Search

Objectives: The Brooker classification is a commonly used tool to characterize the extent of heterotopic ossification (HTO), which is the dystrophic formation of mature lamellar bone in non-osseous tissues such as muscles, connective tissue or nerves. We aim to provide illustrative cases to describe the limitations and challenges of this system. Methods: A retrospective review was conducted in all patients who had retrieved hip and/or pelvic radiotherapy for HTO prophylaxis at Sunnybrook Health Sciences Centre between July 1998 and August 2016. An independent musculoskeletal radiologist who was blinded to the condition of the patient and the clinical outcome evaluated the imaging studies based on the Brooker classification. Results: 22 patients were identified for analysis. Three patient cases were presented to illustrate the discrepancies between the Brooker classification and radiographic images, CT images and different radiographical projections. Two patient cases were presented to demonstrate the inability of the Brooker classification to account for volumetric differences in HTO and arthroplasty lengths. Conclusion: Although the Brooker classification for HTO is a widely used quantitative and qualitative assessment tool given its simplicity and familiarity, it possesses several limitations. Utilization of other radiographic modalities, such as CT, and orthogonal projections may reduce ambiguities from using the HTO system. Development of a classification method that can appropriately correspond to the clinical outcomes such as functional capabilities to further HTO development is warranted. [ABSTRACT FROM AUTHOR]

Goals Half of all patients referred for radiotherapy are treated with palliative intent. Recent emphasis has been placed on the importance of symptom control and palliative care (SCPC) in the radiation oncology community. The purpose of this study was to determine the number of abstracts relating to SCPC presented at the annual Canadian Association of Radiation Oncologists (CARO) meetings, and whether this number has increased over time. Methods SCPC abstracts presented at CARO from 1992 through 2002 were counted. Abstracts were included if they described a patient population with advanced or metastatic cancer treated with palliative intent. Abstracts were then categorized as reporting treatment outcomes, health services research, descriptive studies or literature reviews. Radiation treatment sites were recorded. Main results An average of 6.7% (60/892; range 0?16.2%) of all abstracts presented at CARO from 1992 through 2002 pertained to SCPC. There was a significant increase in the proportion of SCPC abstracts accepted over time ( P=0.0012). Descriptive studies accounted for 46.7%, treatment outcomes 31.7%, health services research 13.3%, and literature reviews 8.3% of the SCPC abstracts. Bone metastases (48.3%), primary lung tumors (11.7%), and brain metastases (10.0%) were the most common treatment sites. Of all the SCPC abstracts, 45% came from dedicated palliative radiotherapy clinics. Conclusions SCPC research is poorly represented at the annual CARO conferences. Research in this field should be promoted as the palliative patient population represents a large component of radiotherapy clinical practice. The recent emergence of dedicated palliative radiotherapy clinics should continue to increase palliative radiotherapy research. [ABSTRACT FROM AUTHOR]

Background The use of both bisphosphonates and palliative radiotherapy for the prevention and treatment of skeletal complications in women with bone metastases from breast cancer is well established. We undertook an evaluation of palliative radiotherapy utilization rates in breast cancer patients who received bisphosphonates for the treatment of bone metastases in a major Canadian cancer center. Methods Charts and electronic files of breast cancer patients with bone metastases who had received either clodronate or pamidronate at any time between January 2000 and December 2001 at our center were retrospectively reviewed. The utilization rates of palliative radiotherapy in these patients were examined. Results The percentage of patients receiving bisphosphonates for the treatment of bone metastases who also received palliative radiotherapy to bone remained relatively constant over our study period in the range of 70%. In patients commenced on bisphosphonates before 1998, 42.9% received palliative radiotherapy as initial therapy for bone metastases, whereas in 2001 only 27.8% of patients received palliative radiotherapy before commencing bisphosphonate therapy. There has been a marked improvement in the time between the diagnosis of bone metastases and the commencement of bisphosphonates from a median of 446 days before 1998 to 21 days in 2001. At the same time, there was also an improvement in time between diagnosis of bone metastases and initiation of palliative radiotherapy from a median of 265 days before 1998 to 49 days in 2001. Conclusion Use of bisphosphonates has not reduced the utilization rates of palliative radiotherapy in breast cancer patients with bone metastases. There is a trend of initiating bisphosphonates before delivery of palliative radiotherapy. The latter was also delivered earlier in the course of bone metastases. [ABSTRACT FROM AUTHOR]

Four distributed link restoration algorithms are analysed in detail using a set of important performance metrics and functional characteristics. The functional characteristics are used to explain how these algorithms function and provide insight into their performance. The analysis and simulation results indicate that the two prong link restoration algorithm, which is based on issuing aggregate restoration requests from both ends of the disruption and on an intelligent backtracking mechanism, outperforms the other three algorithms in terms of restoration time. The RREACT link restoration algorithm consistently found paths that use fewer spares. [ABSTRACT FROM AUTHOR]