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Abbott NL, Chauvie S, Marcu L, DeJean C, Melidis C, Wientjes R, Gasnier A, Lisbona A, Luzzara M, Mazzoni LN, O'Doherty J, Koutsouveli E, Appelt A, Hansen CR. The role of medical physics experts in clinical trials: A guideline from the European Federation of Organisations for Medical Physics. Phys Med 2024; 126:104821. [PMID: 39361978 DOI: 10.1016/j.ejmp.2024.104821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 08/26/2024] [Accepted: 09/22/2024] [Indexed: 10/05/2024] Open
Abstract
The EFOMP working group on the Role of Medical Physics Experts (MPEs) in Clinical Trials was established in 2010, with experts from across Europe and different areas of medical physics. Their main aims were: (1) To develop a consensus guidance document for the work MPEs do in clinical trials across Europe. (2) Complement the work by American colleagues in AAPM TG 113 and guidance from National Member Organisations. (3) To cover external beam radiotherapy, brachytherapy, nuclear medicine, molecular radiotherapy, and imaging. This document outlines the main output from this working group. Giving guidance to MPEs, and indeed all Medical Physicists (MP) and MP trainees wishing to work in clinical trials. It also gives guidance to the wider multidisciplinary team, advising where MPEs must legally be involved, as well as highlighting areas where MPEs skills and expertise can really add value to clinical trials.
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Affiliation(s)
- Natalie Louise Abbott
- King George V Building, St. Bartholomews Hospital, West Smithfield, London EC1A 7BE, UK; National RTTQA Group, Cardiff & London, UK.
| | - Stephane Chauvie
- Medical Physics Division, Santa Croce e Carle Hospital, Cuneo, Italy
| | - Loredana Marcu
- Faculty of Informatics and Science, University of Oradea, Oradea 410087, Romania; UniSA Allied Health & Human Performance, University of South Australia, Adelaide SA 5001, Australia
| | | | - Christos Melidis
- CAP Santé, Radiation Therapy, Clinique Maymard. Bastia, France; milliVolt.eu, a Health Physics Company. Bastia, France
| | | | - Anne Gasnier
- Department of Radiation Oncology, Henri Becquerel Cancer Centre, Rouen, France
| | - Albert Lisbona
- MP emeritus, Institut de Cancérologie de l'Ouest, Saint Herblain, France
| | | | | | - Jim O'Doherty
- Siemens Medical Solutions, Malvern, PA, United States; Radiography & Diagnostic Imaging, University College Dublin, Dublin, Ireland; Department of Radiology & Radiological Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Efi Koutsouveli
- Department of Medical Physics, Hygeia Hospital, Athens, Greece
| | - Ane Appelt
- Leeds Institution of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Medical Physics, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Christian Rønn Hansen
- Institute of Clinical Research, University of Southern Denmark, Denmark; Danish Center of Particle Therapy, Aarhus University Hospital, Denmark; Department of Oncology, Odense University Hospital, Denmark
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Boaz A, Goodenough B, Hanney S, Soper B. If health organisations and staff engage in research, does healthcare improve? Strengthening the evidence base through systematic reviews. Health Res Policy Syst 2024; 22:113. [PMID: 39160553 PMCID: PMC11331621 DOI: 10.1186/s12961-024-01187-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 07/22/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND There is an often-held assumption that the engagement of clinicians and healthcare organizations in research improves healthcare performance at various levels. Previous reviews found up to 28 studies suggesting a positive association between the engagement of individuals and healthcare organizations in research and improvements in healthcare performance. The current study sought to provide an update. METHODS We updated our existing published systematic review by again addressing the question: Does research engagement (by clinicians and organizations) improve healthcare performance? The search covered the period 1 January 2012 to March 2024, in two phases. First, the formal updated search ran from 1 January 2012 to 31 May 2020, in any healthcare setting or country and focussed on English language publications. In this phase two searches identified 66 901 records. Later, a further check of key journals and citations to identified papers ran from May 2020 to March 2024. In total, 168 papers progressed to full-text appraisal; 62 were identified for inclusion in the update. Then we combined papers from our original and updated reviews. RESULTS In the combined review, the literature is dominated by papers from the United States (50/95) and mostly drawn from the Global North. Papers cover various clinical fields, with more on cancer than any other field; 86 of the 95 papers report positive results, of which 70 are purely positive and 16 positive/mixed, meaning there are some negative elements (i.e. aspects where there is a lack of healthcare improvement) in their findings. CONCLUSIONS The updated review collates a substantial pool of studies, especially when combined with our original review, which are largely positive in terms of the impact of research engagement on processes of care and patient outcomes. Of the potential engagement mechanisms, the review highlights the important role played by research networks. The review also identifies various papers which consider how far there is a "dose effect" from differing amounts of research engagement. Additional lessons come from analyses of equity issues and negative papers. This review provides further evidence of contributions played by systems level research investments such as research networks on processes of care and patient outcomes.
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Affiliation(s)
- Annette Boaz
- Health and Social Care Workforce Research Unit, King's Policy Institute, King's College London, Virginia Woolf Building, 20 Kingsway, London, United Kingdom.
| | | | | | - Bryony Soper
- Brunel University London, Uxbridge, United Kingdom
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Breast clinical target volume: HU-based glandular CTVs and ESTRO CTVs in modern and historical radiotherapy treatment planning. Strahlenther Onkol 2021; 198:229-235. [PMID: 34477884 PMCID: PMC8863698 DOI: 10.1007/s00066-021-01839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 08/09/2021] [Indexed: 10/26/2022]
Abstract
PURPOSE The current study aimed to compare contouring of glandular tissue only (gCTV) with the clinical target volume (CTV) as defined according to European Society for Radiotherapy and Oncology (ESTRO) guidelines (eCTV) and historically treated volumes (marked by wire and determined by palpation and anatomic landmarks) in breast cancer radiotherapy. METHODS A total of 56 consecutive breast cancer patients underwent treatment planning based solely on anatomic landmarks/wire markings ("wire based"). From these treatment plans, the 50% and 95% isodoses were transferred as structures and compared to the following CT-based volumes: eCTV; a Hounsfield unit (HU)-based automatic contouring of the gCTV; and standardized planning target volumes (PTVs) generated with 1‑cm safety margins (resulting in the ePTVs and gPTVs, respectively). RESULTS The 95% isodose volume of the wire-based plan was larger than the eCTV by 352.39 ± 176.06 cm3 but smaller than the ePTV by 157.58 ± 189.32 cm3. The 95% isodose was larger than the gCTV by 921.20 ± 419.78 cm3 and larger than the gPTV by 190.91 ± 233.49 cm3. Patients with larger breasts had significantly less glandular tissue than those with small breasts. There was a trend toward a lower percentage of glandular tissue in older patients. CONCLUSION Historical wire and anatomic landmarks-based treatment planning sufficiently covers the glandular tissue and the theoretical gPTV generated for the glandular tissue. Modern CT-based CTV and PTV definition according to ESTRO results in a larger treated volume than the historical wire-based techniques. HU-standardized glandular tissue contouring results in a significantly smaller CTV and might be an option for reducing the treatment volume and improving reproducibility of contouring between institutions.
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Hafeez S, Lewis R, Hall E, Huddart R. Advancing Radiotherapy for Bladder Cancer: Randomised Phase II Trial of Adaptive Image-guided Standard or Dose-escalated Tumour Boost Radiotherapy (RAIDER). Clin Oncol (R Coll Radiol) 2021; 33:e251-e256. [PMID: 33766502 DOI: 10.1016/j.clon.2021.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/18/2021] [Accepted: 02/19/2021] [Indexed: 11/21/2022]
Affiliation(s)
- S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
| | - R Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UKS
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UKS
| | - R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
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Brunt AM, Haviland JS, Sydenham M, Agrawal RK, Algurafi H, Alhasso A, Barrett-Lee P, Bliss P, Bloomfield D, Bowen J, Donovan E, Goodman A, Harnett A, Hogg M, Kumar S, Passant H, Quigley M, Sherwin L, Stewart A, Syndikus I, Tremlett J, Tsang Y, Venables K, Wheatley D, Bliss JM, Yarnold JR. Ten-Year Results of FAST: A Randomized Controlled Trial of 5-Fraction Whole-Breast Radiotherapy for Early Breast Cancer. J Clin Oncol 2020; 38:3261-3272. [PMID: 32663119 PMCID: PMC7526720 DOI: 10.1200/jco.19.02750] [Citation(s) in RCA: 153] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Previous studies of hypofractionated adjuvant whole-breast radiotherapy for early breast cancer established a 15- or 16-fraction (fr) regimen as standard. The FAST Trial (CRUKE/04/015) evaluated normal tissue effects (NTE) and disease outcomes after 5-fr regimens. Ten-year results are presented. METHODS Women ≥ 50 years of age with low-risk invasive breast carcinoma (pT1-2 pN0) were randomly assigned to 50 Gy/25 fr (5 weeks) or 30 or 28.5 Gy in 5 once-weekly fr of 6.0 or 5.7 Gy. The primary end point was change in photographic breast appearance at 2 and 5 years; secondary end points were physician assessments of NTE and local tumor control. Odds ratios (ORs) from longitudinal analyses compared regimens. RESULTS A total of 915 women were recruited from 18 UK centers (2004-2007). Five-year photographs were available for 615/862 (71%) eligible patients. ORs for change in photographic breast appearance were 1.64 (95% CI, 1.08 to 2.49; P = .019) for 30 Gy and 1.10 (95% CI, 0.70 to 1.71; P = .686) for 28.5 Gy versus 50 Gy. α/β estimate for photographic end point was 2.7 Gy (95% CI, 1.5 to 3.9 Gy), giving a 5-fr schedule of 28 Gy (95% CI, 26 to 30 Gy) estimated to be isoeffective with 50 Gy/25 fr. ORs for any moderate/marked physician-assessed breast NTE (shrinkage, induration, telangiectasia, edema) were 2.12 (95% CI, 1.55 to 2.89; P < .001) for 30 Gy and 1.22 (95% CI, 0.87 to 1.72; P = .248) for 28.5 Gy versus 50 Gy. With 9.9 years median follow-up, 11 ipsilateral breast cancer events (50 Gy: 3; 30 Gy: 4; 28.5 Gy: 4) and 96 deaths (50 Gy: 30; 30 Gy: 33; 28.5 Gy: 33) have occurred. CONCLUSION At 10 years, there was no significant difference in NTE rates after 28.5 Gy/5 fr compared with 50 Gy/25 fr, but NTE were higher after 30 Gy/5 fr. Results confirm the published 3-year findings that a once-weekly 5-fr schedule of whole-breast radiotherapy can be identified that appears to be radiobiologically comparable for NTE to a conventionally fractionated regimen.
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Affiliation(s)
- Adrian Murray Brunt
- Cancer Centre, University Hospitals of North Midlands NHS Trust and Keele University, Stoke-on-Trent, Staffordshire, United Kingdom
| | - Joanne S. Haviland
- Clinical Trials and Statistics Unit, Institute of Cancer Research, Sutton, London, United Kingdom
| | - Mark Sydenham
- Clinical Trials and Statistics Unit, Institute of Cancer Research, Sutton, London, United Kingdom
| | - Rajiv K. Agrawal
- Oncology Centre, Lingen Davies Centre, Royal Shrewsbury Hospital, Shrewsbury, Shropshire, United Kingdom
| | - Hafiz Algurafi
- Oncology Department, Southend University Hospital, Southend, Essex, United Kingdom
| | - Abdulla Alhasso
- Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, Scotland
| | | | - Peter Bliss
- Oncology, Torbay Hospital, Torquay, Devon, United Kingdom
| | - David Bloomfield
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, Sussex, United Kingdom
| | - Joanna Bowen
- Oncology Centre, Cheltenham General Hospital, Cheltenham, Gloucestershire, United Kingdom
| | - Ellen Donovan
- Centre for Vision, Speech, and Signal Processing, University of Surrey, Guildford, Surrey, United Kingdom
| | - Andy Goodman
- Exeter Oncology Centre, Royal Devon and Exeter Hospital, Exeter, Devon, United Kingdom
| | - Adrian Harnett
- Oncology and Haematology Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, United Kingdom
| | - Martin Hogg
- The Cancer Centre, Royal Preston Hospital, Preston, Lancashire, United Kingdom
| | - Sri Kumar
- Leeds Cancer Centre, St James’s University Hospital, Leeds, Yorkshire, United Kingdom
| | - Helen Passant
- Velindre Cancer Centre, Velindre Hospital, Cardiff, Wales
| | - Mary Quigley
- Oncology Department, Queen’s Hospital, Romford, Essex, United Kingdom
| | - Liz Sherwin
- Department of Oncology and Haematology, Ipswich Hospital, Ipswich, Suffolk, United Kingdom
| | - Alan Stewart
- Radiotherapy Department, The Christie Hospital, Manchester, Lancashire, United Kingdom
| | - Isabel Syndikus
- The Clatterbridge Cancer Centre, Clatterbridge Hospital, Bebington, Wirral, Cheshire, United Kingdom
| | - Jean Tremlett
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, Sussex, United Kingdom
| | - Yat Tsang
- RTTQA, Mount Vernon Hospital, Rickmansworth, Middlesex, United Kingdom
| | - Karen Venables
- RTTQA, Mount Vernon Hospital, Rickmansworth, Middlesex, United Kingdom
| | - Duncan Wheatley
- The Sunrise Centre, Royal Cornwall Hospital, Truro, Cornwall, United Kingdom
| | - Judith M. Bliss
- Clinical Trials and Statistics Unit, Institute of Cancer Research, Sutton, London, United Kingdom
| | - John R. Yarnold
- Institute of Cancer Research and Royal Marsden Hospital NHS Foundation Trust, Sutton, Surrey, United Kingdom
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COVID-19: A Catalyst for Change for UK Clinical Oncology. Int J Radiat Oncol Biol Phys 2020; 108:462-465. [PMID: 32890533 PMCID: PMC7462794 DOI: 10.1016/j.ijrobp.2020.06.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 01/17/2023]
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Provision of Organ at Risk Contouring Guidance in UK Radiotherapy Clinical Trials. Clin Oncol (R Coll Radiol) 2019; 32:e60-e66. [PMID: 31607614 DOI: 10.1016/j.clon.2019.09.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 08/12/2019] [Accepted: 09/03/2019] [Indexed: 01/01/2023]
Abstract
AIMS Accurate delineation of organs at risk (OAR) is vital to the radiotherapy planning process. Inaccuracies in OAR delineation arising from imprecise anatomical definitions may affect plan optimisation and risk inappropriate dose delivery to normal tissues. The aim of this study was to review the provision of OAR contouring guidance in National Institute of Health Research Clinical Research Network (NIHR CRN) portfolio clinical trials. MATERIALS AND METHODS The National Radiotherapy Quality Trials Assurance (RTTQA) Group carried out a two-round Delphi assessment to determine which OAR descriptions provided optimal guidance. RESULTS Eighty-four clinical trials involving radiotherapy quality assurance were identified as either in recruitment or in setup within the NIHR CRN portfolio. Fifty-nine trials mandated OAR contouring. In total there were 412 OAR; 171 were uniquely named; 159 OAR had more than one name associated with a single structure, with the greatest nomenclature variation seen for the femoral head ± neck, the parotid gland, and bowel. The two-round Delphi assessment determined 42 OAR descriptions as providing optimal contouring guidance. CONCLUSIONS This study identified the need for OAR nomenclature and contouring guidance consistency across clinical trials. In response to this study and in conjunction with the Global Quality Assurance of Radiation Therapy Clinical Trials Harmonisation Group, the RTTQA Group is in collaboration with international partners to provide consensus recommendations for OAR delineation in clinical trials.
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Tsang Y, Hoskin P, Spezi E, Landau D, Lester J, Miles E, Conibear J. Assessment of contour variability in target volumes and organs at risk in lung cancer radiotherapy. Tech Innov Patient Support Radiat Oncol 2019; 10:8-12. [PMID: 32095541 PMCID: PMC7033767 DOI: 10.1016/j.tipsro.2019.05.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 05/19/2019] [Accepted: 05/21/2019] [Indexed: 12/29/2022] Open
Abstract
It aimed to examine if there’s any significant differences in TV & OAR contouring in lung trials QA. Statistically significant difference in trial protocol compliances of TV & OAR contouring existed. Trial protocol compliances of TV & OARs delineation can be identified through trial QA.
Aims This study aimed to examine whether any significant differences existed in trial protocol compliance in target volumes (TV) and organs at risk (OARs) contouring amongst clinical oncologists specialised in lung cancer radiotherapy. Materials/methods Two lung radiotherapy trials that require all prospective investigators to submit pre-trial outlining quality assurance (QA) benchmark cases were selected. The contours from the benchmark cases were compared against a set of reference contours which were defined by the trial management group (TMG). In order to quantify the degree of variation in TV and OARs contouring, the matching index (MI), Dice coefficient (DICE), Jaccard index (JI), Van‘t Riet Index and geographical miss index (GMI) were calculated. Results A total of 198 structures contoured by 21 clinicians were collected from the outlining benchmark cases. There were 40 clinical target volumes (CTV), 32 spinal cord, 36 oesophagus, 36 heart and 54 lungs volumes included in the study. Analysis of the pre-trial benchmark cases revealed statistically significant differences (p ≤ 0.05) in trial protocol compliances between clinical oncologists’ target volume and organs at risk contours. Our results demonstrated that the lung contours had the highest level of conformity, followed by heart, CTV, spinal cord and oesophagus respectively. Conclusions This study showed that there was a statistically significant difference in trial protocol compliance for lung clinical oncologists’ TV and OARs contouring within the pre-trial QA benchmark cases. Trial protocol compliances of TV and OARs delineation can be identified through assessing outlining QA benchmark cases.
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Affiliation(s)
- Yatman Tsang
- NIHR Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood HA6 2RN, UK
- Corresponding author at: Radiotherapy Department, Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK.
| | - Peter Hoskin
- NIHR Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood HA6 2RN, UK
- Division of Cancer Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester, UK
| | - Emiliano Spezi
- Dept. of Medical Physics, Velindre Cancer Centre, Cardiff, UK
- School of Engineering, Cardiff University, UK
| | - David Landau
- Dept. of Clinical Oncology, Guy’s and St. Thomas’ Hospital, London SE1 7EH, UK
| | - Jason Lester
- Dept. of Clinical Oncology, Velindre Cancer Centre, Velindre Road, Cardiff CF14 2TL, UK
| | - Elizabeth Miles
- NIHR Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Rickmansworth Rd, Northwood HA6 2RN, UK
| | - John Conibear
- Dept. of Clinical Oncology, St. Bartholomew’s Hospital, West Smithfield, London EC1A 7BE, UK
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Gwynne S, Higgins E, Poon King A, Radhakrishna G, Wills L, Mukherjee S, Hawkins M, Jones G, Staffurth J, Crosby T. Driving developments in UK oesophageal radiotherapy through the SCOPE trials. Radiat Oncol 2019; 14:26. [PMID: 30717810 PMCID: PMC6360789 DOI: 10.1186/s13014-019-1225-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SCOPE trials (SCOPE 1, NeoSCOPE and SCOPE 2) have been the backbone of oesophageal RT trials in the UK. Many changes in oesophageal RT techniques have taken place in this time. The SCOPE trials have, in addition to adopting these new techniques, been influential in aiding centres with their implementation. We discuss the progress made through the SCOPE trials and include details of a questionnaire sent to participating centres. to establish the role that trial participation played in RT changes in their centre. METHODS Questionnaires were sent to 47 centres, 27 were returned. RESULTS 100% of centres stated their departmental protocol for TVD was based on the relevant SCOPE trial protocol. 4DCT use has increased from 42 to 71%. Type B planning algorithms, mandated in the NeoSCOPE trial, were used in 79.9% pre NeoSCOPE and now in 83.3%. 12.5% of centres were using a stomach filling protocol pre NeoSCOPE, now risen to 50%. CBCT was mandated for IGRT in the NeoSCOPE trial. 66.7% used this routinely pre NeoSCOPE/SCOPE 2 which has risen to 87.5% in the survey. CONCLUSION The results of the questionnaires show how participation in national oesophageal RT trials has led to the adoption of newer RT techniques in UK centres, leading to better patient care.
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Affiliation(s)
- S. Gwynne
- South West Wales Cancer Centre, Swansea, UK
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - E. Higgins
- South West Wales Cancer Centre, Swansea, UK
| | | | | | - L. Wills
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - S. Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Maria Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - G. Jones
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - J. Staffurth
- NIHR Cardiff RTTQA Group, Cardiff, UK
- Cardiff University, Cardiff, UK
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Kirby AM, Bhattacharya IS, Wilcox M, Haviland JS. The IMPORT LOW Trial: Collaborative Research Accelerates Practice Change in Breast Radiotherapy. Clin Oncol (R Coll Radiol) 2019; 31:5-8. [PMID: 30236641 DOI: 10.1016/j.clon.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Affiliation(s)
- A M Kirby
- Royal Marsden NHS Foundation Trust, Sutton, UK; Institute of Cancer Research, Sutton, UK.
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Burbach K, Seifert J, Pieper DH, Camarinha-Silva A. Evaluation of DNA extraction kits and phylogenetic diversity of the porcine gastrointestinal tract based on Illumina sequencing of two hypervariable regions. Microbiologyopen 2015; 5:70-82. [PMID: 26541370 PMCID: PMC4767427 DOI: 10.1002/mbo3.312] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 12/16/2022] Open
Abstract
A robust DNA extraction method is important to identify the majority of microorganisms present in environmental microbial communities and to enable a consistent comparison between different studies. Here, 15 manual and four automated commercial DNA extraction kits were evaluated for their efficiency to extract DNA from porcine feces and ileal digesta samples. DNA yield, integrity, and purity varied among the different methods. Terminal restriction fragment length polymorphism (T‐RFLP) and Illumina amplicon sequencing were used to characterize the diversity and composition of the microbial communities. We also compared phylogenetic profiles of two regions of the 16S rRNA gene, one of the most used region (V1–2) and the V5–6 region. A high correlation between community structures obtained by analyzing both regions was observed at genus and family level for ileum digesta and feces. Based on our findings, we want to recommend the FastDNA™SPIN Kit for Soil (MP Biomedical) as a suitable kit for the analyses of porcine gastrointestinal tract samples.
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Affiliation(s)
- Katharina Burbach
- Institute of Animal Science, University of Hohenheim, Stuttgart, Germany
| | - Jana Seifert
- Institute of Animal Science, University of Hohenheim, Stuttgart, Germany
| | - Dietmar H Pieper
- Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
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Tsang Y, Ciurlionis L, Kirby AM, Locke I, Venables K, Yarnold JR, Titley J, Bliss J, Coles CE. Clinical impact of IMPORT HIGH trial (CRUK/06/003) on breast radiotherapy practices in the United Kingdom. Br J Radiol 2015; 88:20150453. [PMID: 26492402 PMCID: PMC4984937 DOI: 10.1259/bjr.20150453] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/12/2015] [Accepted: 10/20/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE IMPORT HIGH is a multicentre randomized UK trial testing dose-escalated intensity-modulated radiotherapy (IMRT) after tumour excision in females with early breast cancer and higher than average local recurrence risk. A survey was carried out to investigate the impact of this trial on the adoption of advanced breast radiotherapy (RT) techniques in the UK. METHODS A questionnaire was sent to all 26 IMPORT HIGH recruiting RT centres to determine whether the trial has influenced non-trial breast RT techniques in terms of volume delineation, dosimetry, treatment delivery and verification. In order to compare the clinical practice of breast RT between IMPORT HIGH and non-IMPORT HIGH centres, parts of the Royal College of Radiologists (RCR) breast RT audit result were used in this study. RESULTS 26/26 participating centres completed the questionnaire. After joining the trial, the number of centres routinely using tumour bed clips to guide whole-breast RT rose from 5 (19%) to 21 (81%). 20/26 (77%) centres now contour target volumes and organs at risk (OARs) in some or all patients compared with 14 (54%) before the trial. 14/26 (54%) centres offer inverse-planned IMRT for selected non-trial patients with breast cancer, and 10/14 (71%) have adopted the IMPORT HIGH trial protocol for target volume and OARs dose constraints. Only 2/26 (8%) centres used clip information routinely for breast treatment verification prior to IMPORT HIGH, a minority that has since risen to 7/26 (27%). Data on 1386 patients was included from the RCR audit. This suggested that more cases from IMPORT HIGH centres had surgical clips implanted (83 vs 67%), were treated using CT guided planning with full three-dimensional dose compensation (100 vs 75%), and were treated with photon boost RT (30 vs 8%). CONCLUSION The study suggests that participation in the IMPORT HIGH trial has played an important part in providing the guidance and support networks needed for the safe integration of advanced RT techniques, where appropriate, as a standard of care for breast cancer patients treated at participating cancer centres. ADVANCES IN KNOWLEDGE We investigated the impact of the IMPORT HIGH trial on the adoption of advanced breast RT techniques in the UK and the trial has influenced non-trial breast RT techniques in terms of volume delineation, dosimetry, treatment delivery and verification.
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Affiliation(s)
- Yat Tsang
- NCRI Radiotherapy Trials Quality Assurance group, Northwood, UK
- Mount Vernon Cancer Centre, Northwood, UK
| | - Laura Ciurlionis
- NCRI Radiotherapy Trials Quality Assurance group, Northwood, UK
- Mount Vernon Cancer Centre, Northwood, UK
| | - Anna M Kirby
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Imogen Locke
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Karen Venables
- NCRI Radiotherapy Trials Quality Assurance group, Northwood, UK
- Mount Vernon Cancer Centre, Northwood, UK
| | | | | | | | | | - on behalf of the IMPORT Trial Management Group
- NCRI Radiotherapy Trials Quality Assurance group, Northwood, UK
- Mount Vernon Cancer Centre, Northwood, UK
- The Royal Marsden NHS Foundation Trust, Sutton, UK
- The Institute of Cancer Research, Sutton, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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13
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Eaton DJ, Bolton S, Thomas RAS, Clark CH. Inter-departmental dosimetry audits - development of methods and lessons learned. J Med Phys 2015; 40:183-9. [PMID: 26865753 PMCID: PMC4728888 DOI: 10.4103/0971-6203.170791] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 08/05/2015] [Accepted: 08/05/2015] [Indexed: 11/10/2022] Open
Abstract
External dosimetry audits give confidence in the safe and accurate delivery of radiotherapy. In the United Kingdom, such audits have been performed for almost 30 years. From the start, they included clinically relevant conditions, as well as reference machine output. Recently, national audits have tested new or complex techniques, but these methods are then used in regional audits by a peer-to-peer approach. This local approach builds up the radiotherapy community, facilitates communication, and brings synergy to medical physics.
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Affiliation(s)
- David J. Eaton
- Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, London, UK
| | - Steve Bolton
- Inter-departmental Audit Group, Institute of Physics and Engineering in Medicine, York, UK
- Department of Medical Physics and Engineering, Christie Hospital, Manchester, UK
| | | | - Catharine H. Clark
- Radiation Dosimetry Group, National Physical Laboratory, London, UK
- Department of Medical Physics, Royal Surrey County Hospital, Guildford, UK
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14
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Evans CM, Burnet NG, Hall E, Huddart RA, Nutting CM, Coles CE. The Radiotherapy Clinical Trial Research Landscape in the UK Between 2004 and 2013: A Cross-sectional Analysis. Clin Oncol (R Coll Radiol) 2015; 27:491-4. [PMID: 26051438 DOI: 10.1016/j.clon.2015.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/05/2015] [Accepted: 05/13/2015] [Indexed: 11/27/2022]
Affiliation(s)
- C M Evans
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - N G Burnet
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - E Hall
- Clinical Trials and Statistics Unit at the Institute of Cancer Research, London, UK
| | - R A Huddart
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - C M Nutting
- The Royal Marsden NHS Foundation Trust, London, UK
| | - C E Coles
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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15
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Gulliford S. Response to "Comment on 'Future radiotherapy practice will be based on evidence from retrospective interrogation of linked clinical data sources rather than prospective randomized controlled clinical trials'" [Med. Phys. 41(3), 030601 (3pp.) (2014)]. Med Phys 2014; 41:057103. [PMID: 24784412 DOI: 10.1118/1.4871786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Sarah Gulliford
- Joint Department of Physics, The Institute of Cancer Research and Royal Marsden, NHS Foundation Trust, Downs Road - Sutton, Surrey SM2 5PT United Kingdom
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