Clinical oncology : a journal of the Royal College of Radiologists
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Clin Oncol (R Coll Radiol) · Feb 2008
Comparative StudyDosimetric comparison of conventional radiograph- and three-dimensional computed tomography-based planning using dose volume indices for partial breast intraoperative implants.
The dosimetric outcomes of radiograph- and computed tomography-based plans generated with various optimisation strategies were compared using dose volume indices for partial breast intraoperative implants. ⋯ Objective dosimetric evaluation on three-dimensional computed tomography confirms its superiority over conventional two-dimensional radiograph-based planning in terms of a reduction in normal breast irradiated with the prescription dose and improvement in conformity. Interactive graphical optimisation based on the target volume in computed tomography further improves conformity with a reduction in dose homogeneity. The use of dose volume indices allows the comparison of different plans and can be used as a tool to correlate dosimetric with clinical outcome.
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Clin Oncol (R Coll Radiol) · Feb 2008
When should we define the response rates in the treatment of bone metastases by palliative radiotherapy?
It is well established that palliative radiotherapy provides effective pain relief for symptomatic bone metastases, but controversy remains regarding the optimal dose fractionation. Several meta-analyses and systematic reviews of trials comparing the efficacy of single vs multiple fractionated radiotherapy schedules noted that it is difficult to reach a consensus when inconsistent response end point definitions are used. The purpose of this study was to determine when the most appropriate time to evaluate a response is. ⋯ We conclude that 2 months after radiotherapy is the most appropriate time point to measure response rates for two reasons: (i) the maximum pain relief for some patients may take more than 4 weeks to achieve and (ii) attrition poses a major problem when response rates are measured at a later date. Future trials should use standardised criteria for end points to facilitate comparison and analysis across clinical trials. Given the limitations of this study, however, further investigations are needed to confirm the response time points for palliative cancer patients.
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Clin Oncol (R Coll Radiol) · Dec 2007
ReviewGastrointestinal problems after pelvic radiotherapy: the past, the present and the future.
Up to 300,000 patients per year undergo pelvic radiotherapy worldwide. Nine out of 10 will develop a permanent change in their bowel habit as a result. Five out of 10 of all patients will say that this change in their bowel habit affects quality of life and two to three out of 10 will say that this effect on quality of life is moderate or severe. ⋯ Although research carried out into the basic molecular, cytokine and physiological changes underlying radiation-induced bowel symptoms and the optimal treatment that should be provided to symptomatic patients is scant, it does seem probable that a significant proportion of these patients can be cured or improved by specialist gastroenterological intervention. However, most patients never get referred to a specialist gastroenterologist and research into late radiation bowel damage has not been considered a priority. With the advent of more effective cancer therapies leading to greater numbers of affected long-term survivors, much more emphasis is urgently required to provide better information to patients at the start and after treatment, developing techniques that might reduce the frequency of significant bowel toxicity and researching better ways of measuring and treating late-onset side-effects.
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Clin Oncol (R Coll Radiol) · Sep 2007
Comparative StudyA comparison of Hickman line- and Port-a-Cath-associated complications in patients with solid tumours undergoing chemotherapy.
To compare the complication rates of Hickman lines and Port-a-Caths in patients undergoing infusional chemotherapy for solid tumours. ⋯ In this study, Port-a-Caths were shown to be both safer and cheaper than Hickman lines for patients requiring infusional chemotherapy.
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Clin Oncol (R Coll Radiol) · Sep 2007
Detection of occult spinal cord compression with magnetic resonance imaging of the spine.
Spinal cord compression (SCC) is the most significant complication due to skeletal metastasis from prostate cancer. The early detection of SCC is essential as the neurological status before treatment is the major determinant influencing outcome. The aim of this investigation was to determine the role of magnetic resonance imaging of the spine in detecting SCC or occult SCC in patients with metastatic prostate cancer with no functional neurological deficit (FND). ⋯ A significant proportion (27.3%) of patients with metastatic prostate cancer may harbour overt or occult SCC in the absence of FND. MRI of the spine for the early diagnosis of SCC may be considered useful in patients with extensive skeletal metastasis and back pain.