Objectives: The objective of this study was to compare the outcome of two cohorts of patients with anal squamous carcinoma treated with split course chemoradiation as opposed to continuous chemoradiation at Groote Schuur Hospital. Demographics including age at diagnosis, gender and HIV status were reviewed. The stage at diagnosis, the acute treatment toxicities and all surgical procedures were noted. The outcomes included complete response rate, local control rate, loco-regional failure free survival, colostomy-free survival and overall survival. Design and Methods: The data was obtained from patient records of all patients with histologically confirmed anal squamous cell carcinoma seen and registered at the Department of Radiation Oncology at Groote Schuur Hospital. Patients included were those treated with radical intent that presented between the years of 2008 and 2012. This data was then compared with a similar study performed between 2000-2 004-. Results: A total of 72 patients diagnosed with anal squamous carcinoma were seen at Groote Schuur Hospital in the 5-year period, of which 4-0 patients fitted the criteria for this study. The median age was 53 years, with a slight male preponderance (55%) and 27.5% tested HIV positive. A total of 68% of patients had T3 and T4- disease, with 4-2.5% node positive disease. The complete response rate was 60%, the local control rate was 52.5% and the loco-regional failure free survival at 5 years was 56%. The colostomy-free survival was I-"4-% and the 5-year overall survival was 4-0.67%. Haematological, gastrointestinal and skin toxicities were reviewed and the most common acute side effect experienced was grade 2[32.5%] and grade 3[4-15%] skin toxicity. Conclusion: The patient characteristics and treatment toxicities are in keeping with previous study findings. However, complete response rate and overall survival were less than expected. Although there was no statistically significant difference in overall survival between the two cohorts of patients, there was a definite trend to inferior treatment outcomes of those patients treated with continuous chemoradiation. We propose radiation dose escalation for future treatment of patients presenting with anal carcinoma at Groote Schuur Hospital.

Includes abstract. Includes bibliographical references.

Background: Stereotactic radiosurgery (SRS) is the gold standard for treatment of small and medium sized tumours, although fractionated regimens are well described. Access is limited in resource-constrained settings. There are no South African data describing outcomes of AN patients treated with fractionated stereotactic radiotherapy (SRT) using photons. We describe clinical and radiological outcomes of AN patients treated with SRT at an academic centre in Cape Town, South Africa. Objectives: To describe patient demographics, tumour characteristics and patients’ symptoms and changes in symptoms at follow-up. To investigate tumour local control (LC) rates at last follow up MRI, and compare LC rates described for SRS in the literature. To correlate radiologists’ serial 2D maximum linear diameter (MLD) measurements with calculated 3D tumour volume (TV). Methods: Fifteen AN patients treated with modified SRT (18.0gy/3fractions, were identified from the planning database; 13 were included. Patient data and tumour characteristics (size, laterality and previous surgery) were retrospectively extracted from clinic folders. Initial planning data was accessed and checked. Tumour volumes were contoured by the author on all subsequent MRI’s per patient and validated by a second investigator; tumour volume (TV) was automatically calculated. Radiologist’s 2D MLDs were compared with 3D TV. Sensitivity and specificity of radiologist reported change of MLD as a measure of actual change in TV was calculated. LC was calculated, from time of treatment to time of last MRI or time of progression (defined as ≥20% increase in TV). Results: Mean age was 60.4years (range 45-79years), with 4 (30.8%) being female. Seven patients (53.8%) had left sided tumours and median tumour size was 1.15cm3 (mean 1.59 cm3; range 0.62-3.35 cm3). Nine patients (69.2%) had Koos stage 2 ANs, 3 (23.1%) had stage 3 tumours and 1 (7.7%) had a stage I tumour. Two patients had NF2.Median follow-up time 12 was 29 months (range 0-50 months). Median baseline TV, as was 1.15 cm3 (mean 1.59cm3 with range 0.62-3.35 cm3). Three patients had no follow-up MRIs: 2 demised and 1 declined further follow-up. In total 5 patients died, 4 of unrelated causes and 1 of unknown cause (median time to death after RT 24 months, range 6 - 36 months). LC was 74% at 36months. Hearing preservation rate was 67%. No new facial or trigeminal nerve symptoms were noted. Radiologists correctly reported tumour growth in 100% of tumours that grew, and specificity was 77.3% in those that were stable. Conclusion: This is the first local study in hypofractionated SRT using photons. We show lower LC rates than seen in literature; our numbers are small and short follow up time short, with high attrition rates. Acute treatment toxicities were absent. Longer term follow-up is needed to assess late RT effects. A prospective study using this method of treatment would better define LC.

Purpose: To retrospectively evaluate and compare the loco-regional progression free survival (PFS), overall survival (OS) and acute effects of the two breast palliative regimes used in patients with locally advanced or metastatic breast cancer between 2010 and 2013 in a single institution. Methods: Compliance to treatment, acute skin reactions, progression free and overall survival were retrospectively evaluated in patients who received palliative breast radiotherapy for locally advanced breast cancer between 2010 and 2013. The radiotherapy regimes were either 4Gy per fraction for 5 fractions treated 4 times a week (20Gy) or 6Gy per fraction for 6 fractions treated once a week (36Gy). They may have received previous chemotherapy with minimal or no clinical response, as well as hormonal treatment. Results: Forty three patients were followed up over a median period of 24 months, 14 of which received 20Gy and 29 received 36Gy. The average age was 64 years old. Compliance was 88% in both groups. Both groups had either grade 1 (71% vs 62%), grade 2 (21% vs 24%) or grade 3 (8% vs 14%) acute skin reactions. No grade 4 skin reactions were documented. The PFS was shorter at 4.5 months in the 20Gy group compared to 7.7 months in the 36Gy group (p=0.27). The OS was also shorter at 25.8 months in the 20Gy group compared to 29.6 months in the 36Gy group (p=0.51) Conclusion: This study did not show a statistically significant difference in terms of PFS and OS between the two radiotherapy regimes. They both remain reasonable options in local palliation in patients with locally advanced breast cancer.

Includes abstract. Includes bibliographical references.

No description available.

<p> Patients receiving Intensity Modulated Radiation Therapy (IMRT) for late stage head and neck (HN) cancer often experience anatomical changes due to weight loss, tumor regression, and positional changes of normal anatomy (1). As a result, the actual dose delivered may vary from the original treatment plan. The purpose of this study was (a) to evaluate the dosimetric consequences of the parotid glands during the course of treatment, and (b) to determine if there would be an optimal timeframe for replanning. Nineteen locally advanced HN cancer patients underwent definitive IMRT. Each patient received an initial computerized tomography simulation (CT-SIM) scan and weekly cone beam computerized tomography (CBCT) scans. A Deformable Image Registration (DIR) was performed between the CT-SIM and CBCT of the parotid glands and Planning Target Volumes (PTVs) using the Eclipse treatment planning system (TPS) and the Velocity deformation software. A recalculation of the dose was performed on the weekly CBCTs using the original monitor units. The parameters for evaluation of our method were: the changes in volume of the PTVs and parotid glands, the dose coverage of the PTVs, the lateral displacement in the Center of Mass (COM), the mean dose, and Normal Tissue Complication Probability (NTCP) of the parotid glands. The studies showed a reduction of the volume in the PTVs and parotids, a medial displacement in COM, and alterations of the mean dose to the parotid glands as compared to the initial plans. Differences were observed for the dose volume coverage of the PTVs and NTCP of the parotid gland values between the initial plan and our proposed method utilizing deformable registration-based dose calculations.</p>

INTRODUCTION: The demand for healthcare services is expected to increase significantly faster than the rate of growth of healthcare providers in the United States. One method for meeting the demand is the utilization of physician assistants in the management of patient care. Medical doctors and residents have traditionally provided radiation oncology patient care. It was not until recently that the use of physician assistants in radiation oncology became common practice. However, the most effective utilization of physician assistants in radiation oncology has not been fully elucidated at this time. REVIEW OF THE LITERATURE: The demand for radiation oncology services is expected to increase in part because people are living longer; there is increased cancer survivorship, and better treatment modalities. Physician assistants are capable of providing high quality patient care comparable to medical doctors and improving patient satisfaction. The need for Physician assistants in radiation oncology is expected to increase significantly by 2020. Effective models of team-based care are becoming increasingly important as the demand for radiation oncology services increases. PAs can be used in a variety of different models including shared, independent, and mixed models of team-based care. The utilization of physician assistants in radiation oncology is maximized when physician assistants provide care that otherwise could only be performed by a medical doctor. For example, when radiation oncology centers use a mixed model of team-based medicine, the practice can bill services provided by a physician assistant at 100% of the medical doctor service fee rate thus maximizing the cost effectiveness of physician assistants. METHODS: This study is aimed at determining the statistical difference in terms of new patient and established patient visits within an academic medical center radiation oncology unit before and after the addition of a physician assistant. A pre- and post-physician assistant analysis of new and established patient visits will be analyzed using a paired T-test. CONCLUSION: This study is unique in that it is focusing on a single radiation oncology center. A significant limitation of the study will be the small, single center, sample size. However, the results of this study can be used in the future as a reference for the expected impact of a physician assistant on a radiation oncology center.

No description available.

Thesis (Ph.D.)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: Predictive assays are of key importance in clinical radiotherapy, chemotherapy and toxicology. Prior to exposing malignant tissues to irradiation or drugs in the clinic, a good understanding of the damage response to the cytotoxic agent is required. Such information is necessary for effective planning and treatment. Regrettably however the methods which detect DNA damage, namely micronucleus, apoptosis and DNA repair assays do not rank cells according to their intrinsic survival response to cytotoxic agents. The application of predictive assays based on micronuclei and apoptosis in the clinic therefore remains unreliable. Using a panel of 7 neuroblastoma and 6 neuroepithelial cell lines, it is shown that damage assays also do not rank cell lines according to cell survival. However, radiosensitivity can be reconstructed from micronuclei formation and apoptosis, and a new parameter, cell death due to small deletions, chromosome aberrations and misrepair. The interrelationships between radiation-induced micronuclei, apoptosis and repair is complex and varies between cell lines. Micronuclei formation and apoptosis are exponentially interrelated. This suggests that these cell inactivation pathways are strongly correlated. Evidence exists to show that the expression of apoptosis and micronuclei is influenced by the extent of DNA double-strand break repair within the first 2 hours after irradiation. Cell lines which repair more damage in the first 2 hours express more micronuclei and less apoptosis. Micronuclei formation and apoptosis and are not significantly correlated with the 20 hours slow repair component. There is however a strong correlation between 20 hours of repair and radiosensitivity, with the more radioresistant cell lines being more repair proficient. This suggests that the 2 hours (fast) DNA repair component is more error prone, and that cells lines repairing more damage late after irradiation tend to show better survival. In conclusion, micronuclei formation, apoptosis and DNA repair are strictly cell type specific and are not suitable for predicting radiosensitivity in terms of cell survival. However, these assays are very useful for studies on the influences of dose modifying agents i.e. oxygen tension, radiation modality, pH, cytotoxic sensitisers and radiation protectors which alter cellular responses and provide insight into damage mechanisms. / AFRIKAANSE OPSOMMING: Toetse wat kliniese gevolge kan voorspel is van uiterse beking in stralingsterapie, chemoterapie en toksikologie. Voordat kwaadaardige weefsels aan bestraling of chemise middels blootgestel can word in die kliniek, moet daar 'n goeie begrip van die skade weerstand wees van die selgiftige middel. Hierdie inligting is noodsaaklik vir effektiewe beplanning en behandeling. Ongelukkig stem die metodes wat ONS skade, apoptose en ONS hersteltoetse, nie ooreen met die selle se inherente straling sensitiwiteit nie. Die aanwending van voorspelbare toetse gebaseer op mikrokerne en apoptose in die kliniek bly dus onbetroubaar. Deur gebruik te maak van 'n paneel van 13 neurologiese sellyne, is daar bewys dat ONS skade toetse nie sellyne rangskik volgens seloorlewing nie. Radiosensitiwiteit kan herbou word deur 'n neiging om mikrokerne te vorm, apoptose, en sel sterftes weens klein vermiste ONS volgordes, chromosoom aberrasies en verkeerd herstelde ONS. Die verhouding tussen straling-geïnduseerde mikrokerne, apoptose en selgenees is kompleks en varieer tussen sellyne. Die ontstaan van mikrokerne en apoptose is eksponensiel verbind. Dit dui aan dat hierdie seltraagheidsbane streng gekorreleer word. Daar is bewys dat die uitdrukking van apoptose en mikrokerne deur die mate van herstel van die ONS dubbelstring-breuke binne die eerste 2 ure na bestraling beïnvloed is. Daar is gevind dat sellyne wat meer skade herstel binne die eerste 2 ure meer mikrokerne en minder apoptose toon. Die ontstaan van mikrokerne en apoptose is nie betekenisvol gekorreleer met die 20-uur stadige herstel komponent nie. Daar is inderdaad 'n sterk korrelasie tussen die 20-uur herstel komponent en radiosensitiwiteit, en die meer radioweerstandbiedende sellyne net In hoër herstel bekwaamheid. Dit laat mens dink dat die 2 uur (vinnige) DNS herstel komponent meer geneig is om foutief te wees, en dat sellyne wat meer skade, laat na bestraling herstel, beter oorlewing toon. Ten slotte, die ontstaan van mikrokerne, apoptose en DNS herstel is strenggesproke seltipe spesifiek en is nie toepaslik om radiosensitiviteit, in terme van seloorlewing, te voorspel nie. Hierdie toetse is nuttig vir studies waar die invloed van dosismodifiseringsagente, soos suurstof-spanning, straling-tipe, pH, sitotoksieke sensiteerders en stralingsbeskermers, wat sellulêre gevoeligheid verander en insig gee tot skade meganismes.