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1.
Peter Lin Eng-Siew Koh Michael LinShalini K. Vinod Ivan Ho-ShonJune Yap Seu Som 《Radiotherapy and oncology》2011,101(2):284-290
Background and purpose
To evaluate whether FDG-PET performed for radiotherapy (RT) planning can detect disease progression, compared with staging PET.Materials and methods
Twenty-six patients with newly-diagnosed non-small-cell lung cancer underwent planning PET-CT for curative RT within 8 weeks (mean: 33 ± 14 days) of staging PET-CT. Progressive disease (PD) was defined as >25% increase in tumour size (transaxial) or volume, as delineated by SUV threshold of 2.5, or new sites (SUV > 2.5).Results
The planning PET detected PD in 16 patients (61%), compared to four patients (15%) by CT component of PET-CT. The mean scan interval was longer in patients with progression: 40 ± 12 days, compared to 22 ± 11 days without progression. Planning PET detected PD in 13/17 (76%), 12/14 (86%) and 7/7 patients if the interval was ?4, 5 and 6 weeks, respectively, compared with 3/9 patients if interval <4 weeks. Planning PET detected PD in primary metabolic volume in seven patients, 20 new nodal sites in 12 new nodal stations and nine patients, five extra-nodal sites in five patients. This resulted in upstaging in nine patients (35%): stage IIIA in three, IIIB in three and IV in three.Conclusions
RT-planning FDG-PET can provide incremental diagnostic information and may impact on staging in a significant number of patients. 相似文献2.
Jianghong Xiao Hong Zhang Youling Gong Yuchuan Fu Bin Tang Qingfeng Jiang 《Radiotherapy and oncology》2010,96(1):73-77
Background and purpose
To investigate the feasibility of using intravenous contrast-enhanced computed tomography (CT) scans in 3-dimensional conformal radiotherapy (3D-CRT), stereotactic body radiation therapy (SBRT) and intensity-modulated radiotherapy (IMRT) treatment planning for lung cancers, respectively.Materials and methods
Twelve patients with bulky lung tumors and 14 patients with small lung tumors were retrospectively analyzed. Each patient took two sets of CT in the same position with active breathing control (ABC) technique before and after intravenous contrast agent (CA) injections. Bulky tumors were planned with 3D-CRT, while SBRT plans were generated for patients with small tumors based on CT scans with intravenous CA. In addition, IMRT plans were generated for patients with bulky tumors to continue on a planning study. All plans were copied and replaced on the scans without intravenous CA. The radiation doses calculated from the two sets of CTs were compared with regard to planning volumes (PTV), the organ at-risk (OAR) and the lungs using Wilcoxon’s signed rank test.Results
In comparisons for 3D-CRT plans, CT scans with intravenous CA reduced the mean dose and the maximum dose of PTV with significant differences (p < 0.05) that were within 1.0%. Comparing IMRT and SBRT plans, CT scans with intravenous CA obviously increased the minimum irradiation dose and dose of 95% volume of target received (D95) for targets, respectively (p < 0.05). There was no statistical significance for lung parameters between two sets of scans in SBRT plans and IMRT plans.Conclusions
The enhanced CT scans can be used for both target delineation and treatment planning in 3D-CRT. The dose difference caused by intravenous CA is small. But for SBRT and IMRT, the minimum irradiation dose in targets may be estimated to be increased up to 2.71% while the maximum dose may be estimated to be decreased up to 1.36%. However, the difference in dose distribution in most cases were found to be clinical tolerable. 相似文献3.
Hillman GG Singh-Gupta V Runyan L Yunker CK Rakowski JT Sarkar FH Miller S Gadgeel SM Sethi S Joiner MC Konski AA 《Radiotherapy and oncology》2011,101(2):329-336
Background
We have demonstrated that soy isoflavones radiosensitize cancer cells. Prostate cancer patients receiving radiotherapy (RT) and soy tablets had reduced radiation toxicity to surrounding organs. We have now investigated the combination of soy with RT in lung cancer (NSCLC), for which RT is limited by radiation-induced pneumonitis.Methods
Human A549 NSCLC cells were injected i.v. in nude mice to generate lung tumor nodules. Lung tumor-bearing mice were treated with left lung RT at 12 Gy and with oral soy treatments at 1 mg/day for 30 days. Lung tissues were processed for histology.Results
Compared to lung tumor nodules treated with soy isoflavones or radiation, lung tissues from mice treated with both modalities showed that soy isoflavones augmented radiation-induced destruction of A549 lung tumor nodules leading to small residual tumor nodules containing degenerating tumor cells with large vacuoles. Soy isoflavones decreased the hemorrhages, inflammation and fibrosis caused by radiation in lung tissue, suggesting protection of normal lung tissue.Conclusions
Soy isoflavones augment destruction of A549 lung tumor nodules by radiation, and also mitigate vascular damage, inflammation and fibrosis caused by radiation injury to normal lung tissue. Soy could be used as a non-toxic complementary approach to improve RT in NSCLC. 相似文献4.
Wouter van Elmpt Steven Petit Dirk De Ruysscher Philippe Lambin André Dekker 《Radiotherapy and oncology》2010,94(2):188-194
Purpose
To implement a 3D dose verification procedure, based on in-room cone-beam CT imaging and portal dosimetry, for lung cancer patients treated with stereotactic body radiotherapy (SBRT).Materials and methods
MV cone-beam CT scans were made for patient positioning and calibrated for dose calculation purposes. Prior to treatment, the treatment fields were captured using a calibrated electronic portal imaging device (EPID). A Monte Carlo dose reconstruction model was used to estimate the 3D dose delivered to the patient inside the cone-beam CT images. The planned and delivered dose distributions were compared for 4 patients and 10 treatment fractions using dose-volume histograms and gamma analysis.Results
The gamma analysis showed a good agreement between the planned and delivered dose distributions for patients without changes in anatomy. The delivered mean dose per fraction inside the target volume deviated on average 1.1 ± 1.4% from the planned dose. For the critical organs, only minor differences were observed between the reconstructed and planned dose.Conclusions
A method was presented that allows verification of the dose delivered in 3D for lung cancer patients treated with SBRT. The procedure is independent of the treatment planning system and uses in-room MV cone-beam CT imaging and portal dosimetry. 相似文献5.
Introduction
Contamination, defined as screening in the control arm, may dilute the statistical power of randomised screening trials. We investigated the rate of contamination in DLCST during 4 years of annual CT screening.Methods
DLCST is a randomised trial involving 4104 healthy current and ex smokers. 2052 subjects were randomised to annual low dose chest CT scans (CT group) and 2052 were given no intervention (control group). The study is performed in collaboration with the NELSON trial (Nederlands Leuvens Screening Onderzoek) and mortality data will be pooled at the end. We defined contamination as off study CT scan received for lung cancer screening purposes. Annually during the screening period, the participants were asked whether they had received a CT scan and if so the purpose. The causes were divided into the following categories: ‘Off study screening for lung cancer’, ‘Investigation of lung symptoms’, ‘Investigation of incidental finding on chest radiograph’, ‘Participation in other scientific trial involving chest CT’, and finally ‘Chest CT for other reasons’.Results
Response rates were high in both groups: 86.1% (control group), 93.6% (CT group) p < 0.001.Control group
199 out of 7065 answers (2.8%) indicating acquisition of a chest CT during 4 years of the trial. Three answers fulfilled the definition of contamination, while 8 received chest CT due to involvement in other scientific trials. 126 reported CT scans as part of investigation for other diseases, while 10 and 52 went through investigations for abnormal chest radiograph and lung symptoms, respectively.CT group: Significantly lower number of answers (n = 134) indicated acquisition of an off study chest CT. None had received off study lung cancer screening. Three were involved in other scientific trials, while 17 and 115 went through investigation of lung symptoms and chest CT for other reasons, respectively.Conclusion
Although the frequency of off study chest CT was significantly higher in the control group, it was relatively small in both randomisation groups, and thus contamination seems to be modest and acceptable in the DLCST.Clinical Trial no.: Clinical Trials.gov Protocol Registration System (identification no. NCT00496977). 相似文献6.
Raviv Y Shitrit D Amital A Fox B Rosengarten D Fruchter O Bakal I Kramer MR 《Lung cancer (Amsterdam, Netherlands)》2011,74(2):280-283
Background
Lung transplantation is a viable therapy for patients with end-stage lung disease and is being increasingly performed worldwide. The incidence of lung cancer after lung transplantation has increased concomitantly, although data are still sparse.Methods
The computerized medical records of the Pulmonary Institute of a tertiary care medical center were searched for patients who underwent lung transplantation from 1997 to 2009 and acquired lung cancer postoperatively. The prevalence, potential contributing factors, and outcome of bronchogenic cancer were determined, and the medical literature was reviewed.Results
Bronchogenic cancer developed in 7 of the 290 lung transplant recipients (2.4%). All had received a single lung transplant and in most cases, the cancer developed in the native lung. These findings were similar to reports in the literature. The indication for transplantation was chronic obstructive pulmonary disease or idiopathic pulmonary fibrosis/interstitial lung disease. All had a history of smoking. The average interval from transplantation to development of lung cancer was 5 years (range 1-9). Five patients had stage 4 cancer at diagnosis and 2 had stage 1. Six patients died from 10 days to 1 year after diagnosis.Conclusion
Lung transplantation is associated with a relatively high prevalence of bronchogenic cancer, particularly in the native lung, in patients with primary chronic obstructive pulmonary disease/idiopathic pulmonary fibrosis, and a history of smoking. The cancer is usually diagnosed at an advanced stage with poor outcome. Efforts to improve screening are recommended, as aggressive management and treatment may be beneficial for earlier stage disease. 相似文献7.
Yukinori Matsuo Yuji Nakamoto Keiko Shibuya Yoshiki Norihisa Takashi Mizowaki Tatsuya Higashi Masahiro Hiraoka 《Radiotherapy and oncology》2010,97(2):200-204
Background and purpose
The purpose was to characterize 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) findings after stereotactic body radiation therapy (SBRT) for lung cancer.Materials and methods
This was a retrospective review of 32 FDG-PET scans from 23 patients who underwent SBRT for lung cancer and who showed no evidence of local recurrence. The FDG uptake by lesions was assessed visually using a 3-point scale (0, none or faint; 1, mild; or 2, moderate to intense), and the demarcation (ill- or well-defined) was evaluated. For semi-quantitative analysis, the maximum standardized uptake value (SUVmax) was calculated.Results
Grade 2 intensity was observed in 70%, 33%, 30%, and 0% of PET scans performed <6, 6-12, 12-24, and >24 months, respectively, after SBRT; well-defined demarcation was observed in 80%, 33%, 40%, and 17%, respectively, and the respective means of the SUVmax were 4.9, 2.6, 3.0, and 2.3. The SUVmax was significantly higher for scans performed at <6 months than at 6-12 or >24 months.Conclusions
FDG uptake tended to be intense and well-defined at early times after SBRT, especially within 6 months, and was faint and ill-defined at later periods. Moderate to intense FDG uptake observed soon after SBRT does not always indicate a residual tumour. 相似文献8.
Background and purpose
To determine the optimal method of targeting breast and regional nodes in selected breast cancer patients after axillary dissection, we compared the results of IMRT versus no IMRT, and CT-informed versus clinically-placed fields, in supine and prone positions.Materials and methods
Twelve consecutive breast cancer patients simulated both prone and supine provided the images for this study. Four techniques were used to target breast, level III axilla, and supraclavicular fossa in either position: a traditional three-field three-dimensional conformal radiotherapy (3DCRT) plan, a four-field 3DCRT plan using a posterior axillary boost field, and two techniques using a CT-informed target volume consisting of an optimized 3DCRT plan (CT-planned 3D) and an intensity-modulated radiotherapy (IMRT) plan. The prescribed dose was 50 Gy in 25 fractions.Results
CT-planned 3D and IMRT techniques improved nodal PTV coverage. Supine, mean nodal PTV V50 was 50% (3-field), 59% (4-field), 92% (CT-planned 3D), and 94% (IMRT). Prone, V50 was 29% (3-field), 42% (4-field), 97% (CT-planned 3D), and 95% (IMRT). Prone positioning, compared to supine, and IMRT technique, compared to 3D, lowered ipsilateral lung V20.Conclusions
Traditional 3DCRT plans provide inadequate nodal coverage. Prone IMRT technique resulted in optimal target coverage and reduced ipsilateral lung V20. 相似文献9.
Thomas Zilli Philippe Nouet Michael Betz Michel Rouzaud Mahmut Ozsahin 《Radiotherapy and oncology》2010,94(3):334-338
Background and purpose
To evaluate the feasibility and dosimetric optimization potential of a unilateral two-field intensity-modulated radiotherapy (IMRT) technique in the curative treatment of lateralized tonsil cancer.Materials and methods
Six patients with lateralized tonsillar carcinoma were treated unilaterally with a two-field IMRT technique (oblique-anterior and oblique-posterior fields, with or without collimator and couch rotation). Alternative IMRT plans using seven non-opposed coplanar fields were compared with the two-field plans for each patient.Results
Planning target volume (PTV) coverage was excellent with the two-field technique, using a relatively low number of monitor units (MU) (median, 441; range, 309-550). Dose constraints were respected for all organs at risk (OAR). Mean doses to contralateral parotid and submandibular glands were 3.9 and 17.7 Gy, respectively. Seven-field IMRT provided similar PTV coverage, with statistically significant better dose homogeneity and conformality. However, the mean delivered dose to the contralateral parotid (3.9 vs. 9.0 Gy, p = 0.001) as well as the mean number of MU (437 vs. 814, p = 0.002) and consequently machine time were lower with two-field IMRT.Conclusions
Unilateral two-field IMRT is a simple and feasible technique providing excellent tumor coverage and optimal OAR sparing while reducing the number of MU and treatment time. 相似文献10.
Steven F. Petit Wouter J.C. van Elmpt Philippe Lambin André L.A.J. Dekker 《Radiotherapy and oncology》2010,94(3):359-366
Purpose
To correct megavoltage cone-beam CT (MVCBCT) images of the thorax and abdomen for cupping and truncation artefacts to reconstruct the 3D-delivered dose distribution for treatment evaluation.Materials and methods
MVCBCT scans of three phantoms, three lung and two rectal cancer patients were acquired. The cone-beam projection images were iteratively corrected for cupping and truncation artefacts and the resulting primary transmission was used for cone-beam reconstruction. The reconstructed scans were merged into the planning CT scan (MVCBCT+). Dose distributions of clinical IMRT, stereotactic and conformal treatment plans were recalculated on the uncorrected and corrected MVCBCT+ scans using the treatment planning system and compared to the planned dose distribution.Results
The dose distributions on the corrected MVCBCT+ of the phantoms were accurate for 99% of the voxels within 2% or 2 mm. Using this method the errors in mean GTV dose reduced from about 10% to 1% for the patients.Conclusions
The method corrects cupping and truncation artefacts in cone-beam scans of the thorax and abdomen in addition to head-and-neck (demonstrated previously). The corrected scans can be used to calculate the influence of anatomical changes on the 3D-delivered dose distribution. 相似文献11.
Helen A. McNair Juliet Brock J. Richard N. Symonds-Tayler Sue Ashley Sally Eagle Philip M. Evans Anthony Kavanagh Niki Panakis Michael Brada 《Radiotherapy and oncology》2009,93(3):424-429
Introduction
One method to overcome the problem of lung tumour movement in patients treated with radiotherapy is to restrict tumour motion with an active breathing control (ABC) device. This study evaluated the feasibility of using ABC in patients receiving radical radiotherapy for non-small cell lung cancer.Methods
Eighteen patients, median (range) age of 66 (44-82) years, consented to the study. A training session was conducted to establish the patient’s breath hold level and breath hold time. Three planning scans were acquired using the ABC device. Reproducibility of breath hold was assessed by comparing lung volumes measured from the planning scans and the volume recorded by ABC. Patients were treated with a 3-field coplanar beam arrangement and treatment time (patient on and off the bed) and number of breath holds recorded. The tolerability of the device was assessed by weekly questionnaire. Quality assurance was performed on the two ABC devices used.Results
17/18 patients completed 32 fractions of radiotherapy using ABC. All patients tolerated a maximum breath hold time >15 s. The mean (SD) patient training time was 13.8 (4.8) min and no patient found the ABC very uncomfortable. Six to thirteen breath holds of 10-14 s were required per session. The mean treatment time was 15.8 min (5.8 min). The breath hold volumes were reproducible during treatment and also between the two ABC devices.Conclusion
The use of ABC in patients receiving radical radiotherapy for NSCLC is feasible. It was not possible to predict a patient’s ability to hold breath. A minimum tolerated breath hold time of 15 s is recommended prior to commencing treatment. 相似文献12.
13.
Background
The literature consistently shows that lung cancer patients experience both greater number of symptoms and concerns about health and existential issues compared with patients from other cancer populations and that patient distress near diagnosis predicts survival in lung cancer patients. Also evidence suggests that symptom characteristics (e.g. symptom intensity and frequency) influence distress. The relationship between aspects of patients’ symptom experiences can be complex and the mechanisms underpinning this association are not fully understood at present.Methods
Semi-structured interviews were conducted with 17 lung cancer patients and 15 primary caregivers at four time points: at the beginning of treatment and then subsequently at three, six, and twelve months, providing a total of 44 patient and 32 caregiver interviews. Interpretative Phenomenological Analysis was employed in the data analysis.Findings
The analysis presented here concentrates on two areas which was reported to influence distress in this population: (1) patients’ perception of symptoms and symptom characteristics and their associated distress; and (2) the relationship between patients’ causal reasoning and their distress.Conclusion
The complexity of the issues involved in the development of symptom distress needs to be recognised by health care professionals in this poor prognosis group of patients. Better patient preparation about symptoms may alleviate some of the symptom distress in lung cancer patients. 相似文献14.
Hilke Vorwerk Gabriele Beckmann Maria Degen Rainer Fietkau Robert Michael Hermann Ulrike Höller Wolfgang Körber Thomas Martin Ronald Richter Martin Steder Clemens Friedrich Hess Hans Christiansen 《Radiotherapy and oncology》2009,91(3):455-460
Purpose
Differences in the delineation of the gross target volume (GTV) and planning target volume (PTV) in patients with non-small-cell lung cancer are considerable. The focus of this work is on the analysis of observer-related reasons while controlling for other variables.Methods
In three consecutive patients, eighteen physicians from fourteen different departments delineated the GTV and PTV in CT-slices using a detailed instruction for target delineation. Differences in the volumes, the delineated anatomic lymph node compartments and differences in every delineated pixel of the contoured volumes in the CT-slices (pixel-by-pixel-analysis) were evaluated for different groups: ten radiation oncologists from ten departments (ROs), four haematologic oncologists and chest physicians from four departments (HOs) and five radiation oncologists from one department (RO1D).Results
Agreement (overlap ? 70% of the contoured pixels) for the GTV and PTV delineation was found in 16.3% and 23.7% (ROs), 30.4% and 38.6% (HOs) and 32.8% and 35.9% (RO1D), respectively.Conclusion
A large interobserver variability in the PTV and much more in the GTV delineation were observed in spite of a detailed instruction for delineation. The variability was smallest for group ROID where due to repeated discussions and uniform teaching a better agreement was achieved. 相似文献15.
St-Hilaire J Lavoie C Dagnault A Beaulieu F Morin F Beaulieu L Tremblay D 《Radiotherapy and oncology》2011,100(3):390-395
Purpose
To implement SPECT-based optimization in an anatomy-based aperture inverse planning system for the functional avoidance of lung in thoracic irradiation.Material and methods
SPECT information has been introduced as a voxel-by-voxel modulation of lung importance factors proportionally to the local perfusion count. Fifteen cases of lung cancer have been retrospectively analyzed by generating angle-optimized non-coplanar plans, comparing a purely anatomical approach and our functional approach. Planning target volume coverage and lung sparing have been compared. Statistical significance was assessed by a Wilcoxon matched pairs test.Results
For similar target coverage, perfusion-weighted volume receiving 10 Gy was reduced by a median of 2.2% (p = 0.022) and mean perfusion-weighted lung dose, by a median of 0.9 Gy (p = 0.001). A separate analysis of patients with localized or non-uniform hypoperfusion could not show which would benefit more from SPECT-based treatment planning. Redirection of dose sometimes created overdosage regions in the target volume. Plans consisted of a similar number of segments and monitor units.Conclusions
Angle optimization and SPECT-based modulation of importance factors allowed for functional avoidance of the lung while preserving target coverage. The technique could be also applied to implement PET-based modulation inside the target volume, leading to a safer dose escalation. 相似文献16.
Lyons G Quadrelli S Jordan P Colt H Chimondeguy D 《Lung cancer (Amsterdam, Netherlands)》2011,74(2):244-247
Introduction
The purpose of this study, therefore, was to evaluate the impact of the use of the present classification IASLC staging system (TNM7) on the categorization of patients and survival after resection.Methods
Between August 1985 and January 2007, 414 consecutive patients underwent pulmonary resection with a curative intention for NSCLC at the British Hospital in Buenos Aires were included in this study only if they were pathologically staged as N0-M0. Preoperative staging was performed according to the TNM classification system of the International Union Against Cancer (173 men, 58 women).Results
231 tumours were identified as pathological N0. Mean age was 61.4 years. 173 patients (74.9%) were men. When the TNM7 was applied, 28 patients (12.1%) changed their T factor staging (14 were moved towards a higher T and 14 were moved to a lower T) and 41 patients (17.7%) changed their pathological staging by applying the TNM7: 14 patients were downstaged (6.1%) and 27 (11.7%) were upstaged. With the present T definition among 103 patients in stage IB 27 were upstaged (18 to IIA and 9 to IIB) and in the group of stage IIIB (n = 14) all of them were downstaged (5 to IIB and 9 to IIA). The current T definition showed a statistically significant difference between the two T1 subgroups (93% versus 70% 5 year survival between T1a and T1b, p = 0.027).Conclusion
This study shows that the clinical impact of the using the IASLC proposed staging system would be modest but relevant, identifying a subgroup with a better prognosis (T1a). 相似文献17.
Ryu Kanzaki Masahiko HigashiyamaAyako Fujiwara Toshiteru TokunagaJun Maeda Jiro OkamiTakenori Kozuka Takuya HosokiYoshihisa Hasegawa Motohisa TakamiYasuhiko Tomita Ken Kodama 《Lung cancer (Amsterdam, Netherlands)》2011,71(3):333-337
Background
Integrated F18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is widely used for mediastinal lymph node (MLN) staging in patients with non-small cell lung cancer (NSCLC). However, FDG-PET/CT has certain limitations. Prediction of occult MLN metastasis could allow selection of candidates for preoperative cervical mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration. This study defined risk factors for occult MLN metastasis in patients with NSCLC patients who were diagnosed as clinical N0-1 by preoperative integrated FDG-PET/CT and CT.Methods
Consecutive patients with NSCLC who underwent staging using integrated FDG-PET/CT as an adjunct to CT prior to lung resection from October 2006 to September 2009 were evaluated retrospectively. The prevalence of MLN metastasis in patients diagnosed as clinical N0-1 was analyzed according to clinicopathological factors such as tumor location, tumor size, histology, and FDG uptake by the primary tumor. Risk factors for occult MLN metastasis were defined by multivariate analysis. Patterns of occult MLN metastasis were also analyzed and the involved MLNs were further examined histopathologically.Results
The incidence of MLN metastasis was 11% (24 patients of 224). Multivariate analysis identified adenocarcinoma (P = 0.04), tumors located in upper or middle lobe (P = 0.02), tumor size >3 cm (P = 0.01), and SUVmax of primary tumor >4.0 g/ml (P = 0.04) as significant risk factors for MLN metastasis. The pattern of occult MLN metastasis was typical for NSCLC cases. The size of metastatic foci were small, with 68% of foci smaller than 4.0 mm.Conclusions
The present study demonstrated that adenocarcinoma, tumors located in the upper or middle lobe, tumor size >3 cm, and SUVmax of primary tumor >4.0 g/ml are risk factors for occult MLN metastasis in patients with NSCLC who were diagnosed as clinical N0-1 by preoperative integrated FDG-PET/CT and CT. Patients with tumors located in the right upper or middle lobe are considered candidates for cervical mediastinoscopy because the involved metastatic mediastinal lymph nodes are easily accessible by these modalities. 相似文献18.
Anna L. Rich Laila J. TataRosamund A. Stanley Catherine M. FreeMichael D. Peake David R. BaldwinRichard B. Hubbard 《Lung cancer (Amsterdam, Netherlands)》2011,72(1):16-22
Aims
Our aims were to determine whether the information in the National Lung Cancer Audit database (LUCADA) is influenced by the completeness of reporting and to describe the current socio-demographics and survival of people with lung cancer in England.Methods
Using national registry data as a gold standard we stratified NHS Trusts into quartiles on the basis of their patient ascertainment. We assessed the distribution of patient features across these quartiles using Cox and logistic regression. We then examined overall survival and access to treatment.Results
We analysed data for 60,059 patients whose data were entered between 2004 and 2008. There was little variation in key patient features, treatment and median survival across quartiles of data completeness. Socio-economic disadvantage did not influence survival or access to surgery but was related to a decreased use of chemotherapy.Conclusion
Our findings suggest that LUCADA accurately describes people in England who are diagnosed with lung cancer and can therefore be used to drive health care improvements. Individual patient socio-economic status does not affect survival and has only a limited impact on access to treatment and so NHS Trust level factors should be studied to explain the previously published regional variations in these outcomes. 相似文献19.
Vedang Murthy Zubin MasterPranjal Adurkar Indranil MallickUmesh Mahantshetty Ganesh BakshiHemant Tongaonkar Shyamkishore Shrivastava 《Radiotherapy and oncology》2011,99(1):55-60
Background and purpose
This study assessed the potential of tomotherapy based Image Guided Radiotherapy (IGRT) to increase the accuracy of bladder irradiation using a ‘plan of the day’ adaptive radiotherapy (ART) technique.Materials and methods
Ten patients with muscle invasive bladder cancer underwent bladder preservation with trimodality therapy in an ongoing trial. All patients received 64 Gy/32# to the whole bladder and seven of them received a boost of 68 Gy/32# to the tumour bed. The ART technique entailed the generation of six IMRT plans for each patient, using six isotropic PTVs of 5-30 mm applied to the bladder volume (CTV) to generate the PTVs. Megavoltage CT (MVCT) imaging was done to correct positioning errors and choose the ‘plan of the day’.Results
Post treatment MVCT scans (315 scans) were used to generate multiple anisotropic PTVs for three hypothetical scenarios. Overall, coverage of anterior and superior walls required larger margins than other walls. Maximum geographical miss, in spite of IGRT, was noted for the superior (13.8%) and anterior walls (10.3%).Conclusions
Plan of the day ART is a feasible and promising technique for optimal treatment and dose escalation in bladder cancer. 相似文献20.