Clinical oncology : a journal of the Royal College of Radiologists
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Clin Oncol (R Coll Radiol) · Jun 2015
Comparative StudyHypofractionated stereotactic body radiotherapy in spinal metastasis - with or without epidural extension.
To evaluate clinical outcome and the effect of malignant epidural compression (MEC) in the treatment of spine metastasis with stereotactic body radiotherapy (SBRT). ⋯ It is feasible to deliver a high dose of radiation (∼90% of the prescription dose) to the epidural component with volumetric modulated arc therapy SBRT and image guidance. It yielded high rates of pain control and local control in patients with spine metastases with or without MEC.
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The use of stereotactic body radiotherapy (SBRT) for localised prostate cancer is now supported by a substantial body of non-randomised data, with medium-term outcomes consistent with current standard radiotherapy. The ability to deliver profoundly hypofractionated treatment, combined with the relatively low α/β ratio of prostate cancer, may result in a more favourable therapeutic ratio, presenting an opportunity for isotoxic dose escalation. ⋯ However, in a treatment landscape with many competing options of broadly similar efficacy, randomised trials are essential to define the relative benefits of this approach. SBRT also has an emerging application in oligometastatic prostate cancer, with promising early outcomes for delaying disease progression and deferring the need for androgen deprivation therapy.
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Clin Oncol (R Coll Radiol) · Apr 2015
Factors affecting the use of single-fraction radiotherapy for the palliation of bone metastases in Australia.
Palliative radiotherapy for bone metastases remains an important treatment in patients with metastatic malignancy. Previous studies have indicated a reluctance to adopt single-fraction treatment despite considerable evidence. This study aims to describe the factors determining the use of palliative radiotherapy in patients with bone metastases and assess whether fractionation patterns have changed over time with emerging evidence. ⋯ The rate of single-fraction radiotherapy for bone metastases has remained low in two large Australian institutions, despite considerable evidence that single-fraction treatment provides equivalent pain relief to fractionated therapy. This trend towards fractionated treatment was largely maintained, even in patients with limited life expectancy. Further measures to increase the rate of single-fraction therapy are needed.
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Clin Oncol (R Coll Radiol) · Feb 2015
Estimating the need for palliative radiotherapy for brain metastasis: a benchmarking approach.
Palliative radiotherapy (PRT) is useful in the management of many patients with brain metastases, but the need for this treatment in the general cancer population is unknown. The objective of this study was to estimate the appropriate rate of use of PRT for brain metastases (PRT. Br). ⋯ Br is widely underutilised in Ontario. The 25% shortfall in the use of PRT. Br reported here is much greater than the previously reported 7.8% shortfall in the overall lifetime rate of use of any radiotherapy in Ontario.