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Resource Implications for the Implementation of a Dedicated MRI Scanner for Radiotherapy Treatment Planning in Newcastle
Abstracts / Clinical Oncology 23 (2011) S1eS58 P62 Incidence of Second Malignancies in the Treatment Field following Pelvic Radiotherapy: a CaseeControl Study A. Madi *, C. White y, J. Howe y, R. Adams z * Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK y Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK z Velindre Hospital, Cardiff, UK Introduction: Several studies have demonstrated an association between pelvic radiotherapy (RT) and the development of second malignancies (SM) in patients living longer than 10 years. However, there is contradicting evidence in the literature, with some studies refuting such an association or even showing a reduced incidence of SM. In view of improved survival of cancer patients it is prudent to establish whether there is a true association between RT and SM. Methods: Patients who received pelvic RT 1989e2004 in Velindre Cancer Centre, Cardiff, were identified. Data were obtained from hospital records and the Welsh Cancer Intelligence and Surveillance Unit. Data were also collected on a control group who were diagnosed with varied non-pelvic malignancies during the same period. Follow-up data were censored on 31/12/2008. Patients who died or who developed SM within 5 years of first diagnosis were excluded. Significance levels were set at <0.05 and determined using Mantel Haenszel chi squared tests with values adjusted for sex. Results: There were 1375 cases and 6140 controls with a mean follow-up of 9.4 and 10.6 years, respectively. Rates of pelvic and overall SM were not different: 1.6% for cases compared with 2.4% for controls (P ¼ 0.1321) and 7.0% compared with 6.1% (P ¼ 0.0806), respectively. The rate of extra-pelvic SM was significantly higher in cases at 4.8% compared with 3.1% for controls (P ¼ 0.0003). Finally, the rate of haematological SM was the same in both groups at 0.6%. Conclusions: There is no increase in the incidence of pelvic or overall SM after pelvic RT in the first decade after treatment. Our results show an increase in extra-pelvic SM after pelvic RT. However, this outcome is confounded by treatment in the control group; therefore, such an association cannot be confirmed. Finally, longer follow-up is needed to determine outcome after the first decade.
P63 Retrospective Review of Effectiveness and Toxicity of Linac-based Stereotactic Radiosurgery (SRS) for Intra-cranial Arteriovenous Malformations (AVMs): Experience from Edinburgh Cancer Centre J.M. Malik *, L. Carruthers *, J. Burton *, J. Kane *, R. Al-Shahi Salman y, z, P. Keston x, P. White x, R. Sellar x, A. Gregor *, S.C. Erridge *,z * Edinburgh Cancer Centre, Edinburgh, UK y Department of Neurology, Western General Hospital, Edinburgh, UK z University of Edinburgh, Edinburgh, UK x Department of Neuro-Radiology, Western General Hospital, Edinburgh, UK Aims: Stereotactic radiosurgery (SRS) is a key component in the management of AVMs. In 1995, a multidisciplinary team was set up in collaboration with the Department of Neuro-sciences treating these patients using Linac-based SRS and the GTC relocatable frame. Methods: All patients treated 1995e2008 were identified, the demographics, treatment parameters, toxicity and outcome recorded. Results: Seventy-two patients had SRS planned, but 11 did not proceed (three intolerant of frame, two lesions closed on SRS angiogram, two too large and four other reasons). Of the 61 treated patients (median age 39 years; range 14e66), 77% had bled, the size ranged from 0.5e3.8 cm maximum dimension, 67% were <2 cm. Forty-one were Spetzler-Martin grade 0 or 1. Over half (33) had had prior embolisation as part of the multidisciplinary management of complex lesions. All but one patient were treated with 17.5 Gy to the 90% isodose using 15e40 mm collimators. The volume of the PTV ranged from 1 to 32 cc (median 4 cc) and the 12 Gy volume 2e48 cc (median 8 cc). Toxicity was minimal with 13% complaining of fatigue, 7% had a seizure and 7% alopecia. Three patients have developed radio-necrosis, two of which have responded to conservative management and the third required excision. One patient died of a bleed 3 months after treatment. By the end of September 2010, 35 had had angiographic confirmation of closure, three closed on MRI but no angiogram, 17 smaller but not closed on imaging with the remainder unchanged. The rate of closure based on MRI or angiogram was 68% for lesions <2 cm and 50% >2 cm.
S45
Conclusion: LinAc-based SRS is a safe and effective treatment for complex AVMs.
P64 Resource Implications for the Implementation of a Dedicated MRI Scanner for Radiotherapy Treatment Planning in Newcastle H. McCallum *, J. McKenna y, E. Harron * * Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, UK y Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK Aim: To describe the resources required in a northern cancer centre to install and clinically implement MRI for radiotherapy treatment planning purposes within the scope of a PFI installation. Method: The resource implications have been quantified using a parameter based on e-mail activity. The activity has been categorised into clinical, technical and building activities. Results: Analysis demonstrated that management of building and installation issues required the greatest commitment of resource: 48% of the total resource required to deliver the current clinical service. Management of clinical implementation required 38%, with technical and physics commissioning requiring only 14% of the total resources. Particular pitfalls and experiences will be discussed to highlight where resources can be unexpectedly and disproportionately consumed.
P65 Audit of Image Guided HDR Brachytherapy for Cervical Cancer in Northern Ireland U. Mcgivern, M. O'Toole, J. Clarke, G. Workman Belfast Health and Social Care Trust, Belfast, UK Introduction/aims: Image guided HDR brachytherapy was introduced in October 2008 at the Northern Ireland Cancer Centre. An audit was carried out to compare prescribed doses to point A and organs at risk (OAR) with standards set out in the RCR document Implementing image guided brachytherapy for cervix cancer in the UK 2009. Methods: Case notes were reviewed of all patients who received HDR brachytherapy for radically treated cervical cancer. Combining doses from external beam radiotherapy and brachytherapy allowed calculation of equivalent doses in 2 Gy per fraction (EQD2) for both the dose to point A and OAR. Results: Fifty-four patients were treated with radical intent with a median age 47.4 years (23.3e79.4). Fifty-two had concurrent cisplatin. Fifty-seven per cent of the patients were stage IIB. Fifty patients had three insertions/ fractions, and four had two insertions/fractions due to medical fitness. CT was used to contour OAR. The median dose to point A (EQD2 ab10) was 75.5 Gy (67.4e79.4 Gy) with 17 patients receiving less than <75 Gy. In the first 12 months, the median dose was 75.4 Gy (67.4e76.4). This improved to 77.2 Gy (67.4e79.4) in the second 12 months. The median dose to OAR (EQD2a/b3): rectum 64.4 Gy (54.7e81.4 Gy) with four receiving greater than 75 Gy; bowel 71.4 Gy (49.6e79.2 Gy) with eight receiving greater than 75 Gy and bladder 81.2 Gy (70.2e101 Gy) with three receiving greater than 95 Gy. There was no significant variation observed between the first or second 12 months. The median overall treatment time was 42.5 days (39e50 days). Median followup remains short at 9.8 months. Four recurrences have been seen, one central, one pelvic and two distant with one cancer related death. Conclusions: Increasing experience has allowed improved doses to point A, without necessarily increasing doses to OAR. Long term follow-up of these patients is required.
P66 The Importance of Adjuvant Radiotherapy in Treatment of Localised Salivary Duct Carcinoma F. McGrane *, R.K. Shrimali *, y, A.G. Robertson *, C. Paterson *, P.D. Correa *, z * Department of Clinical Oncology, The Beatson West of Scotland Cancer Centre, Glasgow, UK
P63 Retrospective Review of Effectiveness and Toxicity of Linac-based Stereotactic Radiosurgery (SRS) for Intra-cranial Arteriovenous Malformations (AVMs): Experience from Edinburgh Cancer Centre J.M. Malik *, L. Carruthers *, J. Burton *, J. Kane *, R. Al-Shahi Salman y, z, P. Keston x, P. White x, R. Sellar x, A. Gregor *, S.C. Erridge *,z * Edinburgh Cancer Centre, Edinburgh, UK y Department of Neurology, Western General Hospital, Edinburgh, UK z University of Edinburgh, Edinburgh, UK x Department of Neuro-Radiology, Western General Hospital, Edinburgh, UK Aims: Stereotactic radiosurgery (SRS) is a key component in the management of AVMs. In 1995, a multidisciplinary team was set up in collaboration with the Department of Neuro-sciences treating these patients using Linac-based SRS and the GTC relocatable frame. Methods: All patients treated 1995e2008 were identified, the demographics, treatment parameters, toxicity and outcome recorded. Results: Seventy-two patients had SRS planned, but 11 did not proceed (three intolerant of frame, two lesions closed on SRS angiogram, two too large and four other reasons). Of the 61 treated patients (median age 39 years; range 14e66), 77% had bled, the size ranged from 0.5e3.8 cm maximum dimension, 67% were <2 cm. Forty-one were Spetzler-Martin grade 0 or 1. Over half (33) had had prior embolisation as part of the multidisciplinary management of complex lesions. All but one patient were treated with 17.5 Gy to the 90% isodose using 15e40 mm collimators. The volume of the PTV ranged from 1 to 32 cc (median 4 cc) and the 12 Gy volume 2e48 cc (median 8 cc). Toxicity was minimal with 13% complaining of fatigue, 7% had a seizure and 7% alopecia. Three patients have developed radio-necrosis, two of which have responded to conservative management and the third required excision. One patient died of a bleed 3 months after treatment. By the end of September 2010, 35 had had angiographic confirmation of closure, three closed on MRI but no angiogram, 17 smaller but not closed on imaging with the remainder unchanged. The rate of closure based on MRI or angiogram was 68% for lesions <2 cm and 50% >2 cm.
S45
Conclusion: LinAc-based SRS is a safe and effective treatment for complex AVMs.
P64 Resource Implications for the Implementation of a Dedicated MRI Scanner for Radiotherapy Treatment Planning in Newcastle H. McCallum *, J. McKenna y, E. Harron * * Regional Medical Physics Department, Freeman Hospital, Newcastle upon Tyne, UK y Northern Centre for Cancer Care, Freeman Hospital, Newcastle upon Tyne, UK Aim: To describe the resources required in a northern cancer centre to install and clinically implement MRI for radiotherapy treatment planning purposes within the scope of a PFI installation. Method: The resource implications have been quantified using a parameter based on e-mail activity. The activity has been categorised into clinical, technical and building activities. Results: Analysis demonstrated that management of building and installation issues required the greatest commitment of resource: 48% of the total resource required to deliver the current clinical service. Management of clinical implementation required 38%, with technical and physics commissioning requiring only 14% of the total resources. Particular pitfalls and experiences will be discussed to highlight where resources can be unexpectedly and disproportionately consumed.
P65 Audit of Image Guided HDR Brachytherapy for Cervical Cancer in Northern Ireland U. Mcgivern, M. O'Toole, J. Clarke, G. Workman Belfast Health and Social Care Trust, Belfast, UK Introduction/aims: Image guided HDR brachytherapy was introduced in October 2008 at the Northern Ireland Cancer Centre. An audit was carried out to compare prescribed doses to point A and organs at risk (OAR) with standards set out in the RCR document Implementing image guided brachytherapy for cervix cancer in the UK 2009. Methods: Case notes were reviewed of all patients who received HDR brachytherapy for radically treated cervical cancer. Combining doses from external beam radiotherapy and brachytherapy allowed calculation of equivalent doses in 2 Gy per fraction (EQD2) for both the dose to point A and OAR. Results: Fifty-four patients were treated with radical intent with a median age 47.4 years (23.3e79.4). Fifty-two had concurrent cisplatin. Fifty-seven per cent of the patients were stage IIB. Fifty patients had three insertions/ fractions, and four had two insertions/fractions due to medical fitness. CT was used to contour OAR. The median dose to point A (EQD2 ab10) was 75.5 Gy (67.4e79.4 Gy) with 17 patients receiving less than <75 Gy. In the first 12 months, the median dose was 75.4 Gy (67.4e76.4). This improved to 77.2 Gy (67.4e79.4) in the second 12 months. The median dose to OAR (EQD2a/b3): rectum 64.4 Gy (54.7e81.4 Gy) with four receiving greater than 75 Gy; bowel 71.4 Gy (49.6e79.2 Gy) with eight receiving greater than 75 Gy and bladder 81.2 Gy (70.2e101 Gy) with three receiving greater than 95 Gy. There was no significant variation observed between the first or second 12 months. The median overall treatment time was 42.5 days (39e50 days). Median followup remains short at 9.8 months. Four recurrences have been seen, one central, one pelvic and two distant with one cancer related death. Conclusions: Increasing experience has allowed improved doses to point A, without necessarily increasing doses to OAR. Long term follow-up of these patients is required.
P66 The Importance of Adjuvant Radiotherapy in Treatment of Localised Salivary Duct Carcinoma F. McGrane *, R.K. Shrimali *, y, A.G. Robertson *, C. Paterson *, P.D. Correa *, z * Department of Clinical Oncology, The Beatson West of Scotland Cancer Centre, Glasgow, UK