To report on complications from transrectal ultrasound-guided insertion of fiducial markers for prostate image-guided radiotherapy.
234 patients who underwent transrectal fiducial marker insertion ...for prostate cancer image-guided radiotherapy were assessed retrospectively by questionnaire with regard to the duration and severity of eight symptoms experienced following the procedure. Pain during the implantation procedure was assessed according to the Wong-Baker faces pain scale.
Of 234 patients, 32% had at least one new symptom after the procedure. The commonest new symptom following the procedure was urinary frequency affecting 16% of patients who had not been troubled by frequency beforehand. Haematuria, rectal bleeding, dysuria and haematospermia affected 9-13% of patients, mostly at Grade 1 or 2. Pain, obstruction, and fever and shivers affected 3-4% of patients. Grade 3 rectal bleeding, haematuria, fever and shivers, and urinary frequency affected 0.5-1.5% of patients. Only one patient had a Grade 4 complication (i.e. fever and shivers). Overall, 9% of patients had symptoms lasting more than 2 weeks. The commonest symptoms that lasted more than 2 weeks were frequency, dysuria, obstructive symptoms and rectal bleeding. Mean pain score during the procedure was 1.1 (range 0-5).
Transrectal ultrasound-guided fiducial marker insertion for image-guided radiotherapy is well tolerated in the majority of prostate cancer patients. Most symptoms were Grade 1 or 2 in severity. Symptoms in the majority of patients last under 2 weeks. The most serious complication was sepsis in our study.
The trait compensation and cospecialization hypotheses make contrasting predictions on how boldness is co-adapted with antipredator defences. If trait compensation occurs, then bold individuals ...should be equipped with better antipredator defences to compensate for their increased risk exposure. By contrast, if trait co-specialization occurs, shy individuals should be equipped with better antipredator defences to enhance overall protection from predation. Here, we test the two alternative hypotheses by evaluating the among- and within-individual relationships between boldness and chemical defences in the American giant millipede (
Narceus americanus
; order Spirobolida). After controlling for test sequence, body length, air temperature, and time of day, latency to conglobate (i.e. “curl up”) upon disturbance and duration of conglobation were both found to be repeatable (
R
= 0.28 and 0.35). Moreover, the latency and duration of conglobation were negatively correlated at both the among- and within-individual levels (
r
= − 0.46 and − 0.32). Hence, individuals displayed consistent differences in risk-taking along a “shy-bold” axis. Millipedes also displayed—albeit weaker—individual differences in their probability to secrete chemical defences (
R
= 0.12), but no significant relationship was found with conglobation latency or duration. Overall, these results suggest that chemical defences evolved separately from the shy-bold axis (as measured with conglobation behaviour) as two independent antipredator strategies in millipedes.
Significance statement
Many species assume a defensive pose when threatened to protect themselves from predators, which makes them conducive to boldness measurements in a way that is directly relevant to antipredator strategies. The question arises as to whether boldness is co-adapted with other antipredator defences. Here, we demonstrate the existence of a shy-bold axis in American giant millipedes, which both conglobate into a defensive position and secrete a defensive fluid when threatened. We also found consistent individual differences in the propensity to secrete chemical defences, but with no relationship to boldness. While many studies have looked at the relationship between boldness and morphological defences (e.g. size of a protective shell), this is the first study to have partitioned the among- and within-individual correlations between boldness and chemical defences. Despite their importance as predator deterrents, chemical defences seem to have evolved independently from boldness in this species.
Previous reports have shown that quantification of high tumour grade is of prognostic significance for patients with prostate cancer. In particular, percent Gleason pattern 4 (GP4) has been shown to ...predict outcome in several studies, although conflicting results have also been reported. A major issue with these studies is that they rely on surrogate markers of outcome rather than patient survival. We have investigated the prognostic predictive value of quantifying GP4 in a series of prostatic biopsies containing Gleason score 3+4=7 and 4+3=7 tumours. It was found that the length of GP4 tumour determined from the measurement of all biopsy cores from a single patient, percent GP4 present and absolute GP4 were all significantly associated with distant progression of tumour, all-cause mortality and cancer-specific mortality over a 10-year follow-up period. Assessment of the relative prognostic significance showed that these parameters outperformed division of cases according to Gleason score (3+4=7 versus 4+3=7). International Society of Urological Pathology (ISUP) Grade Groups currently divide these tumours, according to Gleason grading guidelines, into grade 2 (3+4=7) and grade 3 (4+3=7). Our results indicate that this simple classification results in the loss of important prognostic information. In view of this we would recommend that ISUP Grade Groups 2 and 3 be amalgamated as grade 2 tumour with the percentage of GP4 carcinoma being appended to the final grade, e.g., 3+4=7 carcinoma with 40% pattern 4 tumour would be classified as ISUP Grade Group 2 (40%).
In 2014 a consensus conference convened by the International Society of Urological Pathology (ISUP) adopted amendments to the criteria for Gleason grading and scoring (GS) for prostatic ...adenocarcinoma. The meeting defined a modified grading system based on 5 grading categories (grade 1, GS 3+3; grade 2, GS 3+4; grade 3, GS 4+3; grade 4, GS 8; grade 5, GS 9–10). In this study we have evaluated the prognostic significance of ISUP grading in 496 patients enrolled in the TROG 03.04 RADAR Trial. There were 19 grade 1, 118 grade 2, 193 grade 3, 88 grade 4 and 79 grade 5 tumours in the series, with follow-up for a minimum of 6.5 years. On follow-up 76 patients experienced distant progression of disease, 171 prostate specific antigen (PSA) progression and 39 prostate cancer deaths. In contrast to the 2005 modified Gleason system (MGS), the hazards of the distant and PSA progression endpoints, relative to grade 2, were significantly greater for grades 3, 4 and 5 of the 2014 ISUP grading scheme. Comparison of predictive ability utilising Harrell’s concordance index, showed 2014 ISUP grading to significantly out-perform 2005 MGS grading for each of the three clinical endpoints.
Abstract In many areas of health care, practice standards have become an accepted method for professions to assess and improve the quality of care delivery. The aim of this work is to present the ...development of practice standards for radiation oncology in Australia, highlighting critical points and lessons learned. Following a review of radiotherapy services in Australia, a multidisciplinary group with support from the Australian Government developed practice standards for radiation oncology in Australia. The standards were produced in a multistep process including a nationwide survey of radiotherapy centres and piloting of the standards in a representative subset of all Australian radiotherapy centres. The standards are grouped into three sections: Facility management (covering staffing, data management, equipment and processes); Treatment planning and delivery (providing more detailed guidance on prescription, planning and delivery); Safety and quality management (including radiation safety, incident monitoring and clinical trials participation). Each of the 16 standards contains specific criteria, a commentary and suggestions for the evidence required to demonstrate compliance. The development of the standards was challenging and time consuming, but the collaborative efforts of the professions resulted in standards applicable throughout Australia and possibly further afield.
Background Management of prostate cancer involves a balance between the risks of cancer death against those from other causes. This study evaluates the potential value of several simple comorbidity ...indices in a large radiotherapy cohort. Methods 1956 men with localised prostate cancer treated with radical radiotherapy between 2000 and 2007, were studied. Tumour features, androgen deprivation use, age, number of prescription medications (PMN), and Adult Comorbidity Evaluation 27 Index (ACE-27) were recorded. Death from prostate cancer (DPCa) and death from other causes (DOthC) were analysed as competing causes of death using a competing risks model, with discrimination assessed using the concordance index. Findings Patients were treated with external beam radiation only (73%) or with high-dose-rate brachytherapy boost (21%) or low-dose-rate brachytherapy (6%). Median age was 70 years (95% confidence interval CI 53–79). ACE-27 scores correlated with number of PMN (median PMN 2, 95% CI 0–7). Tumour features were independent of ACE-27 scores. Median follow up was 66.5 months. Estimated cumulative incidence of DOthC at 10 years was 30.3% (95% CI 24.1–37.4), and for DPCa was 18.0% (95% CI 13.0–24.4). In the low/intermediate risk group ( n = 1026) there was a 3.4-fold predominance of DOthC inside 10 years, with a cumulative incidence of 33.5% (95% CI 23.7–45.1) of DOthC compared with 9.8% (95% CI 4.9–6.1) risk of DPCa. High risk men had approximately equal rates of DPCa and DOthC at 10 years. Multivariable analysis showed age, ACE-27 score ⩾1, and number of PMN to have significant associations with DOthC ( p < 0.002 for all). No tumour-related variables had an impact on DOthC. The discriminatory performance (C-index) of univariable models of age, ACE-27, or PMN was 0.589, 0.612, and 0.608 at 10 years respectively. A multivariable model incorporating all three variables resulted in a C-index of 0.644. Interpretation Age, ACE-27 score, and number of PMN act as independent prognostic factors for DOthC in patients with prostate cancer and can be considered when predicting a patient’s life expectancy and treatment decisions.
Abstract Aims There are limited outcome data after radiotherapy treatment for clinically localised, castration-resistant prostate cancer. We report our single institution experience on patient ...outcomes in this group using high-dose palliative radiotherapy (HDPRT). Materials and methods A retrospective review of patient hospital records was conducted in prostate cancer patients treated with palliative intent radiotherapy and restricted to those who had castration-resistant disease, no evidence of regional or distant disease and who received a local radiotherapy dose equivalent to 40 Gy or greater. Results Fifty-one patients met the study criteria, 88% of these had high-risk disease at initial diagnosis. The median time to delivery of HDPRT was 66 months and the median follow-up from HDPRT was 54 months. Grade 3 or worse toxicity was experienced in 8%. The estimated freedom from local failure, cause-specific survival and overall survival at 5 years were 81, 65 and 35%, respectively. Local procedures were a significant contributor to local morbidity, with the most common procedure a transurethral resection of the prostate (27% patients). Only two patients died from complications of local failure. Conclusion HDPRT was well tolerated and provided a high rate of local control in a clinically localised castration-resistant prostate cancer population. Although prostate cancer remained the most frequent cause of death, some patients had extended survival without evidence of disease progression.
Purpose: To compare the efficacy and toxicity of two hypofractionated radiotherapy schedules for the improvement of local symptoms from muscle-invasive bladder cancer.
Methods and Materials: A ...multicenter randomized trial was conducted comparing the efficacy and toxicity of two radiotherapy schedules (35 Gy in 10 fractions and 21 Gy in 3 fractions) for symptomatic improvement in patients considered unsuitable for curative treatment through disease stage or comorbidity. The primary outcome measures were overall symptomatic improvement of bladder-related symptoms at 3 months and changes in bladder- and bowel-related symptoms from pretreatment to end-of-treatment and 3-month assessments. Overall symptomatic improvement was defined prospectively as the improvement in one bladder-related symptom of at least one grade at 3 months, with no deterioration in any other bladder-related symptom.
Results: Five hundred patients were recruited, but data on symptomatic improvement at 3 months was only available on 272 patients. Of these, 68% achieved symptomatic improvement (71% for 35 Gy, 64% for 21 Gy), with no evidence of a difference in efficacy or toxicity between the two arms. There was no evidence of a difference in survival between the two schedules (hazard ratio HR = 0.99, 95% CI 0.82–1.21,
p = 0.933).
Conclusion: This is the largest prospective trial to date in the palliative treatment of bladder cancer, and provides baseline data against which other results may be compared. The use of 21 Gy in 3 fractions appears as effective as 35 Gy in 10 fractions, although modest differences in survival, symptomatic improvement rates, and toxicity can not be reliably excluded.
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