Radiation Therapyhttp://hdl.handle.net/10523/2522024-01-30T23:17:28Z2024-01-30T23:17:28ZFeasibility of Strata XRT in the Treatment of Radiation Dermatitis in Head and Neck Cancer PatientsRutten, Lucy Ivanahttp://hdl.handle.net/10523/134712023-01-10T13:02:09Z2022-07-13T02:18:34ZFeasibility of Strata XRT in the Treatment of Radiation Dermatitis in Head and Neck Cancer Patients
2018
Rutten, Lucy Ivana
The primary aim of this study was to evaluate the feasibility of Strata XRT in the treatment of radiation dermatitis in head and neck cancer patients compared to the use of the department’s standard of practice; Fatty E Cream. This study was undertaken to gather both the healthcare professional and the patient’s perspective on the use of Strata XRT. Data collection was completed retrospectively for the control patients and prospectively for the study patients. Data was collected through the use of weekly adjusted RIS RAS scoring assessments and CTCAE assessments of patients using Fatty E cream or Strata XRT. Adjusted RIS RAS scores also collected data on patient tolerability, compliance and usage of Strata XRT. Results suggest patients find Strata XRT easy and comfortable to use although can be sticky and painful to apply. An average of 2.7 50g tubes were required for bilateral nodal patients and 1.8 tubes for patients with no nodal irradiation. Strata XRT is feasible if the healthcare provider uses a value-based economic system compared with a cost-effectiveness system.
2022-07-13T02:18:34ZThe unique effects of individual folate vitamers on cancer incidence and outcomes: a protocol for a systematic review and meta-analysis.Cait, AlissaTang, JeffryGell, KatieO'Sullivan, DavidLi, YanyanGrooby, AlixFaulkner, SophieHerst, PatriesGasser, Olivierhttp://hdl.handle.net/10523/119232023-04-05T02:49:57Z2021-05-23T21:09:24ZThe unique effects of individual folate vitamers on cancer incidence and outcomes: a protocol for a systematic review and meta-analysis.
2021-05
Cait, Alissa; Tang, Jeffry; Gell, Katie; O'Sullivan, David; Li, Yanyan; Grooby, Alix; Faulkner, Sophie; Herst, Patries; Gasser, Olivier
The importance of folic acid supplementation in reducing the risk of neural tube defects is well established. However, the effects of folic acid on other diseases, including cancer, are less well understood and have been the subject of several clinical trials. Folate vitamers are chemically similar substances derived from the parent compound pteroyl monoglutamic acid. Several placebo-controlled clinical trials have assessed the impact of folate vitamer supplements on cancer incidence and mortality with differing results. Meta-analyses have found an association between folate supplements and cancer outcomes with different estimates of certainty. However, we believe that differentiating between the different vitamer forms will account for much of the heterogeneity seen in the data. This protocol aims to define the methods for a systematic review and meta-analysis to assess if individual folate vitamers modify the risk of cancer incidence and cancer-associated mortality.
2021-05-23T21:09:24ZCranberry capsules for acute radiation induced cystitis: The Kathleen Kilgour Centre experienceSword, Vanessahttp://hdl.handle.net/10523/103912022-09-01T04:04:26Z2020-09-20T21:34:03ZCranberry capsules for acute radiation induced cystitis: The Kathleen Kilgour Centre experience
2020
Sword, Vanessa
Acute cystitis is a common radiation side effect in prostate cancer patients undergoing radiation therapy treatment which results from radiation damage to the bladder. Acute cystitis symptoms can occur within weeks of starting radiation therapy treatment and symptoms include frequency, nocturia, haematuria, urgency, pain and a reduced capacity to store urine. Current standard of care focuses on symptom management and not on treating cystitis. Previous research had shown that the incidence of radiation cystitis and pain/burning was lower and urinary flow stronger in men taking daily cranberry capsules, compared with men taking placebo capsules. The aim of the current study was to validate these findings in a 100 patient multicentre stage III double blinded randomized controlled clinical trial. Here, I present the analysis of data collected from the Kathleen Kilgour Centre (KKC) between January 2018 and January 2019.
Prostate cancer patients were randomised to take either 2 cranberry capsules containing 72mg of proanthocyanidins or 2 placebo capsules per day; these capsules were indistinguishable from each other. The capsules were taken daily starting on day 1 of radiation treatment and finishing two weeks after completion of radiation treatment. Three assessment scales were used measure the severity of acute radiation induced cystitis on day 1 of radiation treatment and once weekly after that until 2 weeks after completion of radiation treatment. Two of the scales are validated (the Modified Radiation Therapy and Oncology Group Scores and Interstitial Cystitis Symptom/Problem Scores) and one novel scale (Radiation Induced Cystitis Assessment Scale) was used to assess acute radiation induced cystitis. Participants filled out the Interstitial Cystitis Symptom/Problem Scores and the Radiation Induced Cystitis Assessment Scale themselves with the research radiation therapist (the author of this thesis) completing the Modified Radiation Therapy and Oncology Group Scores. These assessment scales included items on severity and frequency of symptoms as well as the impact of these symptoms on daily life for participants.
Between December 2016 and February 2019, 34 men were recruited, and 33 men completed the trial (16 men in the cranberry arm and 17 in the placebo arm). This thesis reports on those that were recruited during enrolment of BRT Hons. A total of 19 men were recruited between January 2018 and January 2019 (9 men in cranberry arm and 10 men in the placebo arm). There was no statistically significant difference between the severity of cystitis symptoms of patients who took cranberry capsules compared with patients who took placebo capsules, using any of the cystitis severity scales.
Prostate cancer can lead to cystitis-like symptoms; therefore, it was anticipated that some men would present with these symptoms at baseline. Randomisation evenly distributed these men with baseline symptoms between the cranberry and placebo arms therefore minimising any potential confounding of the results. To further ensure that the baseline symptoms did not confound the results, the maximum score minus the baseline score was determined and used in the statistical analysis. This allowed for the assessment of any worsening of cystitis symptoms as participants went through their radiation treatment. Therefore, the results will most accurately depict any effect cranberry capsules might have on the change in the severity of cystitis that the participants experience as they undergo radiation therapy treatment.
Participants were allocated to one of three treatment regimens; a conventional regimen of 74Gy in 37 fractions, a hypofractionated CHHiP regimen of 60Gy in 20 fractions, or the prostate bed regimen of 66Gy in 33 fractions. A lower total dose or a higher dose per fraction could affect cystitis severity. Randomisation between these three treatment regimens was stratified to minimise the confounding that the different treatment regimens could have on any potential differences in cystitis severity between men taking cranberry or placebo capsules.
The placebo capsules used in this study contained red beetroot powder to make them indistinguishable from the cranberry capsules. This aided in successfully blinding the participants from visually assessing and knowing if they were on the cranberry or placebo capsules. However, beetroot contains antioxidants such as betalains, which also have anti-inflammatory properties. Both cranberry and placebo capsules were tested and compared to cranberry capsules, the placebo capsules had very low anti-inflammatory activity and no antioxidant activity. Therefore, the placebo capsules could be used in this trial as true inactive placebos.
Participants are required to have a full bladder daily for their radiation therapy treatment. A full bladder reduces the irradiated volume of the bladder, therefore reducing the severity of the side effects. The bladder volumes and bladder doses received were similar between the cranberry and placebo arms and were not likely to confound the results of this study. Bladder volume is likely to be inconsistent from day to day and participants’ bladder volumes were checked daily on cone beam CT and participants were encouraged to hydrate to fill their bladder as full as when they did their planning CT scan. Daily variation in bladder volume is a potential unavoidable confounder in the study.
In conclusion, this study found that cranberry capsules were not superior to capsules containing beetroot for managing acute radiation induced cystitis in this small KKC cohort.
2020-09-20T21:34:03ZThe effect of Mepitel Film on skin reaction severity in patients undergoing radiation therapy for head and neck cancer: a feasibility studyWooding, Hayleyhttp://hdl.handle.net/10523/73322022-09-01T04:08:18Z2017-05-25T02:08:44ZThe effect of Mepitel Film on skin reaction severity in patients undergoing radiation therapy for head and neck cancer: a feasibility study
2017
Wooding, Hayley
Radiation skin reactions are a common side effect of radiation therapy and can be distressing and painful for patients. Head and neck cancer patients receive a high dose of radiation to the skin and are therefore at high risk of acute skin toxicity. There have been many clinical trials investigating topical agents to reduce or prevent these reactions but the evidence to date is lacking and many centres still base their practice on anecdotal evidence. Recently clinical trials in breast cancer patients have shown that using Mepitel Film® (Mölnlycke Health Care AB, Gothenburg, Sweden) reduced skin reaction severity and stopped the development of moist desquamation when used prophylactically (from the first day of radiation therapy). Mepitel Film and other soft silicone dressings that adhere very closely to the folds of the skin, have been hypothesized to decrease skin reaction severity by stopping friction by clothing and allow the radiation damaged skin to repair itself.
The aim of this randomised controlled feasibility study in this thesis was to investigate whether Mepitel Film dressings were superior to Sorbolene cream in reducing or managing radiation-induced skin reactions in patients with head and neck cancer Head and neck cancer patients are prescribed a higher dose than breast cancer patients, have an uneven surface for the Mepitel Film to adhere to and have complex non-homogenous dose distributions, This means that testing the effect of Mepitel Film in this cohort would be challenging. Despite this, it was hypothesised that Mepitel Film was superior to standard Sorbolene cream in decreasing the severity of acute radiation-induced skin reaction in patients receiving radiation therapy for head and neck cancer.
In order to test this hypothesis a randomised, controlled, multi-centre, international, open label intra-patient feasibility study was conducted in New Zealand and China. This thesis analyses a subset of 12 patients recruited at the Canterbury Regional Cancer and Haematology Service (CRCHS) at Christchurch Public Hospital. For the first six patients, the study area was chosen as the area of first erythema which was divided into equal halves. Each half was randomised to either Mepitel Film or Sorbolene cream. Mepitel Film was applied as soon as erythema was visible (management protocol). For the next six patients, the study area was chosen at the planning stage to include an area of relatively uniform high dose (>40Gy). This area was divided into two equal halves; one half was randomised to Mepitel Film the other half to Sorbolene cream. Mepitel Film was applied from day one of radiation therapy treatment (prophylactic protocol). Sorbolene cream was applied twice a day by the patient. The Modified Radiation-induced Skin Reaction Assessment Scale (RISRAS) and the Modified Radiation Therapy Oncology Group (RTOG) skin toxicity score were used to assess skin reaction severity three times a week. Patients also filled out the New Zealand validated Distress screening tool once a week and completed exit questionnaires at the end of the follow-up period. Thermoluminescent dosimeters (TLDs) were used to measure the actual dose to the skin underneath Mepitel Film and the control cream for all patients.
When results of all 12 patients were combined, there was a statistically significant decrease in skin reaction severity in favour of Mepitel Film of 29% for combined scores, of 15% for researcher scores and of 49% for patients’ scores (p= 0.001, 0.002 and 0.004 respectively). The difference in peak RISRAS score between skin covered with Mepitel Film and control skin covered in cream was also significantly lower (p=0.02). The results were disappointing compared to those reported by the breast cancer trial where skin reaction severity was reduced by more than 90% when Mepitel Film was used prophylactically. Several factors may explain the lack of effectiveness of the Mepitel Film in this patient cohort. Dose to the skin was significantly higher in head and neck cancer patients and Mepitel Film did not adhere well to skin with heavy beard stubble, which meant Mepitel Film needed to be replaced almost daily for the first few weeks of radiation therapy. The latter may also explain why there was no difference in the Mepitel Film effect between the skin of patients on the management protocol and those on the prophylactic protocol which should have had the strongest skin protective effect. In addition, compared with skin covering the breast area, skin in the neck area may be “tougher” and less likely to benefit from “friction protection”.
The results suggest that Mepitel Film does reduce skin reaction severity in head and neck cancer patients but the increase in skin folds, beard growth and high skin dose mean that the protective effects of Mepitel Film are limited, particularly in men with heavy beard growth. Mepitel Film appeared to be more effective in women but there were too few women in this trial to perform a statistically meaningful analysis. Future research should include clinical studies in different cohorts of head and neck patients, such as in women and men with less beard growth.
2017-05-25T02:08:44ZMen’s experience of virtual simulation to aid patient education for radiation treatment to the prostateFlockton, Alannah - Jaynehttp://hdl.handle.net/10523/72332022-09-01T03:32:20Z2017-03-28T20:16:43ZMen’s experience of virtual simulation to aid patient education for radiation treatment to the prostate
2017
Flockton, Alannah - Jayne
Prostate cancer affects more than 3000 New Zealand men each year. Many of these men receive a complex type of radiation treatment which requires patients to have a full bladder and empty rectum to aid in the accuracy of treatment delivery and minimise side effects. These concepts can be difficult to explain and current patient education involves verbal and written materials.
A 3D immersive teaching tool Virtual Environment Radiotherapy Training system (VERT) can visually simulate and demonstrate how radiation treatment is delivered to the prostate. There is sufficient evidence to support VERT as a useful teaching tool in the academic environment however; using VERT for one-on-one patient education is a novel approach.
This qualitative, pilot study set out to explore men’s experience of VERT when it was incorporated into education sessions for prostate radiation treatment. More specifically, how VERT shaped the men’s understanding of how radiation treatment is delivered; why a full bladder and empty rectum is required; and their initial treatment experience. Data collection involved semi-structured interviews one week after the participants had experienced the VERT education and received their first week of radiation treatment.
Interpretative phenomenological analysis (IPA) was used to offer insight into the men’s experience of the VERT education session. The findings strongly suggest VERT education enhances patient understanding of radiation treatment through visual learning. There is a preference to have the VERT education delivered sometime near the first treatment appointment and VERT has the potential to support men through engagement, information sharing and encouraging peer support. There is a role for visual tools such as VERT to be included as part of patient education sessions for radiation treatment to the prostate.
2017-03-28T20:16:43ZFollowing the journey of seven patients with recurrent high grade glioma through hypo-fractionated salvage radiation therapy and beyondKnight, Jennyhttp://hdl.handle.net/10523/67102022-09-01T03:40:36Z2016-07-25T23:04:05ZFollowing the journey of seven patients with recurrent high grade glioma through hypo-fractionated salvage radiation therapy and beyond
2016
Knight, Jenny
Primary glioblastoma multiforme is the main primary brain cancer in adults. It is a diagnosis that carries with it a devastatingly poor prognosis. Best current practice, consisting of debulking surgery, radiation therapy and Temozolomide chemotherapy, results in a mean overall survival of 15-20 months after diagnosis. There is no standard treatment for relapsed high grade glioma. The most promising chemotherapy regimens, using Temozolomide, Bevacizumab and Irinotecan, have resulted in a mean overall survival of 8.8 to 9.3 months from salvage therapy. Several clinical studies have reported a mean overall survival of 3.9 - 12.5 months after salvage hypo-fractionated radiation therapy. The aim of salvage treatment for high grade glioma patients is the palliation of symptoms and maintenance of quality of life.
The research presented in this thesis follows the journey of seven patients with recurrent high-grade glioma through their salvage radiation therapy and beyond at Auckland Radiation Oncology between September 2014 and December 2015. The objectives were to 1] gain an insight into the impact of hypo-fractioned re-irradiation on Health Related Quality of Life during and after the completion of salvage treatment and to 2] determine the nature and severity of tumour associated symptoms before, during and after completion of hypo-fractioned re-irradiation.
A prospective observational study design was used with a variety of methods of gathering information to document the patients’ journeys. Patients completed the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and BN-20 quality of life questionnaires to capture self-reported severity of symptoms scores, overall health and quality of life at baseline, during and after treatment. The author attended follow-up consultations with the radiation oncologist to gain an insight into the disease and treatment-related symptoms and their effect on day-to-day life. Any notes taken during the consultations were cross referenced with notes from the treatment radiation therapists and radiation oncologist in the patient file. The author also reviewed patient notes and CT and MRI scans to understand the disease trajectory from primary diagnosis to recurrence and gain details of the radiation therapy treatment plan. The intent was to document treatment-related side effects using the Common Terminology for Adverse Events (CTCAE) adverse events criteria. CTCAE scoring was discontinued after the first patient due to the burden of an additional interview with these vulnerable patients and the similarity of the CTCAE items to those covered in the quality of life questionnaires. Side effects were also discussed during consultations with the radiation oncologist, which the author attended.
The journey of each of the seven patients was very distinct. Patient expectations regarding their health and quality of life throughout salvage therapy depended on a combination of age, stage in life, time to relapse, severity of disease symptoms and the extent to which they had accepted their prognosis. All of the patients experienced some level of psychosocial distress. Six patients reported at least “a little worry or depression”; patients also reported feeling at least “a little uncertain about their future”.
Salvage re-irradiation to a median dose of 35Gy in 10 fractions was found to be well tolerated although a decrease in overall health and quality of life from baseline was reported in five of the seven patients during the two weeks of treatment. Fatigue, exacerbation of tumour symptoms and disruption to daily life worsened during radiation treatment. A majority of patients responded to salvage re-irradiation with a partial response and six patients had further salvage chemotherapy. Most patients reported an increase in or reasonably stable overall health and quality of life scores after completion of radiation treatment.
Limitations of the study included cohort demographics and a short and varied follow-up time. Because of the time constraints of an honours thesis project, only a small number of patients participated. Patients enrolled early in the study were followed for a much longer period of time (up to 15 months) than patients who enrolled later (minimum of five months). Even though this small cohort was very heterogeneous with respect to age, stage in life, time to relapse and salvage treatment, they all attended a private clinic and most likely belonged to a higher socioeconomic class where the pressures of having to keep working to provide for the family were not key factors. The cohort also lacked ethnic diversity as all patients identified themselves as NZ European.
The patients themselves were supposed to fill in quality of life questionnaires at the start, during treatment and follow. This did not happen for all time points for all patients because in a few instances the author was not advised of a change in follow-up appointments or could not be released from clinical duties to hand out the questionnaires and in some cases patients were too sick to fill them in.
Overall, the experience of this small cohort of patients suggests that hypo-fractionated radiation may be a salvage therapy option for at least some patients with relapsed high grade glioma. One of the major costs of salvage radiation therapy for patients is disruption to everyday life due to the logistics of attending daily treatment sessions. It is therefore appropriate that it is delivered over a relatively short period of two weeks. The study further identified the need for more research into the physical and psychosocial wellbeing of high grade glioma patients and the best ways to support them in coping with the challenges that living with an incurable brain tumour presents.
2016-07-25T23:04:05ZReview of a multidisciplinary team approach to patient positioning in head-and-neck cancer: a quantitative analysisMoore, Sarahhttp://hdl.handle.net/10523/57722022-09-01T21:25:36Z2015-07-06T20:41:23ZReview of a multidisciplinary team approach to patient positioning in head-and-neck cancer: a quantitative analysis
2015
Moore, Sarah
Accurate patient positioning is extremely important in radiation therapy for head-and-neck cancer. With the introduction of three-dimensional cone beam computed tomography (CBCT) at the Wellington Blood and Cancer Centre (WBCC), it was agreed that positioning accuracy required improvement. This led to the establishment of a multidisciplinary team (MDT) focused on patient positioning. Following a number of process changes made by the MDT, improvements in setup accuracy were observed but not formally quantified.
The aim of this thesis was to retrospectively quantify setup accuracy at WBCC, using CBCT images of 96 patients treated for head-and-neck cancer. On average 7 CBCT scans per patient were sequentially registered using each of the following match structures: C1-C3, C3-C5, C5-C7, C7-caudal, mandible occipital bone and the larynx. This enabled quantification of patient deformation as the measure of setup accuracy, by calculating the position of each structure relative to C1-C3. Statistical Process Control (SPC) was then used to assess trends in setup accuracy over time, allowing identification of specific time points where improvements occurred and correlation with process changes to be made.
The multiple rigid registration protocol and deformation values calculated for this patient cohort clearly demonstrated the relative movement of anatomical sub regions in the head-and-neck. SPC charts showed that a significant and consistent reduction in deformation was achieved since the instigation of the MDT. A reduction in the magnitude and variation of the patient systematic 3D-deformation vector was observed, from 2.8 mm ± 0.1 mm (1 S.D.) in 2011 to 0.9 ± 0.0 mm (1 S.D.) in late 2013/early 2014. Statistical correlation analysis revealed that the introduction of new head supports (p = 0.003), as well as retraining of staff in making immobilisation equipment (p = 0.003) had a significant impact on patient systematic deformation. Both of these changes were actions initiated by the multidisciplinary team, which shows that a multidisciplinary approach to patient positioning had a positive impact on setup accuracy in our department.
2015-07-06T20:41:23ZMepitel Film. The Effect of Mepitel Film Dressings on Acute Radiation-Induced Skin Reactions in Patients Receiving Post-Wide Local Excision IrradiationSutherland, Annie Elizabeth Maryhttp://hdl.handle.net/10523/54582022-09-01T04:04:26Z2015-02-12T00:09:47ZMepitel Film. The Effect of Mepitel Film Dressings on Acute Radiation-Induced Skin Reactions in Patients Receiving Post-Wide Local Excision Irradiation
2015
Sutherland, Annie Elizabeth Mary
The most common malignancy for women in New Zealand is breast cancer. As part of their treatment regimen the majority of these women will receive radiation therapy. A significant number of patients will experience severe acute radiation-induced skin reactions. At the time of writing, there is no evidence-based standard treatment for these reactions, the most extreme of which is moist desquamation which has a severe effect on patient comfort and psychological well-being.
Previous studies in our department had shown that Mepilex Lite, an adhesive soft silicon dressing (Mölnlycke Health Care AB, Gothenburg, Sweden), reduced the severity of acute radiation-induced skin reaction by 40% when used to treat existing erythema. It is theorised that these soft silicone dressings prevent further mechanical damage to the radiation-damaged basal layer of the skin, allowing time for repair. Mepitel Film is another soft silicone dressing from the same company. This Film is fully breathable, transparent, very thin and with no clinically significant bolus effect; it can be left on during radiation therapy and can therefore be used prophylactically. We hypothesized that Mepitel Film would be more successful in minimizing acute radiation induced skin reactions when used in this way.
In order to test the hypothesis we conducted an intra-individual randomised controlled trial (n=80) which investigated whether the prophylactic use of Mepitel Film would be superior to aqueous cream in reducing both the incidence of moist desquamation and the severity of radiation-induced skin reactions in breast cancer patients.
The skin area to be irradiated was divided into a medial half and lateral half (which included the axilla). These two halves were then randomised to Mepitel Film (trial area) or aqueous cream (control area) from the start of radiation treatment. This trial was carried out by the author and one other radiation therapist researcher (RTR) at the Dunedin Radiation Oncology Centre (DROC) in New Zealand. Modified RTOG as well as the modified Radiation-Induced Skin Reaction Assessment Scale (RISRAS) was used to assess the visible signs (researcher component) and symptoms (patient component) of the skin reactions. Patients were reviewed three times a week during radiation therapy treatment, then once a week post-treatment for four weeks or until reactions had completely resolved. All patients filled out an Exit Questionnaire after completion of treatment.
This thesis analyses the results of the first 10 mastectomy patients and the first 10 non-mastectomy patients who completed the trial. The results of this 20 patient cohort demonstrated that Mepitel Film, when used prophylactically, completely prevented the occurrence of moist desquamation and decreased the severity of radiation-induced skin reactions by more than 90%.
A major limitation of this trial was the fact that neither the researcher nor the patient could be blinded as it was very clear where the film was and it was important that the film remained in place for as long as possible (up to several weeks).
In conclusion, the results of this study show that using Mepitel Film prophylactically reduces the incidence and severity of radiation-induced moist desquamation in breast cancer patients.
2015-02-12T00:09:47Z