving radical irradiation for either prostate or bladder cancer were randomized to be treated with or without the use of rigid immobilization (RI) devices. Of these, 96 patients were suitable for analysis. The control group consisted of the patients being simulated and treated in the prone position with no immobilization devices. Patients randomized to the immobilized arm were simulated and treated prone using a customized Uvex cast of the pelvis as well as ankle- and shoulder-stabilizing devices. Weekly orthogonal port films (PFs) were obtained for each patient. Using previously specified bone landmarks, we measured variations in the isocenter position on each PF compared with the simulation film. The assessors were unaware of the treatment assignment. Patient comfort, skin toxicity, and treatment times were recorded. RESULTS: The average simulation-to-treatment deviation of the isocenter position was 8.5 mm in the control group and 6.2 mm in the immobilization group (p < 0.001). In the control arm, 30.9% of port films had isocenter deviations >10 mm compared with 10.6% in the immobilized arm (p = 0.001). For the control group, average deviations in the anteroposterior, right-left, and superior-inferior directions were 5.2 mm, 3.2 mm, and 4.3 mm, respectively, compared with 2.9 mm, 2.1 mm, and 3.9 mm for the immobilized group (p = <0.001, p < 0.001, p = 0.55). The RTOG skin reaction was greater with in patients with a cast (28% having Grade 2 toxicity vs. 10% in the control arm), although this was not statistically significant (p = 0.68). Patients in both groups found the treatment position comfortable: 90% in the immobilized group and 87% in the control group scored the treatment position either reasonably or very comfortable. Treatment times were very similar between the two groups: the average treatment time was 15.5 min in the control group vs. 16.1 min in the immobilized group (p = 0.82). CONCLUSIONS: The use of rigid immobilization improves the accuracy of treatment delivery for the prone position, especially in the anteroposterior direction. Of clinical importance, the number of major deviations >10 mm (that is, that would result in a geographic miss) was reduced from 31% to 11%.

Aged↗
PubMed2003

Australian prostate-specific antigen outcome and toxicity following radiation therapy for localized prostate cancer.

The objective of the present study was to examine prostate-specific antigen relapse free survival (PSA-RFS) and morbidity following 'conventional' radical radiation therapy for prostate cancer in two Australian regional treatment services. Four hundred and eighty men with clinically localized prostate cancer were treated between 1993 and 1997 at Liverpool and Westmead Hospitals using a standardized 4-field, CT-planned radiotherapy technique. Principal endpoints were PSA-RFS (American Society for Therapeutic Radiology and Oncology guidelines definition) and late rectal and urinary morbidity (Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer criteria). The median follow up of patients from the end of RT was 55 months. Prospectively, they were divided into three prognostic categories: (i) high risk T3 or 4 and/or PSA > 20 ng/mL and/or Gleason score 8-10 (40% of cohort); (ii) intermediate risk T1 or 2 and PSA 10-20 ng/mL and/or Gleason score 7 (33% of cohort); and (iii) low risk T1 or 2 and PSA < 10 ng/mL and Gleason score < 6 (27% of cohort). The 5-year actuarial PSA-RFS was 53% for the whole patient group. The 4-year rates were 32, 56 and 75% for high, intermediate and low risk groups, respectively. On multivariate analysis, T-stage, Gleason score, pre-RT-PSA were strong independent predictors of PSA-defined outcome. Late (grade 2) rectal and urinary morbidity occurred at some point in time in the post-RT period in 8.0 and 5.8% of patients, respectively. These results confirm that low Gleason score, low T stage, presenting PSA < 10 ng/mL and nadir < 1 ng/mL remain the strongest predictors of a good outcome. Long-term toxicity was very acceptable. However, further improvement in outcome is desirable, and with the adoption of new technology allowing escalation of radiotherapy doses such an expectation might be achieved.

Adult↗