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11دورية أكاديمية
المؤلفون: Vaidya, Jayant S, Bulsara, Max, Baum, Michael, Wenz, Frederik, Massarut, Samuele, Pigorsch, Steffi, Alvarado, Michael, Douek, Michael, Saunders, Christobel, Flyger, Henrik, Eiermann, Wolfgang, Brew-Graves, Chris, Williams, Norman R, Potyka, Ingrid, Roberts, Nicholas, Bernstein, Marcelle, Brown, Douglas, Sperk, Elena, Laws, Siobhan, Sutterlin, Marc, Corica, Tammy, Lungren, Steinar, Holmes, Dennis, Vinante, Lorenzo, Bozza, Fernando, Pazos, Montserrat, Le Blanc-Onfroy, Magali, Gruber, Gunther, Polkowski, Wojciech, Dedes, Konstantin J, Niewald, Marcus, Blohmer, Jens, McCready, David, Hoefer, Richard, Kelemen, Pond, Petralia, Gloria, Falzon, Mary, Joseph, David J, Tobias, Jeffrey S
المصدر: IHR Papers and Journal Articles
مصطلحات موضوعية: breast cancer, randomised clinical trial, single dose targeted intraoperative radiotherapy, Medicine and Health Sciences
الوصف: Objective: To determine whether risk adapted intraoperative radiotherapy, delivered as a single dose during lumpectomy, can effectively replace postoperative whole breast external beam radiotherapy for early breast cancer. Design: Prospective, open label, randomised controlled clinical trial. Setting: 32 centres in 10 countries in the United Kingdom, Europe, Australia, the United States, and Canada. Participants: 2298 women aged 45 years and older with invasive ductal carcinoma up to 3.5 cm in size, cN0-N1, eligible for breast conservation and randomised before lumpectomy (1:1 ratio, blocks stratified by centre) to either risk adapted targeted intraoperative radiotherapy (TARGIT-IORT) or external beam radiotherapy (EBRT). Interventions: Random allocation was to the EBRT arm, which consisted of a standard daily fractionated course (three to six weeks) of whole breast radiotherapy, or the TARGIT-IORT arm. TARGIT-IORT was given immediately after lumpectomy under the same anaesthetic and was the only radiotherapy for most patients (around 80%). TARGIT-IORT was supplemented by EBRT when postoperative histopathology found unsuspected higher risk factors (around 20% of patients). Main outcome measures: Non-inferiority with a margin of 2.5% for the absolute difference between the five year local recurrence rates of the two arms, and long term survival outcomes. Results: Between 24 March 2000 and 25 June 2012, 1140 patients were randomised to TARGIT-IORT and 1158 to EBRT. TARGIT-IORT was non-inferior to EBRT: the local recurrence risk at five year complete follow-up was 2.11% for TARGIT-IORT compared with 0.95% for EBRT (difference 1.16%, 90% confidence interval 0.32 to 1.99). In the first five years, 13 additional local recurrences were reported (24/1140 v 11/1158) but 14 fewer deaths (42/1140 v 56/1158) for TARGIT-IORT compared with EBRT. With long term follow-up (median 8.6 years, maximum 18.90 years, interquartile range 7.0-10.6) no statistically significant difference was found for local recurrence-free survival ...
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12دورية أكاديمية
المؤلفون: Keshtgar Mohammed RS, Eaton David J, Reynolds Claire, Pigott Katharine, Davidson Tim, Gauter-Fleckenstein Benjamin, Wenz Frederik
المصدر: Radiation Oncology, Vol 7, Iss 1, p 128 (2012)
مصطلحات موضوعية: Pacemaker, Safety, Targeted intraoperative radiotherapy (TARGIT), INTRABEAM, Breast cancer, Medical physics. Medical radiology. Nuclear medicine, R895-920, Neoplasms. Tumors. Oncology. Including cancer and carcinogens, RC254-282
الوصف: We present the case of an 83 year old woman with a cardiac pacemaker located close in distance to a subsequently diagnosed invasive ductal carcinoma of the left breast. Short range intraoperative radiotherapy was given following wide local excision and sentinel node biopsy. The challenges of using ionising radiation with pacemakers is also discussed.
العلاقة: http://www.ro-journal.com/content/7/1/128Test; https://doaj.org/toc/1748-717XTest; https://doaj.org/article/33adc23dcad14f008aa074372c022bf3Test
الإتاحة: https://doi.org/10.1186/1748-717X-7-128Test
https://doaj.org/article/33adc23dcad14f008aa074372c022bf3Test -
13تقرير
المؤلفون: Keshtgar, Mohammed RS, Eaton, David J, Reynolds, Claire, Pigott, Katharine, Davidson, Tim, Gauter-Fleckenstein, Benjamin, Wenz, Frederik
مصطلحات موضوعية: Pacemaker, Safety, Targeted intraoperative radiotherapy (TARGIT), INTRABEAM, Breast cancer
الوصف: We present the case of an 83 year old woman with a cardiac pacemaker located close in distance to a subsequently diagnosed invasive ductal carcinoma of the left breast. Short range intraoperative radiotherapy was given following wide local excision and sentinel node biopsy. The challenges of using ionising radiation with pacemakers is also discussed.
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14دورية أكاديمية
المؤلفون: Corica, Tammy, Nowak, Anna K, Saunders, Christobel M, Bulsara, Max K, Taylor, Mandy, Williams, Norman R, Keshtgar, Mohammed, Joseph, David J, Vaidya, Jayant S
المصدر: Health Sciences Papers and Journal Articles
مصطلحات موضوعية: CCT.core, breast cancer, cosmesis, cosmetic rating systems, external beam radiotherapy, targeted intraoperative radiotherapy, TARGIT-IORT, Life Sciences, Medicine and Health Sciences
الوصف: Background: The purpose of this research was to assess agreement between four rating systems of cosmetic outcome measured in a subset of patients with early breast cancer participating in the randomised TARGIT-A trial. TARGIT-A compared risk-adapted single-dose intra-operative radiotherapy (TARGIT-IORT) to whole breast external beam radiotherapy (EBRT). Methods: Patients, their Radiation Oncologist and Research Nurse completed a subjective cosmetic assessment questionnaire before radiotherapy and annually thereafter for five years. Objective data previously calculated by the validated BCCT.core software which utilizes digital photographs to score symmetry, colour and scar was also used. Agreement was assessed by the Kappa statistic and longitudinal changes were assessed by generalized estimating equations. Results: Overall, an Excellent-Good (EG) cosmetic result was scored more often than a Fair-Poor (FP) result for both treatment groups across all time points, with patients who received TARGIT-IORT scoring EG more often than those who received EBRT however this was statistically significant at Year 5 only. There was modest agreement between the four rating systems with the highest Kappa score being moderate agreement which was between nurse and doctor scores at Year 1 with Kappa = 0.46 (p < 0.001), 95% CI (0.24, 0.68). Conclusion: Despite similar overall findings between treatment groups and rating systems, the inter-rater agreement was only modest. This suggests that the four rating systems utilized may not necessarily be used interchangeably and it is arguable that for an outcome such as cosmetic appearance, the patient’s point of view is the most important. Trial Registration: TARGIT-A ISRCTN34086741, Registered 21 July 2004, retrospectively registered.
وصف الملف: application/pdf
العلاقة: https://researchonline.nd.edu.au/health_article/219Test; https://researchonline.nd.edu.au/cgi/viewcontent.cgi?article=1224&context=health_articleTest
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15
المؤلفون: Anna K. Nowak, Jayant S. Vaidya, Norman R. Williams, David Joseph, Max Bulsara, Tammy Corica, Mandy Taylor, Mohammed Keshtgar, Christobel Saunders
المصدر: Radiation Oncology (London, England)
Radiation Oncology, Vol 13, Iss 1, Pp 1-10 (2018)مصطلحات موضوعية: lcsh:Medical physics. Medical radiology. Nuclear medicine, Targeted Intraoperative Radiotherapy, medicine.medical_specialty, Esthetics, medicine.medical_treatment, lcsh:R895-920, Nurses, Breast Neoplasms, lcsh:RC254-282, 03 medical and health sciences, Intraoperative Period, 0302 clinical medicine, Cohen's kappa, Breast cancer, Physicians, Breast Cancer, Medicine, Humans, Radiology, Nuclear Medicine and imaging, 030212 general & internal medicine, External beam radiotherapy, Generalized estimating equation, Radiation oncologist, Aged, TARGIT-IORT, Aged, 80 and over, Core (anatomy), Radiotherapy, business.industry, BCCT.core, Research, Cosmesis, Middle Aged, medicine.disease, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, 3. Good health, Radiation therapy, Treatment Outcome, Oncology, Patient Satisfaction, 030220 oncology & carcinogenesis, Physical therapy, External Beam Radiotherapy, Female, Cosmetic Rating Systems, business, Software
الوصف: Background The purpose of this research was to assess agreement between four rating systems of cosmetic outcome measured in a subset of patients with early breast cancer participating in the randomised TARGIT-A trial. TARGIT-A compared risk-adapted single-dose intra-operative radiotherapy (TARGIT-IORT) to whole breast external beam radiotherapy (EBRT). Methods Patients, their Radiation Oncologist and Research Nurse completed a subjective cosmetic assessment questionnaire before radiotherapy and annually thereafter for five years. Objective data previously calculated by the validated BCCT.core software which utilizes digital photographs to score symmetry, colour and scar was also used. Agreement was assessed by the Kappa statistic and longitudinal changes were assessed by generalized estimating equations. Results Overall, an Excellent-Good (EG) cosmetic result was scored more often than a Fair-Poor (FP) result for both treatment groups across all time points, with patients who received TARGIT-IORT scoring EG more often than those who received EBRT however this was statistically significant at Year 5 only. There was modest agreement between the four rating systems with the highest Kappa score being moderate agreement which was between nurse and doctor scores at Year 1 with Kappa = 0.46 (p
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::6ab5b28a211d8c884721b13605b3edd1Test
https://pubmed.ncbi.nlm.nih.gov/29653541Test -
16دورية أكاديمية
المؤلفون: Vaidya, Anil, Vaidya, Param, Both, Brigitte, Brew-Graves, Chris, Bulsara, Max, Vaidya, Jayant S
المصدر: Health Sciences Papers and Journal Articles
مصطلحات موضوعية: targeted intraoperative radiotherapy, TARGIT-IORT, cost-utility analysis, Mardov model, United Kingdom, Life Sciences, Medicine and Health Sciences
الوصف: Objective: The clinical effectiveness of targeted intraoperative radiotherapy (TARGIT-IORT) has been confirmed in the randomised TARGIT-A (targeted intraoperative radiotherapy-alone) trial to be similar to a several weeks’ course of whole-breast external-beam radiation therapy (EBRT) in patients with early breast cancer. This study aims to determine the cost effectiveness of TARGIT-IORT to inform policy decisions about its wider implementation. Setting TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy. Methods: Cost-utility analysis using decision analytic modelling by a Markov model. A cost-effectiveness Markov model was developed using TreeAge Pro V.2015. The decision analytic model compared two strategies of radiotherapy for breast cancer in a hypothetical cohort of patients with early breast cancer based on the published health state transition probability data from the TARGIT-A trial. Analysis was performed for UK setting and National Health Service (NHS) healthcare payer’s perspective using NHS cost data and treatment outcomes were simulated for both strategies for a time horizon of 10 years. Model health state utilities were drawn from the published literature. Future costs and effects were discounted at the rate of 3.5%. To address uncertainty, one-way and probabilistic sensitivity analyses were performed. Main outcome measures: Quality-adjusted life-years (QALYs). Results: In the base case analysis, TARGIT-IORT was a highly cost-effective strategy yielding health gain at a lower cost than its comparator EBRT. Discounted TARGITIORT and EBRT costs for the time horizon of 10 years were £12 455 and £13 280, respectively. TARGIT-IORT gained 0.18 incremental QALY as the discounted QALYs gained by TARGIT-IORT were 8.15 and by EBRT were 7.97 showing TARGIT-IORT as a dominant strategy over EBRT. Model outputs were robust to one-way and probabilistic sensitivity ...
وصف الملف: application/pdf
العلاقة: https://researchonline.nd.edu.au/health_article/203Test; https://researchonline.nd.edu.au/cgi/viewcontent.cgi?article=1208&context=health_articleTest
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17
المصدر: Frontiers in Oncology. 7
مصطلحات موضوعية: biomarkers, IN-VITRO, RANDOMIZED CONTROLLED-TRIAL, PROSTATE-CANCER, NORMAL TISSUE-REACTIONS, CHROMOSOMAL RADIOSENSITIVITY, toxicity tests, trial design, SINGLE NUCLEOTIDE POLYMORPHISMS, PHASE-II, TARGETED INTRAOPERATIVE RADIOTHERAPY, GENOME-WIDE ASSOCIATION, BREAST-CANCER PATIENTS, radiotherapy, patient selection
الوصف: The ability to stratify patients using a set of biomarkers, which predict that toxicity risk would allow for radiotherapy (RT) modulation and serve as a valuable tool for precision medicine and personalized RT. For patients presenting with tumors with a low risk of recurrence, modifying RT schedules to avoid toxicity would be clinically advantageous. Indeed, for the patient at low risk of developing radiation-associated toxicity, use of a hypofractionated protocol could be proposed leading to treatment time reduction and a cost-utility advantage. Conversely, for patients predicted to be at high risk for toxicity, either a more conformal form or a new technique of RT, or a multidisciplinary approach employing surgery could be included in the trial design to avoid or mitigate RT when the potential toxicity risk may be higher than the risk of disease recurrence. In addition, for patients at high risk of recurrence and low risk of toxicity, dose escalation, such as a greater boost dose, or irradiation field extensions could be considered to improve local control without severe toxicities, providing enhanced clinical benefit. In cases of high risk of toxicity, tumor control should be prioritized. In this review, toxicity biomarkers with sufficient evidence for clinical testing are presented. In addition, clinical trial designs and predictive models are described for different clinical situations.
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=od________83::789b97982624499dff0f00a0685fec2dTest
https://doi.org/10.3389/fonc.2017.00083Test -
18
المؤلفون: David Azria, Ariane Lapierre, Sophie Gourgou, Dirk De Ruysscher, Jacques Colinge, Philippe Lambin, Muriel Brengues, Tim Ward, Søren M. Bentzen, Hubert Thierens, Tiziana Rancati, Christopher J. Talbot, Ana Vega, Sarah L. Kerns, Christian Nicolaj Andreassen, Jenny Chang-Claude, Catharine M. L. West, Corey M. Gill, Barry S. Rosenstein
المساهمون: Institut de Recherche en Cancérologie de Montpellier (IRCM - U1194 Inserm - UM), CRLCC Val d'Aurelle - Paul Lamarque-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Maastricht University Medical Centre (MUMC), Maastricht University [Maastricht], University of Manchester [Manchester], Department of Epidemiology [Baltimore], Johns Hopkins Bloomberg School of Public Health [Baltimore], Johns Hopkins University (JHU)-Johns Hopkins University (JHU), Iminds [Ghent], Universiteit Gent = Ghent University [Belgium] (UGENT), Fondazione IRCCS Istituto Nazionale Tumori - National Cancer Institute [Milan], University Hospitals Leicester, Fundación Pública Galega Medicina Xenómica - SERGAS [Santiago de Compostela, Spain] (Grupo de Medicina Xenómica), CIBER de Enfermedades Raras (CIBERER)-Universidade de Santiago de Compostela [Spain] (USC ), University of Rochester Medical Center (URMC), Aarhus University Hospital, Heidelberg University Hospital [Heidelberg], Icahn School of Medicine at Mount Sinai [New York] (MSSM), Universiteit Gent = Ghent University (UGENT), Salvy-Córdoba, Nathalie
المصدر: Frontiers in Oncology
Frontiers in Oncology, Frontiers, 2017, 7, ⟨10.3389/fonc.2017.00083⟩
Frontiers in Oncology, Vol 7 (2017)
Azria, D, West, C & Rosenstein, B S 2017, ' Data-Based Radiation Oncology: Design of Clinical Trials in the Toxicity Biomarkers Era. ', Frontiers in Oncology, vol. 7, no. 83, pp. 1-11 . https://doi.org/10.3389/fonc.2017.00083Test
Frontiers in Oncology, 2017, 7, ⟨10.3389/fonc.2017.00083⟩مصطلحات موضوعية: 0301 basic medicine, Oncology, Cancer Research, medicine.medical_specialty, Pathology, Toxicity biomarkers, medicine.medical_treatment, [SDV.CAN]Life Sciences [q-bio]/Cancer, Disease, Review, lcsh:RC254-282, law.invention, 03 medical and health sciences, Prostate cancer, NORMAL TISSUE-REACTIONS, CHROMOSOMAL RADIOSENSITIVITY, 0302 clinical medicine, Randomized controlled trial, [SDV.CAN] Life Sciences [q-bio]/Cancer, law, Internal medicine, toxicity tests, Medicine, GENOME-WIDE ASSOCIATION, radiotherapy, Manchester Cancer Research Centre, business.industry, ResearchInstitutes_Networks_Beacons/mcrc, biomarkers, IN-VITRO, RANDOMIZED CONTROLLED-TRIAL, Precision medicine, medicine.disease, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, 3. Good health, PROSTATE-CANCER, Clinical trial, Radiation therapy, 030104 developmental biology, 030220 oncology & carcinogenesis, Toxicity, SINGLE NUCLEOTIDE POLYMORPHISMS, PHASE-II, trial design, TARGETED INTRAOPERATIVE RADIOTHERAPY, BREAST-CANCER PATIENTS, business, patient selection
الوصف: International audience; The ability to stratify patients using a set of biomarkers, which predict that toxicity risk would allow for radiotherapy (RT) modulation and serve as a valuable tool for precision medicine and personalized RT. For patients presenting with tumors with a low risk of recurrence, modifying RT schedules to avoid toxicity would be clinically advantageous. Indeed, for the patient at low risk of developing radiation-associated toxicity, use of a hypofractionated protocol could be proposed leading to treatment time reduction and a cost-utility advantage. Conversely, for patients predicted to be at high risk for toxicity, either a more conformal form or a new technique of RT, or a multidisciplinary approach employing surgery could be included in the trial design to avoid or mitigate RT when the potential toxicity risk may be higher than the risk of disease recurrence. In addition, for patients at high risk of recurrence and low risk of toxicity, dose escalation, such as a greater boost dose, or irradiation field extensions could be considered to improve local control without severe toxicities, providing enhanced clinical benefit. In cases of high risk of toxicity, tumor control should be prioritized. In this review, toxicity biomarkers with sufficient evidence for clinical testing are presented. In addition, clinical trial designs and predictive models are described for different clinical situations.
وصف الملف: application/pdf
الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::3a75486ecfbd028efe4c571e97485da3Test
https://hal.umontpellier.fr/hal-02294898/documentTest -
19دورية أكاديمية
مصطلحات موضوعية: Targeted Intraoperative Radiotherapy, Intensity-Modulated Radiotherapy, Randomized Controlled-Trial, Comparing Total Mastectomy, Lumpectomy Plus Tamoxifen, Beam Radiation-Therapy, 20-Year Follow-Up, Targit-A Trial, Whole-Breast, Conserving Surgery, 2700 Medicine, 2736 Pharmacology (medical)
الوصف: Background: Breast-conserving therapy for women with breast cancer consists of local excision of the tumour (achieving clear margins) followed by radiotherapy (RT). RT is given to sterilize tumour cells that may remain after surgery to decrease the risk of local tumour recurrence. Most true recurrences occur in the same quadrant as the original tumour. Whole breast radiotherapy (WBRT) may not protect against the development of a new primary cancer developing in other quadrants of the breast. In this Cochrane review, we investigated the delivery of radiation to a limited volume of the breast around the tumour bed (partial breast irradiation (PBI)) sometimes with a shortened treatment duration (accelerated partial breast irradiation (APBI)). Objectives: To determine whether PBI/APBI is equivalent to or better than conventional or hypo-fractionated WBRT after breast-conserving therapy for early-stage breast cancer. Search methods: We searched the Cochrane Breast Cancer Group Specialized Register (4 May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 5), MEDLINE (January 1966 to 4 May 2015), EMBASE (1980 to 4 May 2015), CINAHL (4 May 2015) and Current Contents (4 May 2015). We searched the International Standard Randomised Controlled Trial Number Register (5 May 2015), the World Health Organization's International Clinical Trials Registry Platform (4 May 2015) and ClinicalTrials.gov (17 June 2015). We searched for grey literature: OpenGrey (17 June 2015), reference lists of articles, several conference proceedings and published abstracts, and applied no language restrictions. Selection criteria: Randomized controlled trials (RCTs) without confounding, that evaluated conservative surgery plus PBI/APBI versus conservative surgery plus WBRT. Published and unpublished trials were eligible. Data collection and analysis: Two review authors (BH and ML) performed data extraction and used Cochrane's 'Risk of bias' tool, and resolved any disagreements through discussion. We entered data into ...
العلاقة: orcid:0000-0002-2771-8026; Not set; IF-14-09
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20دورية أكاديمية
المؤلفون: Coombs, N, Coombs, J, Vaidya, U, Singer, J, Bulsara, M, Tobias, J, Wenz, F, Joseph, D, Brown, D, Rainsbury, R, Davidson, T, Adamson, D, Massarut, S, Morgan, D, Potyka, I, Corica, T, Falzon, M, Williams, N, Baum, M, Vaidya, J
المصدر: Health Sciences Papers and Journal Articles
مصطلحات موضوعية: breast cancer, targeted intraoperative radiotherapy (TARGIT), external beam whole breast radiotherapy (EBRT), TARGIT-A randomized clinical trial, CO2 emissions, Life Sciences, Medicine and Health Sciences
الوصف: Objective: To quantify the journeys and CO2 emissions if women with breast cancer are treated with risk-adapted single-dose targeted intraoperative radiotherapy (TARGIT) rather than several weeks’ course of external beam whole breast radiotherapy (EBRT) treatment. Setting: (1) TARGIT-A randomised clinical trial (ISRCTN34086741) which compared TARGIT with traditional EBRT and found similar breast cancer control, particularly when TARGIT was given simultaneously with lumpectomy, (2) 2 additional UK centres offering TARGIT. Participants: 485 UK patients (249 TARGIT, 236 EBRT) in the prepathology stratum of TARGIT-A trial (where randomisation occurred before lumpectomy and TARGIT was delivered simultaneously with lumpectomy) for whom geographical data were available and 22 patients treated with TARGIT after completion of the TARGIT-A trial in 2 additional UK breast centres. Outcome measures: The shortest total journey distance, time and CO2 emissions from home to hospital to receive all the fractions of radiotherapy. Methods: Distances, time and CO2 emissions were calculated using Google Maps and assuming a fuel efficiency of 40 mpg. The groups were compared using the Student t test with unequal variance and the nonparametric Wilcoxon rank-sum (Mann-Whitney) test. Results: TARGIT patients travelled significantly fewer miles: TARGIT 21 681, mean 87.1 (SE 19.1) versus EBRT 92 591, mean 392.3 (SE 30.2); had lower CO2 emissions 24.7 kg (SE 5.4) vs 111 kg (SE 8.6) and spent less time travelling: 3 h (SE 0.53) vs 14 h (SE 0.76), all p<0.0001. Patients treated with TARGIT in 2 hospitals in semirural locations were spared much longer journeys (753 miles, 30 h, 215 kg CO2 per patient). Conclusions: The use of TARGIT intraoperative radiotherapy for eligible patients with breast cancer significantly reduces their journeys for treatment and has environmental benefits. If widely available, 5 million miles (8 000 000 km) of travel, 170 000 woman-hours and 1200 tonnes of CO2 (a forest of 100 hectares) will be saved annually in ...
وصف الملف: application/pdf
العلاقة: https://researchonline.nd.edu.au/health_article/161Test; https://researchonline.nd.edu.au/cgi/viewcontent.cgi?article=1166&context=health_articleTest
النص الكامل