Search

Introduction Methods Results Conclusion The techniques employed in palliative radiation therapy are highly variable, ranging from basic (2D/3D‐conformal) to more advanced (beam modulation and stereotactic techniques), and their relative use has not previously been formally investigated at a national level. The purpose of this work was to assess the current utilisation of palliative techniques and technologies in Australia and New Zealand (ANZ).A voluntary, anonymous, internet‐based, RANZCR approved survey was offered to all practising radiation oncology (RO) Fellows in ANZ. Participants selected their preferred methods of managing patients in five case studies involving bone, brain, lung metastases and locally advanced lung cancer.From October 2022 to February 2023, 146 of 485 eligible participants (30%) responded. In all, 61% and 81% would treat an uncomplicated breast cancer solitary spinal metastasis with stereotactic body radiation therapy routinely and ideally, respectively; 11% and 32% would treat a solitary lung cancer brain metastasis with dedicated stereotactic radiosurgery routinely and ideally; 36% and 56% would treat multiple low‐volume brain metastases with a stereotactic technique routinely and ideally. There was negligible difference in the routine and preferred use of advanced technologies for a solitary bowel cancer lung metastasis; 69% and 77% would treat a locally advanced primary lung cancer with an advanced technique routinely and ideally. Relative to Australia, NZ ROs routinely treat uncomplicated solitary spinal metastases (P < 0.001), solitary brain metastases (P < 0.001), multiple low‐volume brain metastases (P < 0.02), and locally advanced primary lung cancer (P < 0.001) more commonly with basic technologies, mainly due to limited local availability of advanced technology and departmental waiting lists.Participants generally favoured treating with advanced techniques and technologies in palliative settings, if available, but there were notable disparities between the two countries. Enhanced local access and clinical training may facilitate optimal utilisation of advanced technologies and improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Shortening the duration of radiation therapy would benefit women with early breast cancer treated with breast conserving surgery. It may also improve access to radiation therapy by improving efficiency in radiation oncology departments globally. This can only happen if the shorter treatment is as effective and safe as conventional radiation therapy. This is an update of a Cochrane Review first published in 2008 and updated in 2009., Objectives: To assess the effect of altered radiation fraction size for women with early breast cancer who have had breast conserving surgery., Search Methods: We searched the Cochrane Breast Cancer Specialised Register (23 May 2015), CENTRAL (The Cochrane Library 2015, Issue 4), MEDLINE (Jan 1996 to May 2015), EMBASE (Jan 1980 to May 2015), the WHO International Clinical Trials Registry Platform (ICTRP) search portal (June 2010 to May 2015) and ClinicalTrials.gov (16 April 2015), reference lists of articles and relevant conference proceedings. No language or publication constraints were applied., Selection Criteria: Randomised controlled trials of altered fraction size versus conventional fractionation for radiation therapy in women with early breast cancer who had undergone breast conserving surgery., Data Collection and Analysis: Two authors performed data extraction independently, with disagreements resolved by discussion. We sought missing data from trial authors., Main Results: We studied 8228 women in nine studies. Eight out of nine studies were at low or unclear risk of bias. Altered fraction size (delivering radiation therapy in larger amounts each day but over fewer days than with conventional fractionation) did not have a clinically meaningful effect on: local recurrence-free survival (Hazard Ratio (HR) 0.94, 95% CI 0.77 to 1.15, 7095 women, four studies, high-quality evidence), cosmetic outcome (Risk ratio (RR) 0.90, 95% CI 0.81 to 1.01, 2103 women, four studies, high-quality evidence) or overall survival (HR 0.91, 95% CI 0.80 to 1.03, 5685 women, three studies, high-quality evidence). Acute radiation skin toxicity (RR 0.32, 95% CI 0.22 to 0.45, 357 women, two studies) was reduced with altered fraction size. Late radiation subcutaneous toxicity did not differ with altered fraction size (RR 0.93, 95% CI 0.83 to 1.05, 5130 women, four studies, high-quality evidence). Breast cancer-specific survival (HR 0.91, 95% CI 0.78 to 1.06, 5685 women, three studies, high quality evidence) and relapse-free survival (HR 0.93, 95% CI 0.82 to 1.05, 5685 women, three studies, moderate-quality evidence) did not differ with altered fraction size. We found no data for mastectomy rate. Altered fraction size was associated with less patient-reported (P < 0.001) and physician-reported (P = 0.009) fatigue at six months (287 women, one study). We found no difference in the issue of altered fractionation for patient-reported outcomes of: physical well-being (P = 0.46), functional well-being (P = 0.38), emotional well-being (P = 0.58), social well-being (P = 0.32), breast cancer concerns (P = 0.94; 287 women, one study). We found no data with respect to costs., Authors' Conclusions: We found that using altered fraction size regimens (greater than 2 Gy per fraction) does not have a clinically meaningful effect on local recurrence, is associated with decreased acute toxicity and does not seem to affect breast appearance, late toxicity or patient-reported quality-of-life measures for selected women treated with breast conserving therapy. These are mostly women with node negative tumours smaller than 3 cm and negative pathological margins.

Introduction: Prostate cancer is the sixth most common cancer in the world, and 85% of cases are diagnosed in men over the age of 65 years. In men with well to moderately differentiated prostate cancer that remains within the capsule, clinical progression-free survival is 70% at 5 years, and 40% at 10 years., Methods and Outcomes: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for early prostate cancer? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2006 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA)., Results: We found 25 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions., Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding hormone therapy to external beam radiation therapy, or to brachytherapy; adding neoadjuvant hormone therapy to surgery alone, or to surgery plus adjuvant hormone therapy; brachytherapy alone; external beam radiation therapy alone; hormone therapy plus standard care; immediate hormone therapy; radical prostatectomy; and watchful waiting.