The Christie School of Oncology: Christie Research Publications Repository
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Normal tissue outlining guidelines development for soft tissue sarcoma of the extremities
No full textINTRODUCTION: Radiotherapy (RT) plans for soft tissue sarcoma of the extremities (STSE) are optimised to achieve maximum target coverage whilst avoiding high doses to weight-bearing bones and intermediate doses to the normal tissue (NT) limb corridor. Within this study, novel lower extremity NT outlining guidelines and atlas were developed based on the hypothesis that using these for RT planning may reduce RT toxicity. Usability and applicability of the guidance were also investigated. METHODS: Guidelines for NT outlining were developed. Two STSE cases were selected and a set of reference volumes was outlined on each case by one Therapeutic Radiographer/Radiation Therapist (RTT) and peer-reviewed by a consultant radiation oncologist (RO). NTs were then outlined following the guidelines by 11 (8 RTT and 3 RO) and 12 (9 RTT and 3 RO) additional observers, respectively for cases 1 and 2. Dice coefficient (DICE), Maximum Hausdorff distance (maxHD) and mean surface distance (MSD) were calculated for individual NT volumes against the reference volumes. The Kruskal-Wallis test was performed. Analysis of interobserver variability was then used to inform guidance improvement. RESULTS: Good agreement and reproducibility were observed in DICE, MSD and maxHD for the anterior, posterior, adductor and gluteal muscle compartments, femur and femoral head and neck, knee and hip joints. Moderate agreement was observed for the lateral rotator and iliopsoas muscle compartments, and the femoral and inguinofemoral neurovascular bundle. Poor agreement was observed for the deep thigh neurovascular bundle. CONCLUSION: Our results identify that the new NT outlining guidance for STSE is reproducible between observers and within a multi-professional environment, with consistent RTT and RO scores. This reproducibility is attributed to the use of guidelines. This study has also identified areas for refinement of the guidelines, particularly for the deep thigh neurovascular bundle
Bayesian analysis of dose to the medulla oblongata and dysphagia One-Year after head and neck radiotherapy
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Does living in a rural area reduce access to cancer treatment more for ethnic minorities? a population-based study on treatment for early stage non-small-cell lung cancer (NSCLC)
No full textDose accumulation and its correlation with toxicity and clinical outcome in MR-guided pancreatic SABR
No full textEPIC-B: phase II trial of cemiplimab as first-line treatment in advanced penile carcinoma
No full textRobotic cytoreductive surgery and heated intraperitoneal chemotherapy for low-grade pseudomyxoma peritonei and as a risk reduction procedure
No full textDeveloping a prospective rapid-learning methodology to evaluate the survival impact of changing radiotherapy practice to include a new heart dose limit for patients with lung cancer in a UK specialist cancer centre (RAPID-RT): a protocol
No full textINTRODUCTION: The RAPID-RT study is part of a large-scale research programme investigating the use of routinely collected real-world patient data to rapidly and prospectively evaluate and optimise the impact of changes in radiotherapy practice on clinical outcome, an approach often referred to as 'rapid learning'. As a proof of concept, a prospective, observational clinical study using realworld data is embedded within the programme. This study implements a new dose limit to a defined region of the heart in patients with stage I-III lung cancer treated with curative-intent radiotherapy at The Christie NHS Foundation Trust. The RAPID-RT study includes both methodological and clinical objectives. Its primary aim is to assess the feasibility and clinical acceptability of using rapid learning with real-world data to evaluate outcomes following modifications to standard-of-care radiotherapy protocols. This work has the potential to establish rapid learning as a robust, evidence-based approach for the continuous optimisation of radiotherapy workflows. METHODS AND ANALYSIS: RAPID-RT is a series of prospective single-arm observational studies with historic controls that uses only real-world data. A clinical decision was made to implement a dose limit to a specific region of the heart in all patients with stage I-III non-small cell lung cancer treated with curative-intent radiotherapy. The research focuses on using real-world data, the information collected as a part of patients' routine care, to evaluate the impact of this change on overall survival and treatment-related toxicities. The study employs broad inclusion criteria, and data are extracted directly from the electronic patient record. Patients are provided with clear patient information materials and consent for data use via an informed opt-out process. Outcomes for patients treated before and after the introduction of the dose limit are compared using a Bayesian analytical framework to allow sequential updating of results as patients are recruited to the study. Evidence of clinical impact will guide the clinical team in determining whether refinements to the heart dose limit are necessary. These changes will, in turn, be evaluated in subsequent rapid-learning cycles. The RAPID-RT study aims to complete at least two iterative learning cycles to support the continuous optimisation of radiotherapy protocols. ETHICS AND DISSEMINATION: The study has received ethical approval (REC reference 22/NW/0390) from the North West Haydock Research Ethics Committee, is sponsored by The Christie NHS Foundation Trust and is funded by the UK National Institute for Health and Care Research. The programme management group is supported by an independent programme steering committee, an independent statistical review panel, a clinical management team and patient advisory group. Findings from the RAPID-RT study will be shared widely through conferences, focus groups and a stakeholder event, including a public 'People's Forum' to co-create guiding principles for trusted rapid learning in radiotherapy. In parallel, interviews with participants, professionals and regulators will inform consensus and the development of practical, ethical and legal guidelines to support the adoption of rapid learning across NHS radiotherapy centres. TRIAL REGISTERATION NUMBER: ISRCTN17129364
