• Primary thromboprophylaxis for cancer patients with central venous catheters--a reappraisal of the evidence.

      Cunningham, M S; White, B; Hollywood, D; O'Donnell, J (2006-01-30)
      Venous thromboembolism (VTE) is responsible for an estimated 25 000 deaths per annum in UK hospital practice. It is well established that many of these deaths could be prevented through the use of appropriate thromboprophylaxis. This issue is of particular relevance in oncology practice, where the risks of VTE and bleeding are both significantly higher than those observed in general medical patients. Cancer patients with in-dwelling central venous catheters (CVCs) are at particularly high risk of developing thrombotic complications. However, the literature has produced conflicting conclusions regarding the efficacy of using routine primary thromboprophylaxis in these patients. Indeed such is the level of confusion around this topic, that the most recent version of the American College of Chest Physicians (ACCP) guidelines published in 2004 actually reversed their previous recommendation (published in 2001). Nevertheless, minidose warfarin continues to be routinely used in many oncology centres in the UK. In this article, we have performed a systematic review of the published literature regarding the efficacy and the risks, associated with using thromboprophylaxis (either minidose warfarin or low-dose LMWH) in cancer patients with CVC. On the basis of this evidence, we conclude that there is no proven role for using such thromboprophylaxis. However, asymptomatic CVC-related venous thrombosis remains common, and further more highly powered studies of better design are needed in order to define whether specific subgroups of cancer patients might benefit from receiving thromboprophylaxis.
    • A prospective randomised controlled clinical trial investigating patient-customised headrest versus standard (non-patient specific) headrests in the immobilisation of head and neck radiotherapy patients. [ICORG 08-09]

      Mullaney, L.; O'Shea, E.; Carter, P.; Garret, B.; Kenny, J.; Clayton-Lea, A.; Howlin, C.; Thirion, P.; St Luke's Radiation Oncology Network (2010-03)
      Oral presemtation - 10th Annual All-Ireland Radiation Therapists Study Day March 2010.
    • A prospective randomised controlled clinical trial to evaluate three immobilisation devices for intra-thoracic radiation therapy

      O'Shea, Evelyn; Armstrong, John; Gillham, Charles; McCloy, Roisin; Murrells, Rachel; O'Hara, Tom; Clayton-Lea, Angela; Murphy, Michael; Browne, Patricia; Booth, Catherine; et al. (2010-07-07)
      Purpose: To determine the optimal of three immobilisation devices for lung radiotherapy in terms of set-up reproducibility, patient comfort, radiation therapists’ (RTs) satisfaction and cost-effectiveness. Materials and methods: A total of 30 lung CRT patients were randomised to one of three immobilisation techniques – Arm A, headsponge; Arm B, BreastBoard dedicated immobilisation device; and Arm C, LungBoard dedicated immobilisation device. Results: Random errors were larger for Arm A versus C in all directions ( p < 0.05). Random errors were larger for Arm A versus B for y and z directions ( p < 0.05). When the data for the immobilisation devices (Arms B+C) were pooled and compared with Arm A (no dedicated device), the systematic errors were larger in the z direction for A ( p < 0.05). Arm C was cheaper and was more comfortable for patients. Therapists preferred this device (Arm C) and treatment times were less ( p < 0.05). Conclusion: This is the first prospective randomised controlled lung immobilisation trial, based on 3-DCRT, that takes into account treatment accuracy, users satisfaction and resource implications. It suggests that the LungBoard immobilisation device is optimal.
    • A prospective study of patients with impending spinal cord compression treated with palliative radiotherapy alone

      O'Sullian, L.; Clayton-Lea, A.; McArdle, O.; McGarry, M.; Kenny, J.; Dunne, M.; O'Shea, E.; Small, C.; Moriarty, M.; Thirion, P. (Cambridge University Press, 2013)
      mpending malignant spinal cord compression (IMSCC) may be defined as compression of the thecal sac, without any visible pressure on the spinal cord itself. Although there is a perception that IMSCC patients have a better prognosis and less severe clinical symptoms than true malignant spinal cord compression (MSCC) patients, these factors have never been documented in the literature.
    • Prostate cancer in a male with Holt-Oram syndrome: first clinical association of the TBX5 mutation.

      Aherne, Noel J; Rangaswamy, Guhan; Thirion, Pierre; Department of Radiation Oncology, North Coast Cancer Institute, Coffs Harbour, NSW 2450, Australia. (Hindawi Publishing Corp., 2013-08-05)
      Holt-Oram syndrome is an autosomal dominant disorder which is caused by mutations of TBX5 and is characterised by cardiac and skeletal abnormalities. TBX5 is part of the T-box gene family and is thought to upregulate tumour cell proliferation and metastasis when mutated. We report the first clinical case of prostate cancer in an individual with Holt Oram syndrome.
    • Proteomic analysis of combined hormone and radiation therapy for localised prostate cancer [ICORG 06-15]

      Morrissey, B.; Armstrong, J.; Pennington, S.; St Luke's Radiation Oncology Network (2011-05)
      Oral presentation - Waters Postgraduate Prize in Mass Spectrometry for Proteomics and Biopharmaceuticals 2011, 2nd Feb. 2011. Irish Mass Spectrometry Society Annual Meeting Dublin, 11th May 2011.
    • Psycho-oncology best practice guidelines and a service perspective: conceptualising the fit and towards bridging the gap

      Coleman, Niamh; Connolly, Allison; Hession, Natalie; Department of Psycho-oncology, St. Luke's Hospital, Dublin, (Routledge, Taylor & Francis Group, 2011)
    • Quantification of organ motion during chemoradiotherapy of rectal cancer using cone-beam computed tomography.

      Chong, Irene; Hawkins, Maria; Hansen, Vibeke; Thomas, Karen; McNair, Helen; O'Neill, Brian; Aitken, Alexandra; Tait, Diana; Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, United Kingdom. (Elsevier, 2011-11-15)
      There has been no previously published data related to the quantification of rectal motion using cone-beam computed tomography (CBCT) during standard conformal long-course chemoradiotherapy. The purpose of the present study was to quantify the interfractional changes in rectal movement and dimensions and rectal and bladder volume using CBCT and to quantify the bony anatomy displacements to calculate the margins required to account for systematic (Σ) and random (σ) setup errors.
    • A Randomized Trial (Irish Clinical Oncology Research Group 97-01) Comparing Short Versus Protracted Neoadjuvant Hormonal Therapy Before Radiotherapy for Localized Prostate Cancer.

      Armstrong, John G; Gillham, Charles M; Dunne, Mary T; Fitzpatrick, David A; Finn, Marie A; Cannon, Mairín E; Taylor, Judy C; O'Shea, Carmel M; Buckney, Steven J; Thirion, Pierre G; et al. (Elsevier, 2010-08-24)
      PURPOSE: To examine the long-term outcomes of a randomized trial comparing short (4 months; Arm 1) and long (8 months; Arm 2) neoadjuvant hormonal therapy before radiotherapy for localized prostate cancer. METHODS AND MATERIALS: Between 1997 and 2001, 276 patients were enrolled and the data from 261 were analyzed. The stratification risk factors were prostate-specific antigen level >20 ng/mL, Gleason score >/=7, and Stage T3 or more. The intermediate-risk stratum had one factor and the high-risk stratum had two or more. Staging was done from the bone scan and computed tomography findings. The primary endpoint was biochemical failure-free survival. RESULTS: The median follow-up was 102 months. The overall survival, biochemical failure-free survival. and prostate cancer-specific survival did not differ significantly between the two treatment arms, overall or at 5 years. The cumulative probability of overall survival at 5 years was 90% (range, 87-92%) in Arm 1 and 83% (range, 80-86%) in Arm 2. The biochemical failure-free survival rate at 5 years was 66% (range, 62-71%) in Arm 1 and 63% (range, 58-67%) in Arm 2. CONCLUSION: No statistically significant difference was found in biochemical failure-free survival between 4 months and 8 months of neoadjuvant hormonal therapy before radiotherapy for localized prostate cancer.
    • A randomized trial comparing bladder volume consistency during fractionated prostate radiation therapy

      Mullaney, L.; O'Shea, E.; Dunne, M.; Finn, M.; Thirion, P.; Cleary, L. A.; McGarry, M.; O'Neill, L.; Armstrong, J.G. (2014-01-10)
      Organ motion is a contributory factor to the variation in location of the prostate and organs at risk during a course of fractionated prostate radiation therapy (RT). A prospective randomized controlled trial was designed with the primary endpoint to provide evidence-based bladder-filling instructions to achieve a consistent bladder volume (BV) and thus reduce the bladder-related organ motion. The secondary endpoints were to assess the incidence of acute and late genitourinary (GU) and gastrointestinal (GI) toxicity for patients and patients’ satisfaction with the bladder-filling instructions.
    • Rectal preparation for prostate RT patients: a solution to address rectal volume variation. [ICORG 05-04]

      Mullaney, L.; O'Shea, E.; Coffey, M.; Thirion, P.; St. Luke's Radiation Oncology Network (2009-09)
      Oral presentation - Annual Scientific Meeting, Faculty of Radiologists, RCSI, Sept. 2009.
    • Review of surface dose detectors in radiotherapy

      O'Shea, E.; McCavana, P. (2006-11-20)
      Several instruments have been used to measure absorbed radiation dose under non-electronic equilibrium conditions, such as in the build-up region or near the interface between two different media, including the surface. Many of these detectors are discussed in this paper. A common method of measuring the absorbed dose distribution and electron contamination in the build-up region of high-energy beams for radiation therapy is by means of parallel-plate ionisation chambers. Thermoluminescent dosimeters (TLDs), diodes and radiographic film have also been used to obtain surface dose measurements. The diamond detector was used recently by the author in an investigation on the effects of beam-modifying devices on skin dose and it is also described in this report
    • The Role of Proteomics in Biomarker Development for Improved Patient Diagnosis and Clinical Decision Making in Prostate Cancer.

      Tonry, Claire L; Leacy, Emma; Raso, Cinzia; Finn, Stephen P; Armstrong, John; Pennington, Stephen R (2016-07-18)
      Prostate Cancer (PCa) is the second most commonly diagnosed cancer in men worldwide. Although increased expression of prostate-specific antigen (PSA) is an effective indicator for the recurrence of PCa, its intended use as a screening marker for PCa is of considerable controversy. Recent research efforts in the field of PCa biomarkers have focused on the identification of tissue and fluid-based biomarkers that would be better able to stratify those individuals diagnosed with PCa who (i) might best receive no treatment (active surveillance of the disease); (ii) would benefit from existing treatments; or (iii) those who are likely to succumb to disease recurrence and/or have aggressive disease. The growing demand for better prostate cancer biomarkers has coincided with the development of improved discovery and evaluation technologies for multiplexed measurement of proteins in bio-fluids and tissues. This review aims to (i) provide an overview of these technologies as well as describe some of the candidate PCa protein biomarkers that have been discovered using them; (ii) address some of the general limitations in the clinical evaluation and validation of protein biomarkers; and (iii) make recommendations for strategies that could be adopted to improve the successful development of protein biomarkers to deliver improvements in personalized PCa patient decision making.
    • Sensitivity of volumetric modulated arc therapy patient specific QA results to multileaf collimator errors and correlation to dose volume histogram based metrics.

      Coleman, Linda; Skourou, Christina; University Hospital Galway, Newcastle Road, Galway, Ireland. (2013-11)
      This study investigates the impact of systematic multileaf collimator (MLC) positional errors on gamma analysis results used for quality assurance (QA) of Rapidarc treatments. In addition, this study evaluates the relationship of these gamma analysis results and clinical dose volume histogram metrics (DVH) for Rapidarc treatment plans.
    • Small-cell carcinoma of the cervix at 23 weeks gestation.

      Smyth, Elizabeth C; Korpanty, Grzegorz; McCaffrey, John A; Mulligan, Niall; Carney, Desmond N (2010-06-20)
    • Stereotactic Radiosurgery (SRS) / Stereotactic body radiotherapy (SBRT): Benefit to Irish patients and Irish Healthcare Economy

      Cagney, DN; Armstrong, JG (Irish Medical Journal, 2017-01)
      Cancer incidence across Europe is projected to rise rapidly over the next decade. This rising cancer incidence is mirrored by increasing use of and indications for stereotactic radiation. This paper seeks to summarize the exponential increase in indications for stereotactic radiotherapy as well as the evolving economic advantages of stereotactic radiosurgery and stereotactic body radiotherapy
    • Temporal patterns of bowel and bladder toxicity in a randomised controlled trial assessing duration of neo-adjuvant hormones prostate cancer.[ICORG 97-01]

      Barry, A.; Lyons, C.; Dunne, M.; Thirion, P.; Armstrong, J.; St. Luke's Radiation Oncology Network (2011-10)
      Poster presentation - ASTRO annual meeting, Florida, October, 2011.
    • Toxicity of cetuximab versus cisplatin concurrent with radiotherapy in locally advanced head and neck squamous cell cancer (LAHNSCC).

      Walsh, Lorraine; Gillham, Charles; Dunne, Mary; Fraser, Ian; Hollywood, Donal; Armstrong, John; Thirion, Pierre; Department of Radiation Oncology, St. Luke's Hospital, Dublin, Ireland. (Elsevier, 2011-01)
      We retrospectively reviewed acute toxicity with cetuximab and radiotherapy, comparing it with a matched cisplatin group. The cetuximab group experienced significantly more toxicity--grade ≥3 oral mucositis (p=0.014), skin dermatitis (p=0.0004), ≥10% weight loss (p=0.03), and enteral feeding requirement (p=0.05). This finding of enhanced toxicity is similar to recent publications.
    • Transdermal hyoscine induced unilateral mydriasis.

      Hannon, Breffni; Jennings, Valerie; Twomey, Marie; O'Reilly, Maeve; Palliative Medicine Department, Our Lady's Children's Hospital, Dublin, Ireland. breffnilhannon@yahoo.co.uk (2012-03-20)
      The authors present a case of unilateral mydriasis in a teenager prescribed transdermal hyoscine hydrobromide (scopolamine) for chemotherapy induced nausea and vomiting. The authors discuss the ocular side-effects associated with this particular drug and delivery system and the potential use of transdermal hyoscine as an antiemetic agent in this group.