47 results on '"Gains J"'
Search Results
2. Improving the outcomes for high-risk neuroblastoma through the optimisation of radiotherapeutic techniques
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Gains, J. E.
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616.99 - Abstract
Neuroblastoma is a childhood cancer with highly variable clinical behaviour and outcomes. The long-term survival rate for high-risk neuroblastoma remains poor and new therapeutic advances and optimisation of existing therapies is therefore required. Both external beam radiotherapy and molecular radiotherapy have a significant role to play in the multi-modality treatment of high-risk disease. This collection of work examines ways in which the outcome for neuroblastoma may be improved through the introduction of new and enhancement of existing radiotherapeutic techniques. 131I-meta-Iodobenzylguanidine molecular radiotherapy has been used in the treatment of neuroblastoma since the mid 1980's. Despite this, its role and efficacy remain undefined. A systematic review of 131I-mIBG therapy in neuroblastoma is therefore presented. Radiolabelled somatostatin analogues target a distinct and separate molecular target on neuroblastoma cells to the noradrenaline transporter targeted by 131I-mIBG. This study reports on the use of radiolabelled somatostatin analogues for the imaging and therapy of patients with high-risk neuroblastoma. The expression of the two different molecular targets by immunohistochemistry for the noradrenaline transporter molecule and somatostatin receptor type-2 in archived neuroblastoma tumour samples is also explored. The radiation doses received by comforters and carers providing necessary support to children undergoing molecular radiotherapy over a 10 year period is presented. The gold standard imaging modality for response assessment in neuroblastoma is 123I-mIBG scinitgraphy. The role of other functional imaging techniques such as 18F- FDG PET/CT remains undefined. This study will look to see if 18F-FDG PET/CT can give additional information with regards to response assessment. External beam radiotherapy is standardly delivered using conventional anterior and posterior parallel opposed beams and this can result in a compromise on target volume coverage to stay within the tolerance of normal tissues. The use of an Intensity Modulated Arc Therapy technique to improve target volume coverage is examined.
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- 2015
3. Development of Population-Based Pediatric Computational Phantoms for Radiotherapy Applications
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Ahmad, R., primary, Cantwell, J., additional, Borrelli, C., additional, Lim, P., additional, D'Souza, D., additional, Gaze, M.N., additional, Moinuddin, S., additional, Gains, J., additional, and Veiga, C., additional
- Published
- 2023
- Full Text
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4. Evaluation of Radiotherapy Dose and Survival Outcomes for Teenagers, and Young Adults with Nasopharyngeal Carcinoma in UK and Ireland
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Gaffney, J., primary, Rieu, R., additional, France, A.K., additional, Glynn, A.M., additional, Brown, K., additional, Rooney, C., additional, Swan, A., additional, Kapacee, Z., additional, Brennan, B., additional, Dyker, K., additional, Noble, D., additional, Dixon, L., additional, Houghton, F., additional, Mandeville, H.C., additional, Brennan, S.M., additional, Gains, J., additional, Lim, P., additional, Thomson, D.D., additional, McPartlin, A., additional, and Pan, S., additional
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- 2023
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5. Pancreas: An Organ-at-Risk to Consider in Future Pediatric Abdominal Radiotherapy
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Taylor, S., primary, D'Souza, D., additional, Moinuddin, S., additional, Gains, J., additional, Gaze, M.N., additional, Gaunt, T., additional, Veiga, C., additional, and Lim, P., additional
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- 2023
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6. PO-1939 PBS proton therapy for neuroblastoma: dosimetric robustness to bowel gas variation
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Toltz, A., primary, Court, S.J., additional, Rompokos, V., additional, Gains, J., additional, Gaze, M., additional, Chang, Y., additional, and Lim, P., additional
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- 2023
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7. PO-1689 An automated strategy to evaluate the structure consistency of CBCT-to-CT synthesis
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Szmul, A., primary, Taylor, S., additional, Moreira, I., additional, Lim, P., additional, Cantwell, J., additional, D'Souza, D., additional, Moinuddin, S., additional, Gaze, M., additional, Gains, J., additional, and Veiga, C., additional
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- 2023
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8. PO-2321 Innovative RTT-Led voluming of CSI CTVs and OARs in proton beam therapy (PBT)
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Thould, C., primary, Davda, J., additional, Gains, J., additional, Lim, P.S., additional, Hyare, H., additional, and Chang, Y., additional
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- 2023
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9. A randomised phase II trial of radiotherapy dose escalation, facilitated by intensity-modulated arc therapy techniques, in high-risk neuroblastoma
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Gains, J., primary, Patel, A., additional, Mandeville, H., additional, Stacey, C., additional, Smyth, G., additional, Talbot, J., additional, Chang, Y.C., additional, Wheatley, K., additional, and Gaze, M., additional
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- 2022
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10. MO-0384 Dosimetric impact of bowel filling during proton therapy for paediatric abdominal neuroblastoma
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Ghica, A., Botnariuc, D., Hussein, M., Rompokos, V., D'Souza, D., Gaze, M., Gains, J., Lim, P., and Veiga, C.
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- 2023
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11. Impact of cyclic changes in pharmacokinetics and absorbed dose in pediatric neuroblastoma patients receiving [177Lu]Lu-DOTATATE
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Malcolm, J, Falzone, N, Gains, J, Aldridge, M, Mirando, D, Lee, B, Gaze, M, and Vallis, K
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Radiation ,Biomedical Engineering ,Radiology, Nuclear Medicine and imaging ,Instrumentation - Abstract
Purpose Recent reports personalizing the administered activity (AA) of each cycle of peptide receptor radionuclide therapy based on the predicted absorbed dose (AD) to the kidneys (dose-limiting organ) have been promising. Assuming identical renal pharmacokinetics for each cycle is pragmatic, however it may lead to over- or under-estimation of the optimal AA. Here, we investigate the influence that earlier cycles of [177Lu]Lu-DOTATATE had on the biokinetics and AD of subsequent cycles in a recent clinical trial that evaluated the safety and activity of [177Lu]Lu-DOTATATE in pediatric neuroblastoma (NBL). We investigated whether predictions based on an assumption of unchanging AD per unit AA (Gy/GBq) prove robust to cyclical changes in biokinetics. Methods A simulation study, based on dosimetry data from six children with NBL who received four-cycles of [177Lu]Lu-DOTATATE in the LuDO trial (ISRCTN98918118), was performed to explore the effect of variable biokinetics on AD. In the LuDO trial, AA was adapted to the patient’s weight and SPECT/CT-based dosimetry was performed for the kidneys and tumour after each cycle. The largest tumour mass was selected for dosimetric analysis in each case. Results The median tumour AD per cycle was found to decrease from 15.6 Gy (range 8.12–26.4) in cycle 1 to 11.4 Gy (range 9.67–28.8), 11.3 Gy (range 2.73–32.9) and 4.3 Gy (range 0.72–20.1) in cycles 2, 3 and 4, respectively. By the fourth cycle, the median of the ratios of the delivered AD (ADD) and the predicted (or “expected”) AD (ADE) (which was based on an assumption of stable biokinetics from the first cycle onwards) were 0.16 (range 0.02–0.92, p = 0.013) for the tumour and 1.08 (range 0.84–1.76, p > 0.05) for kidney. None of the patients had an objective response at 1 month follow up. Conclusion This study demonstrates variability in Gy/GBq and tumour AD per cycle in children receiving four administrations of [177Lu]Lu-DOTATATE treatment for NBL. NBL is deemed a radiation sensitive tumour; therefore, dose-adaptive treatment planning schemes may be appropriate for some patients to compensate for decreasing tumour uptake as treatment progresses. Trial registration ISRCTN ISRCTN98918118. Registered 20 December 2013 (retrospectively registered).
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- 2022
12. OC-0773 CBCT-to-CT synthesis using weakly-paired cycle-consistent generative adversarial networks
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Szmul, A., primary, Taylor, S., additional, Lim, P., additional, Cantwell, J., additional, D’Souza, D., additional, Moinuddin, S., additional, Gaze, M., additional, Gains, J., additional, and Veiga, C., additional
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- 2022
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13. PO-1616 Evaluation of deep learning-based OAR segmentation in paediatric radiotherapy settings
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Silva, I., primary, Szmul, A., additional, Cantwell, J., additional, Lim, P., additional, D’Souza, D., additional, Moinuddin, S., additional, Alves, V., additional, Gains, J., additional, and Veiga, C., additional
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- 2022
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14. PO-1497 Identifying an optimal proton planning strategy for varying bowel density in complex neuroblastomas
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Toltz, A., primary, Court, S., additional, Rompokos, V., additional, Gains, J., additional, Gaze, M., additional, Poynter, A., additional, Chang, Y., additional, and Lim, P., additional
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- 2022
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15. OC-0786 Surface imaging to track inter-fractional anatomical variation in paediatric abdominal radiotherapy.
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Taylor, S., primary, Lim, P., additional, Cantwell, J., additional, D’Souza, D., additional, Moinuddin, S., additional, Ching-Chang, Y., additional, Gaze, M., additional, Gains, J., additional, and Veiga, C., additional
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- 2022
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16. PO-1789 Quantitative evaluation of whole-body spatial normalisation in paediatric patients
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Veiga, C., primary, Cantwell, J., additional, Ahmad, R., additional, Lim, P., additional, D'Souza, D., additional, Gaze, M., additional, Moinuddin, S., additional, and Gains, J., additional
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- 2022
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17. Hippocampal Sparing Radiotherapy in adults with Primary Brain Tumors: A comparative planning and dosimetric study using IMPT, IMRT and 3DCRT
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Aka, P, Taylor, R, Hugtenburg, R, Lambert, J, Powell, J, Bevolo, T, Gao, M, Gondi, V, Hartsell, W.H, Bolsi, A, Beer, J, Belosi, M.F, Siewert, D, Lomax, A.J, Weber, D.C, Huang, Y.J, Huang, C.C, Chao, P.J, Liu, C, Shang, H, Ding, X, Wang, Y, Mammar, H, Froelich, Sébastien, Alapetite, Claire, Bolle, Stéphanie, Calugaru, Valentin, Feuvret, Loic, Helfre, Sylvie, Champion, Laurence, Goudjil, Farid, Dendal, Remi, Engelholm, S.A, Munck Af Rosenschold, P, Kristensen, I, Smulders, B, Muhic, A, Alkner, S, Jacob, E, Engelholm, S, Aljabab, S, Lui, A, Wong, T, Liao, J, Laramore, G, Parvathaneni, U, Kharouta, M, Pidikiti, R, Jesseph, F, Smith, M, Dobbins, D, Mattson, D, Choi, S, Mansur, D, Machtay, M, Bhatt, A, Lütgendorf-Caucig, C, Dunavölgyi, R, Georg, P, Perpar, A, Fussl, C, Konstantinovic, R, Ulrike, M, Piero, F, Eugen, H, Vidal, M, Gerard, A, Barnel, C, Maneval, D, Herault, J, Claren, A, Doyen, J, Dendale, R, Toutee, A, Pasquie, I, Goudjil, F, Lumbroso Lerouic, L, Levy, C, Desjardins, L, Cassoux, N, Elisei, G, Pella, A, Calvi, G, Ricotti, R, Tagaste, B, Valvo, F, Ciocca, M, Via, R, Mastella, E, Baroni, G, Saotome, N, Yonai, S, Makishima, H, Hara, Y, Inaniwa, T, Sakama, M, Kanematsu, N, Tsuji, H, Furukawa, T, Shirai, T, Sauerwein, W, Finger, P.T, Gallie, B, Gavrylyuk, Y, Thariat, J, Salleron, J, Maschi, C, Fevrier, E, Caujolle, J.P, Hofverberg, P, Angellier, G, Peyrichon, M.L, Breneman, J, Esslinger, H, Pater, L, Vatner, R, Habrand, J.L, Stefan, D, Lesueur, P, Kao, W, Véla, A, Geffrelot, J, Tessonnier, T, Balosso, J, Mahé, M.A, Lim, P.S, Rompokos, V, Chang, Y.C, Royle, G, Gaze, M, Gains, J, Vennarini, S, Francesco, F, Rombi, B, Amichetti, M, Schwarz, M, Lorentini, S, Mee, T, Burnet, N.G, Crellin, A, Kirkby, N.F, Smith, E, Kirkby, K.J, Roggio, M, Buwenge, M, Melchionda, F, Ammendolia, I, Ronchi, L, Cammelli, S, Morganti, A.G, Youn, S.H, Kim, J.Y, Park, H.J, Shin, S.H, Lee, S.H, Hong, E.K, Czerska, K, Winczura, P, Wejs-Maternik, J, Blukis, A, Antonowicz-Szydlowska, M, Rucinski, A, Olko, P, Badzio, A, Kopec, R, Franceschini, D, Cozzi, L, De Rose, F, Meattini, I, Fogliata, A, Cozzi, S, Becherini, C, Tomatis, S, Livi, L, Scorsetti, M, Garda, A, Fattahi, S, Michel, A, Mutter, R, Yan, E, Park, S, Corbin, K, Giap, H, LAM, W.W, Geng, H, Tang, K.K, Lee, T.Y, Kong, C.W, Yang, B, Chiu, T.L, Cheung, K.Y, Yu, S.K, Ma, M, Gao, X, Zhao, Z, Zhao, B, Mullikin, T, Routman, D, Yu, J, Greco, K, Fagundes, M, Shan, J, Daniels, T, Rule, W, DeWees, T, Hu, Y, Bues, M, Sio, T, Liu, W, chenbin, L, yuehu, P, yuenan, W, Bai, Y, Gao, X.S, Zhao, Z.L, Ma, M.W, Ren, X.Y, Salem, A, Woolf, D, Aznar, M, Azadeh, A, Eccles, C, Charlwood, F, Faivre-Finn, C, Teoh, S, Fiorini, F, George, B, Vallis, K, Van den Heuvel, F, Huang, E.Y, Juang, P.J, Pan, S, Hawkins, M, Clarke, M, Lowe, M, Radhakrishna, G, Schaub, S, Bowen, S, Nyflot, M, Chapman, T, Apisarnthanarax, S, Vitek, P, Kubes, J, Vondracek, V, Vinakurau, S, Zamecnik, L, Vitolo, V, Barcellini, A, Brugnatelli, S, Cobianchi, L, Vanoli, A, Fossati, P, Facoetti, A, Dionigi, P, Orecchia, R, Iannalfi, A, Vischioni, B, Ronchi, S, D’Ippolito, E, Petrucci, R, Yamaguchi, H, Honda, M, Hamada, K, Todate, Y, Seto, I, Suzuki, M, Wada, H, Murakami, M, Yu, Z, Zheng, W, Lien-Chun, L, Zhengshan, H, Qing, Z, Jiade, L, Guoliang, J, Fiore, M.R, D'Ippolito, E, Fukumitsu, N, Hayakawa, T, Yamashita, T, Mima, M, Demizu, Y, Suzuki, T, Soejima, T, Hartsell, W, Collins, S, Casablanca, V, Mihalcik, S, Brennan, E, Van Nispen, A, Corbett, A, Mohammed, N, Lee, P, van Nispen, A, Liang, Y.S, Mein, S, Kopp, B, Choi, K, Haberer, T, Debus, J, Abdollahi, A, Mairani, A, Ogino, H, Iwata, H, Hashimoto, S, Nakajima, K, Hattori, Y, Nomura, K, Shibamoto, Y, Li, P, Wu, S, Deng, L, Zhang, G, Zhang, Q, Fu, S, Yang, Z, Zhang, Y, Sasaki, R, Okimoto, T, Akasaka, H, Miyawaki, D, Yoshida, K, Wang, T, Komatsu, S, Fukumoto, T, Shuang, W, Xin, C, zhengshan, H, Shen, F, Vorobyov, N, Andreev, G, Martynova, N, Lyubinsky, A, Kubasov, A, Chen, J, Ma, N, Lu, Y, Zhao, J, Shahnazi, K, Lu, J, Jiang, G, Mao, J, Walser, M, Bojaxhiu, B, Kawashiro, S, Tran, S, Pica, A, Bachtiary, B, Weber, D, Gaito, S, Abravan, A, Richardson, J, Colaco, R, Saunders, D, Brennan, B, Petersen, I, Ahmed, S, Laack, N, Mizoe, J.E, Iizumi, T, Minohara, S, Kusano, Y, Matsuzaki, Y, Tsuchida, K, Serizawa, I, Yoshida, D, Katoh, H, Sakurai, H, Tujii, H, Kim, T.H, Park, J.W, Bo Hyun, K, Hyunjung, K, Sung Ho, M, Sang Soo, K, Sang Myung, W, Young-Hwan, K, Woo Jin, L, Dae Yong, K, Hong, Z, Wang, Z, Koroulakis, A, Molitoris, J, Kaiser, A, Hanna, N, Jiang, Y, Regine, W, DeCesaris, C.M, Choi, J.I, Carr, S.R, Burrows, W.M, Regine, W.F, Simone, C.B, Aihara, T, Hiratsuka, J, Kamitani, N, Higashino, M, Kawata, R, Kumada, H, Ono, K, Chou, Y.C, Dippolito, E, Bonora, M, Alterio, D, Gandini, S, Jereczeck, B.A, Kelly, C, Dobeson, C, Iqbal, S, Chatterjee, S, Hague, C, Li, T, Lin, A, Lukens, J, Slevin, N, Thomson, D, van Herk, M, West, C, Teo, K, Jeans, E, Manzar, G, Patel, S, Ma, D, Lester, S, Foote, R, Friborg, J, Jensen, K, Hansen, C.R, Andersen, E, Andersen, M, Eriksen, J.G, Johansen, J, Overgaard, J, Grau, C, Dědečková, K, Vítek, P, Ondrová, B, Sláviková, S, Zapletalová, S, Zapletal, R, Vondráček, V, Rotnáglová, E, Kwanghyun, J, Woojin, L, Dongryul, O, Yong Chan, A, Paudel, N, Schmidt, S, Ruckman, M, Gans, S, Stauffer, M, Helenowski, I, Patel, U, Samant, S, Gentile, M, Damico, N, Yao, M, Shuja, M, Routman, D.M, Foote, R.L, Garces, Y.I, Neben-Wittich, M.A, Patel, S.H, McGee, L.A, Harmsen, W.S, Ma, D.J, Sommat, K, Tong, A.K.T, Hu, J, Ong, A.L.K, Wang, F, Sin, S.Y, Wee, T.S, Tan, W.K, Fong, K.W, Soong, Y.L, Wallace, N, Fredericks, S, Fitzgerald, T, Vernimmen, F, Petringa, G, Cirrone, P, Agosteo, S, Attili, A, Cammarata, F.P, Cuttone, G, Conte, V, La Tessa, C, Manti, L, Rosenfeld, A, Lojacono, P.A, Hennings, F, Fattori, G, Peroni, M, Lomax, A, Hrbacek, J, Nguyen, H.G, Bach Cuadra, M, Sznitman, R, Schalenbourg, A, Pflaeger, A, Weber, A, Seidel, S, Stark, R, Heufelder, J, Mailhot Vega, R, Bradley, J, Lockney, N, Macdonald, S, Liang, X, Mazal, A, Mendenhall, N, Sher, D, Korreman, S.S, Andreasen, S, Petersen, J.B, Offersen, B.V, Gergelis, K, Jethwa, K, Whitaker, T, Shiraishi, S, Shumway, D, Press, R, Shelton, J, Zhang, C, Dang, Q, Tian, S, Shu, T, Seldon, C, Jani, A, Zhou, J, McDonald, M, Gort, E, Beukema, J.C, Spijkerman-Bergsma, M.J, Both, S, Langendijk, J.A, Matysiak, W.P, Brouwer, C.L, Baba, K, Numajiri, H, Murofushi, K, Oshiro, Y, Mizumoto, M, Onishi, K, Nonaka, T, Ishikawa, H, Okumura, T, Dominietto, M, Adam, K, Ahlhelm, F.J, Safai, S, Abdul-Jabbar, L, Song, J, Tseng, Y. D, Rockhill, J, Fink, J, Chang, L, Halasz, L. 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- Subjects
Biology: Biological Differences between Carbon, Proton and Photons Poster Discussion SessionsPTC58-0642 ,Physics: Absolute and Relative DosimetryPTC58-0180 ,Biology: Biology and Clinical InterfacePTC58-0685 ,Physics: Commissioning New FacilitiesPTC58-0385 ,Physics: 4D Treatment and DeliveryPTC58-0546 ,Clinics: EyePTC58-0714 ,Biology: Biological Differences between Carbon, Proton and Photons Poster Discussion SessionsPTC58-0528 ,Physics: Quality Assurance and VerificationPTC58-0507 ,Oral AbstractsPhysics: Dose Calculation and OptimisationPTC58-0661 ,Biology: Translational and Biomarkers Poster Discussion SessionsPTC58-0221 ,Oral AbstractsPhysics: Dose Calculation and OptimisationPTC58-0531 ,Oral AbstractsPhysics: Dose Calculation and OptimisationPTC58-0653 ,Biology: Drug and Immunotherapy CombinationsPTC58-0163 ,Clinics: Sarcoma - LymphomaPTC58-0055 ,Biology: Drug and Immunotherapy CombinationsPTC58-0166 ,Clinics: CNS / Skull BasePTC58-0198 ,Physics: Treatment PlanningPTC58-0421 ,Clinics: PediatricsPTC58-0560 ,General: New HorizonsPTC58-0709 ,Physics: Treatment PlanningPTC58-0664 ,Clinics: Eye / Breast / Pelvis Poster Discussion SessionsPTC58-0286 ,Physics: Treatment PlanningPTC58-0666 ,Biology: Translational and Biomarkers Poster Discussion SessionsPTC58-0346 ,Physics: Treatment PlanningPTC58-0547 ,Physics: Treatment PlanningPTC58-0308 ,Physics: Treatment PlanningPTC58-0549 ,Physics: Beam Delivery and Nozzle Design Poster Discussion SessionsPTC58-0111 ,Physics: Absolute and Relative DosimetryPTC58-0050 ,Biology: Enhanced Biology in Treatment Planning Poster Discussion SessionsPTC58-0587 ,Biology: Biology and Clinical InterfacePTC58-0454 ,Physics: Absolute and Relative DosimetryPTC58-0052 ,Physics: Commissioning New FacilitiesPTC58-0395 ,Physics: 4D Treatment and DeliveryPTC58-0534 ,Physics: Dose Calculation and OptimisationPTC58-0072 ,Physics: 4D Treatment and DeliveryPTC58-0533 ,Physics: 4D Treatment and DeliveryPTC58-0538 ,Physics: Commissioning New Facilities Poster Discussion SessionsPTC58-0113 ,Physics: Quality Assurance and VerificationPTC58-0633 ,Physics: Treatment PlanningPTC58-0431 ,Physics: Beam Delivery and Nozzle DesignPTC58-0230 ,Biology: Mathematical Modelling SimulationPTC58-0179 ,Clinics: Head and Neck / EyePTC58-0365 ,Physics: Treatment PlanningPTC58-0319 ,Biology: Translational and Biomarkers Poster Discussion SessionsPTC58-0697 ,Biology: Biology and Clinical InterfacePTC58-0663 ,Physics: Commissioning New FacilitiesPTC58-0240 ,Physics: Adaptive TherapyPTC58-0177 ,Physics: Commissioning New FacilitiesPTC58-0363 ,Physics: Commissioning New FacilitiesPTC58-0487 ,Physics: 4D Treatment and DeliveryPTC58-0209 ,Physics: 4D Treatment and DeliveryPTC58-0206 ,Clinics: CNS / Skull BasePTC58-0294 ,Physics: Commissioning New FacilitiesPTC58-0127 ,Biology: Mathematical Modelling SimulationPTC58-0068 ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0062 ,Physics: 4D Treatment and DeliveryPTC58-0692 ,Physics: Quality Assurance and VerificationPTC58-0723 ,Physics: Commissioning New Facilities Poster Discussion SessionsPTC58-0494 ,Physics: Treatment PlanningPTC58-0643 ,Physics: Treatment PlanningPTC58-0521 ,Physics: Treatment PlanningPTC58-0402 ,Physics: Treatment PlanningPTC58-0405 ,Clinics: Head and Neck / EyePTC58-0273 ,Clinics: GIPTC58-0397 ,Physics: Treatment PlanningPTC58-0648 ,Biology: Enhanced Biology in Treatment Planning Poster Discussion SessionsPTC58-0489 ,Physics: Quality Assurance and VerificationPTC58-0617 ,Physics: Quality Assurance and VerificationPTC58-0616 ,Physics: Dose Calculation and Optimisation Poster Discussion SessionsPTC58-0668 ,Clinics: CNS / Skull BasePTC58-0188 ,Oral AbstractsPhysics: Dose Calculation and OptimisationPTC58-0625 ,Physics: Treatment PlanningPTC58-0654 ,Physics: Treatment PlanningPTC58-0655 ,Biology: Drug and Immunotherapy Combinations Poster Discussion SessionsPTC58-0133 ,Clinics: PediatricsPTC58-0313 ,Physics: Treatment PlanningPTC58-0659 ,Poster AbstractsClinics: CNSPTC58-0290 ,Physics: Commissioning New FacilitiesPTC58-0064 ,Physics: Adaptive TherapyPTC58-0396 ,Physics: Dose Calculation and OptimisationPTC58-0281 ,Physics: Quality Assurance and VerificationPTC58-0427 ,Physics: Quality Assurance and VerificationPTC58-0669 ,General: New Horizons SessionPTC58-0191 ,Physics: Dose Calculation and Optimisation Poster Discussion SessionsPTC58-0217 ,Physics: Quality Assurance and VerificationPTC58-0303 ,Physics: Quality Assurance and VerificationPTC58-0665 ,Clinics: Sarcoma - LymphomaPTC58-0495 ,Physics: Dose Calculation and OptimisationPTC58-0398 ,Physics: Quality Assurance and VerificationPTC58-0667 ,Physics: Quality Assurance and VerificationPTC58-0425 ,Physics: Quality Assurance and VerificationPTC58-0541 ,Physics: Treatment PlanningPTC58-0584 ,Physics: Quality Assurance and VerificationPTC58-0540 ,Biology: Drug and Immunotherapy Combinations Poster Discussion SessionsPTC58-0163 ,Physics: Treatment PlanningPTC58-0224 ,Physics: Treatment PlanningPTC58-0229 ,Clinics: PediatricsPTC58-0249 ,Physics: Beam Delivery and Nozzle Design Poster Discussion SessionsPTC58-0555 ,Clinics: PediatricPTC58-0463 ,Physics: Commissioning New Facilities Poster Discussion SessionsPTC58-0556 ,Physics: Absolute and Relative DosimetryPTC58-0498 ,Physics: Commissioning New FacilitiesPTC58-0078 ,Physics: Dose Calculation and OptimisationPTC58-0270 ,Physics: Dose Calculation and OptimisationPTC58-0032 ,Physics: Dose Calculation and OptimisationPTC58-0274 ,Physics: 4D Treatment and DeliveryPTC58-0614 ,Physics: Dose Calculation and OptimisationPTC58-0026 ,Clinics: Head and Neck / EyePTC58-0280 ,Clinics: Eye / Breast / Pelvis Poster Discussion SessionsPTC58-0091 ,Physics: Treatment PlanningPTC58-0593 ,Biology: Drug and Immunotherapy CombinationsPTC58-0012 ,Physics: Dose Calculation and OptimisationPTC58-0025 ,Physics: Dose Calculation and OptimisationPTC58-0146 ,Clinics: Sarcoma - LymphomaPTC58-0261 ,Physics: Treatment PlanningPTC58-0110 ,Clinics: Lung / Sarcoma / LymphomaPTC58-0733 ,Physics: Quality Assurance and VerificationPTC58-0554 ,Physics: Treatment PlanningPTC58-0597 ,Physics: Dose Calculation and Optimisation Poster Discussion SessionsPTC58-0330 ,Physics: Treatment PlanningPTC58-0115 ,Physics: Treatment PlanningPTC58-0598 ,Physics: Absolute and Relative DosimetryPTC58-0040 ,Physics: Absolute and Relative DosimetryPTC58-0282 ,Biology: Enhanced Biology in Treatment Planning Poster Discussion SessionsPTC58-0399 ,Physics: Absolute and Relative DosimetryPTC58-0283 ,Physics: Commissioning New Facilities Poster Discussion SessionsPTC58-0569 ,Clinics: GUPTC58-0647 ,Biology: Biological Differences between Carbon, Proton and Photons Poster Discussion SessionsPTC58-0506 ,Physics: Commissioning New FacilitiesPTC58-0047 ,Physics: Dose Calculation and OptimisationPTC58-0067 ,Clinics: GUPTC58-0409 ,Physics: Dose Calculation and OptimisationPTC58-0065 ,Biology: BNCT Poster Discussion SessionsPTC58-0586 ,Physics: Absolute and Relative Dosimetry PTC58-0393 ,Physics: Image GuidancePTC58-0712 ,Physics: Quality Assurance and VerificationPTC58-0645 ,Physics: Treatment PlanningPTC58-0683 ,Biology: BNCT Poster Discussion SessionsPTC58-0107 ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0266 ,Physics: Monitoring and Modelling MotionPTC58-0530 ,Biology: BNCT Poster Discussion SessionsPTC58-0341 ,Physics: Commissioning New FacilitiesPTC58-0172 ,Physics: Commissioning New Facilities Poster Discussion SessionsPTC58-0456 ,Physics: Dose Calculation and OptimisationPTC58-0170 ,Physics: Commissioning New Facilities Poster Discussion SessionsPTC58-0458 ,Physics: Absolute and Relative DosimetryPTC58-0034 ,Physics: Quality Assurance and VerificationPTC58-0417 ,Physics: Quality Assurance and VerificationPTC58-0413 ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0492 ,Physics: Dose Calculation and OptimisationPTC58-0168 ,Clinics: GI / Sarcoma Poster Discussion SessionsPTC58-0724 ,Physics: Treatment PlanningPTC58-0694 ,Physics: Adaptive TherapyPTC58-0005 ,Physics: Treatment PlanningPTC58-0696 ,Physics: Treatment PlanningPTC58-0453 ,Physics: Adaptive TherapyPTC58-0366 ,Clinics: BreastPTC58-0197 ,Physics: Beam Delivery and Nozzle DesignPTC58-0652 ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0017 ,Physics: Treatment PlanningPTC58-0338 ,Clinics: Head and Neck / EyePTC58-0539 ,General: New Horizons SessionPTC58-0390 ,Physics: Image Guidance Poster Discussion SessionsPTC58-0651 ,General: New HorizonsPTC58-0660 ,Physics: Dose Calculation and OptimisationPTC58-0360 ,Physics: Image GuidancePTC58-0297 ,Physics: 4D Treatment and DeliveryPTC58-0147 ,Scientific: RTTPTC58-0388 ,Physics: Dose Calculation and OptimisationPTC58-0484 ,General: New HorizonsPTC58-0301 ,Physics: Dose Calculation and OptimisationPTC58-0485 ,General: New HorizonsPTC58-0304 ,Physics: 4D Treatment and Delivery Poster Discussion SessionsPTC58-0532 ,Clinics: GIPTC58-0575 ,General: New HorizonsPTC58-0306 ,Physics: Quality Assurance and VerificationPTC58-0589 ,Clinics: CNS / Pediatrics / Lung Poster Discussion SessionsPTC58-0344 ,Physics: Quality Assurance and VerificationPTC58-0225 ,Physics: Treatment PlanningPTC58-0381 ,Physics: Quality Assurance and VerificationPTC58-0467 ,Clinics: CNS / Pediatrics / Lung Poster Discussion SessionsPTC58-0585 ,Physics: Commissioning New FacilitiesPTC58-0416 ,Physics: Quality Assurance and VerificationPTC58-0228 ,Physics: Quality Assurance and VerificationPTC58-0348 ,Physics: Dose Calculation and OptimisationPTC58-0234 ,Physics: Quality Assurance and VerificationPTC58-0101 ,Physics: Treatment PlanningPTC58-0386 ,Physics: Dose Calculation and OptimisationPTC58-0118 ,Physics: Treatment PlanningPTC58-0265 ,Physics: Dose Calculation and OptimisationPTC58-0119 ,Clinics: GIPTC58-0218 ,Physics: Treatment PlanningPTC58-0267 ,Physics: Treatment PlanningPTC58-0387 ,Clinics: BreastPTC58-0142 ,Physics: Treatment PlanningPTC58-0269 ,Physics: Beam Delivery and Nozzle DesignPTC58-0620 ,Clinics: PediatricsPTC58-0048 ,Physics: Quality Assurance and VerificationPTC58-0220 ,Physics: Quality Assurance and VerificationPTC58-0461 ,Physics: Treatment PlanningPTC58-0029 ,Physics: Absolute and Relative DosimetryPTC58-0571 ,Physics: Image GuidancePTC58-0046 ,Clinics: GUPTC58-0557 ,Physics: Absolute and Relative DosimetryPTC58-0211 ,Oral AbstractsPhysics: Dose Calculation and OptimisationPTC58-0131 ,Oral AbstractsPhysics: Dose Calculation and OptimisationPTC58-0373 ,General: New HorizonsPTC58-0411 ,Physics: Dose Calculation and OptimisationPTC58-0595 ,Clinics: CNS / Skull BasePTC58-0361 ,General: New HorizonsPTC58-0414 ,General: New HorizonsPTC58-0537 ,Clinics: GI / Sarcoma Poster Discussion SessionsPTC58-0628 ,Physics: Treatment PlanningPTC58-0271 ,Physics: Commissioning New FacilitiesPTC58-0307 ,Physics: Quality Assurance and VerificationPTC58-0359 ,Physics: Quality Assurance and VerificationPTC58-0354 ,General: New HorizonsPTC58-0419 ,Physics: Treatment PlanningPTC58-0035 ,Biology: BNCTPTC58-0474 ,Clinics: GIPTC58-0460 ,Biology: BNCTPTC58-0596 ,Clinics: GIPTC58-0222 ,Physics: Image GuidancePTC58-0193 ,Clinics: PediatricPTC58-0312 ,Clinics: GUPTC58-0441 ,Clinics: LungPTC58-0701 ,Clinics: EyePTC58-0536 ,Clinics: GUPTC58-0205 ,Physics: Dose Calculation and OptimisationPTC58-0140 ,Clinics: GUPTC58-0208 ,Physics: Dose Calculation and OptimisationPTC58-0020 ,Physics: Image GuidancePTC58-0195 ,Poster AbstractsClinics: CNSPTC58-0717 ,Physics: Quality Assurance and VerificationPTC58-0325 ,Physics: Dose Calculation and OptimisationPTC58-0015 ,Physics: Commissioning New FacilitiesPTC58-0634 ,General: New HorizonsPTC58-0646 ,Physics: Quality Assurance and VerificationPTC58-0566 ,Physics: Dose Calculation and OptimisationPTC58-0134 ,Physics: Dose Calculation and OptimisationPTC58-0376 ,Biology: Mathematical Modelling SimulationPTC58-0462 ,Biology: BNCTPTC58-0567 ,General: New HorizonsPTC58-0527 ,Physics: Treatment PlanningPTC58-0482 ,Clinics: GI, GU, BreastPTC58-0693 ,Physics: Commissioning New FacilitiesPTC58-0518 ,Physics: Quality Assurance and VerificationPTC58-0686 ,Physics: Quality Assurance and VerificationPTC58-0202 ,Physics: Quality Assurance and VerificationPTC58-0322 ,Physics: Quality Assurance and VerificationPTC58-0564 ,Physics: Quality Assurance and VerificationPTC58-0680 ,Physics: Treatment PlanningPTC58-0247 ,Physics: Quality Assurance and VerificationPTC58-0682 ,Physics: Quality Assurance and VerificationPTC58-0440 ,Biology: Translational and BiomarkersPTC58-0514 ,Physics: Beam Delivery and Nozzle Design Poster Discussion SessionsPTC58-0178 ,Clinics: EyePTC58-0520 ,Physics: Absolute and Relative DosimetryPTC58-0231 ,Clinics: Head and Neck / EyePTC58-0424 ,Physics: Absolute and Relative DosimetryPTC58-0471 ,Physics: Absolute and Relative DosimetryPTC58-0356 ,Physics: Dose Calculation and OptimisationPTC58-0491 ,Physics: Dose Calculation and OptimisationPTC58-0250 ,Physics: Commissioning New FacilitiesPTC58-0650 ,Biology: Biology and Clinical InterfacePTC58-0719 ,Physics: Absolute and Relative DosimetryPTC58-0232 ,Physics: Absolute and Relative DosimetryPTC58-0353 ,General: New HorizonsPTC58-0511 ,Physics: Quality Assurance and VerificationPTC58-0219 ,Physics: Absolute and Relative DosimetryPTC58-0238 ,General: New HorizonsPTC58-0512 ,Physics: 4D Treatment and Delivery Poster Discussion SessionsPTC58-0401 ,Clinics: PediatricPTC58-0688 ,Physics: Quality Assurance and VerificationPTC58-0457 ,Physics: Quality Assurance and VerificationPTC58-0214 ,Physics: Quality Assurance and VerificationPTC58-0459 ,General: New HorizonsPTC58-0516 ,Physics: Treatment PlanningPTC58-0372 ,Physics: Treatment PlanningPTC58-0011 ,Physics: Treatment PlanningPTC58-0254 ,Physics: Quality Assurance and VerificationPTC58-0332 ,Clinics: CNS / Skull BasePTC58-0468 ,Biology: Mathematical Modelling SimulationPTC58-0357 ,Clinics: GI / Sarcoma Poster Discussion SessionsPTC58-0649 ,Physics: Dose Calculation and OptimisationPTC58-0006 ,Physics: Quality Assurance and VerificationPTC58-0212 ,Physics: Image Guidance Poster Discussion SessionsPTC58-0565 ,Physics: Treatment PlanningPTC58-0018 ,Physics: Treatment PlanningPTC58-0019 ,Clinics: BreastPTC58-0576 ,Clinics: Head and Neck / EyePTC58-0335 ,Clinics: Head and Neck / EyePTC58-0577 ,General: New HorizonsPTC58-0621 ,Physics: Absolute and Relative DosimetryPTC58-0426 ,Physics: Commissioning New Facilities Poster Discussion SessionsPTC58-0268 ,Physics: Absolute and Relative DosimetryPTC58-0423 ,Physics: Treatment PlanningPTC58-0184 ,Physics: Quality Assurance and VerificationPTC58-0149 ,Clinics: GIPTC58-0378 ,Clinics: GIPTC58-0257 ,Clinics: CNS / Pediatrics / Lung Poster Discussion SessionsPTC58-0662 ,General: New HorizonsPTC58-0627 ,Physics: Treatment PlanningPTC58-0186 ,Physics: Treatment PlanningPTC58-0185 ,Physics: Quality Assurance and VerificationPTC58-0144 ,Biology: BNCT Poster Discussion SessionsPTC58-0602 ,Physics: Treatment PlanningPTC58-0189 ,Physics: Dose Calculation and OptimisationPTC58-0315 ,Clinics: Head and neckPTC58-0300 ,General: New Horizons SessionPTC58-0347 ,Physics: Image GuidancePTC58-0082 ,Clinics: BreastPTC58-0443 ,Physics: 4D Treatment and Delivery Poster Discussion SessionsPTC58-0629 ,Physics: Adaptive Therapy Poster Discussion SessionsPTC58-0007 ,Physics: Commissioning New FacilitiesPTC58-0472 ,Clinics: GI, GU, BreastPTC58-0515 ,Physics: Dose Calculation and Optimisation Poster Discussion SessionsPTC58-0606 ,Oral AbstractsPhysics: Dose Calculation and OptimisationPTC58-0450 ,Physics: Absolute and Relative DosimetryPTC58-0657 ,Physics: Dose Calculation and OptimisationPTC58-0551 ,Physics: Treatment PlanningPTC58-0192 ,Clinics: CNS / Pediatrics / Lung Poster Discussion SessionsPTC58-0675 ,Physics: Treatment PlanningPTC58-0194 ,Physics: Dose Calculation and OptimisationPTC58-0544 ,Physics: Treatment PlanningPTC58-0199 ,Physics: Quality Assurance and VerificationPTC58-0037 ,Oral AbstractsPhysics: Dose Calculation and OptimisationPTC58-0207 ,Clinics: CNS / Pediatrics / Lung Poster Discussion SessionsPTC58-0434 ,Physics: Quality Assurance and VerificationPTC58-0036 ,Physics: Quality Assurance and VerificationPTC58-0278 ,Physics: Quality Assurance and VerificationPTC58-0394 ,Physics: Quality Assurance and VerificationPTC58-0151 ,Physics: Quality Assurance and VerificationPTC58-0154 ,Physics: Dose Calculation and OptimisationPTC58-0428 ,Clinics: BreastPTC58-0116 ,Biology: Enhanced Biology in Treatment Planning Poster Discussion SessionsPTC58-0435 ,Physics: Commissioning New FacilitiesPTC58-0681 ,Physics: Absolute and Relative DosimetryPTC58-0323 ,Physics: Dose Calculation and OptimisationPTC58-0583 ,Physics: Absolute and Relative DosimetryPTC58-0448 ,Clinics: CNS / Skull BasePTC58-0251 ,General: New HorizonsPTC58-0721 ,Physics: Absolute and Relative DosimetryPTC58-0203 ,Physics: Dose Calculation and OptimisationPTC58-0455 ,Physics: 4D Treatment and DeliveryPTC58-0130 ,Physics: Commissioning New FacilitiesPTC58-0679 ,Physics: Absolute and Relative DosimetryPTC58-0329 ,General: New HorizonsPTC58-0604 ,Physics: Absolute and Relative DosimetryPTC58-0449 ,Clinics: CNS / Skull BasePTC58-0132 ,General: New HorizonsPTC58-0607 ,Physics: Quality Assurance and VerificationPTC58-0122 ,Physics: Quality Assurance and VerificationPTC58-0243 ,Physics: Treatment PlanningPTC58-0165 ,Oral AbstractsPhysics: Dose Calculation and OptimisationPTC58-0437 ,Physics: 4D Treatment and DeliveryPTC58-0377 ,Physics: Quality Assurance and VerificationPTC58-0125 ,Physics: Quality Assurance and VerificationPTC58-0245 ,Physics: Dose Calculation and OptimisationPTC58-0337 ,Clinics: GI / Sarcoma Poster Discussion SessionsPTC58-0334 ,Physics: Quality Assurance and VerificationPTC58-0121 ,General: New Horizons SessionPTC58-0563 ,General: New Horizons SessionPTC58-0321 ,Clinics: Head and Neck / EyePTC58-0477 ,Physics: Quality Assurance and VerificationPTC58-0480 ,Clinics: GUPTC58-0010 ,Clinics: EyePTC58-0684 ,Clinics: GUPTC58-0496 ,Clinics: Head and neckPTC58-0676 ,Clinics: GUPTC58-0137 ,Physics: Beam Delivery and Nozzle Design Poster Discussion SessionsPTC58-0256 ,Physics: 4D Treatment and DeliveryPTC58-0117 ,Physics: Absolute and Relative DosimetryPTC58-0552 ,Physics: Absolute and Relative DosimetryPTC58-0310 ,Physics: Absolute and Relative DosimetryPTC58-0672 ,Physics: Absolute and Relative DosimetryPTC58-0436 ,Physics: Dose Calculation and OptimisationPTC58-0452 ,Physics: Dose Calculation and OptimisationPTC58-0331 ,Physics: Commissioning New FacilitiesPTC58-0213 ,Biology: Mathematical Modelling SimulationPTC58-0272 ,Clinics: EyePTC58-0326 ,Physics: Commissioning New FacilitiesPTC58-0568 ,Physics: Dose Calculation and OptimisationPTC58-0444 ,Physics: Quality Assurance and VerificationPTC58-0379 ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0095 ,Physics: Treatment PlanningPTC58-0053 ,Physics: Absolute and Relative DosimetryPTC58-0438 ,Physics: Absolute and Relative DosimetryPTC58-0317 ,Physics: Quality Assurance and VerificationPTC58-0497 ,Physics: Quality Assurance and VerificationPTC58-0375 ,Physics: Treatment PlanningPTC58-0056 ,Physics: 4D Treatment and DeliveryPTC58-0124 ,Clinics: GIPTC58-0009 ,Physics: Quality Assurance and VerificationPTC58-0014 ,Physics: Quality Assurance and VerificationPTC58-0374 ,Clinics: LungPTC58-0727 ,General: New Horizons SessionPTC58-0578 ,Clinics: GI / Sarcoma Poster Discussion SessionsPTC58-0470 ,Clinics: LungPTC58-0204 ,Clinics: Head and neckPTC58-0227 ,Clinics: LungPTC58-0446 ,Physics: Quality Assurance and VerificationPTC58-0190 ,Clinics: Eye / Breast / Pelvis Poster Discussion SessionsPTC58-0609 ,Clinics: LungPTC58-0689 ,General: New HorizonsPTC58-0021 ,General: New HorizonsPTC58-0262 ,Biology: BNCT Poster Discussion SessionsPTC58-0081 ,Clinics: GIPTC58-0726 ,General: New HorizonsPTC58-0145 ,Physics: Image GuidancePTC58-0573 ,General: New HorizonsPTC58-0027 ,General: New HorizonsPTC58-0028 ,Biology: Mathematical Modelling and SimulationPTC58-0148 ,Physics: Dose Calculation and OptimisationPTC58-0635 ,Physics: Image GuidancePTC58-0215 ,Physics: Image GuidancePTC58-0336 ,Poster AbstractsClinics: CNSPTC58-0535 ,Physics: Quality Assurance and VerificationPTC58-0187 ,Biology: BNCT Poster Discussion SessionsPTC58-0084 ,General: New Investigator SessionPTC58-0339 ,General: New Horizons SessionPTC58-0420 ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0523 ,Biology: BNCT Poster Discussion SessionsPTC58-0088 ,Clinics: GI / Sarcoma Poster Discussion SessionsPTC58-0112 ,Physics: Quality Assurance and VerificationPTC58-0182 ,Clinics: Eye / Breast / Pelvis Poster Discussion SessionsPTC58-0615 ,Physics: Quality Assurance and VerificationPTC58-0080 ,Biology: BNCTPTC58-0085 ,Physics: Adaptive Therapy Poster Discussion SessionsPTC58-0722 ,General: New HorizonsPTC58-0253 ,General: New HorizonsPTC58-0255 ,Clinics: PediatricPTC58-0703 ,General: New HorizonsPTC58-0499 ,Physics: Image Guidance Poster Discussion SessionsPTC58-0380 ,General: New HorizonsPTC58-0259 ,Clinics: GI, GU, BreastPTC58-0288 ,Clinics: GI, GU, BreastPTC58-0045 ,Physics: Absolute and Relative DosimetryPTC58-0619 ,Clinics: PediatricPTC58-0707 ,Physics: Quality Assurance and VerificationPTC58-0196 ,Physics: Quality Assurance and VerificationPTC58-0074 ,Physics: Quality Assurance and VerificationPTC58-0077 ,Biology: BNCT Poster Discussion SessionsPTC58-0073 ,Biology: BNCTPTC58-0075 ,Biology: Biological Differences between Carbon, Proton and Photons Poster Discussion SessionsPTC58-0093 ,Clinics: GUPTC58-0161 ,Clinics: GI / Sarcoma Poster Discussion SessionsPTC58-0371 ,Physics: Monitoring and Modelling MotionPTC58-0181 ,General: New HorizonsPTC58-0120 ,General: New HorizonsPTC58-0362 ,General: New HorizonsPTC58-0364 ,Physics: Image GuidancePTC58-0473 ,Scientific: RTTPTC58-0641 ,Clinics: CNS / Pediatrics / Lung Poster Discussion SessionsPTC58-0296 ,General: New HorizonsPTC58-0004 ,General: New HorizonsPTC58-0128 ,Clinics: BreastPTC58-0316 ,Physics: 4D Treatment and Delivery Poster Discussion SessionsPTC58-0236 ,General: New HorizonsPTC58-0008 ,General: New Investigator SessionPTC58-0673 ,Physics: Quality Assurance and VerificationPTC58-0167 ,Physics: Quality Assurance and VerificationPTC58-0289 ,Physics: Quality Assurance and VerificationPTC58-0284 ,General: New Horizons SessionPTC58-0522 ,Physics: Quality Assurance and VerificationPTC58-0164 ,Physics: Quality Assurance and VerificationPTC58-0285 ,Clinics: Eye / Breast / Pelvis Poster Discussion SessionsPTC58-0623 ,Clinics: Eye / Breast / Pelvis Poster Discussion SessionsPTC58-0502 ,Clinics: GUPTC58-0293 ,Biology: Translational and BiomarkersPTC58-0599 ,Biology: BNCTPTC58-0063 ,Clinics: LungPTC58-0656 ,General: New HorizonsPTC58-0592 ,Biology: BNCT Poster Discussion SessionsPTC58-0092 ,Poster AbstractsClinics: CNSPTC58-0302 ,Physics: Image GuidancePTC58-0464 ,General: New HorizonsPTC58-0352 ,Physics: Image GuidancePTC58-0465 ,General: New HorizonsPTC58-0476 ,Physics: Image GuidancePTC58-0100 ,General: New HorizonsPTC58-0235 ,Biology: Mathematical Modelling and SimulationPTC58-0349 ,Physics: Treatment PlanningPTC58-0094 ,Physics: 4D Treatment and Delivery Poster Discussion SessionsPTC58-0367 ,Physics: Dose Calculation and OptimisationPTC58-0400 ,Biology: Translational and BiomarkersPTC58-0244 ,Physics: Dose Calculation and OptimisationPTC58-0640 ,Biology: Mathematical Modelling and SimulationPTC58-0355 ,General: New Investigator SessionPTC58-0320 ,Physics: Quality Assurance and VerificationPTC58-0057 ,Physics: Quality Assurance and VerificationPTC58-0174 ,Physics: Quality Assurance and VerificationPTC58-0295 ,Physics: Dose Calculation and OptimisationPTC58-0529 ,Clinics: GI / Sarcoma Poster Discussion SessionsPTC58-0123 ,Physics: Quality Assurance and VerificationPTC58-0171 ,Biology: Biological Differences between Carbon, Proton and Photons Poster Discussion SessionsPTC58-0049 ,Clinics: BreastPTC58-0731 ,General: New HorizonsPTC58-0223 ,General: New HorizonsPTC58-0102 ,General: New HorizonsPTC58-0466 ,Scientific: RTTPTC58-0503 ,Clinics: CNS / Pediatrics / Lung Poster Discussion SessionsPTC58-0389 ,General: New HorizonsPTC58-0108 ,General: New HorizonsPTC58-0109 ,Physics: Commissioning New FacilitiesPTC58-0736 ,Biology: Mathematical Modelling and SimulationPTC58-0343 ,Biology: Mathematical Modelling and SimulationPTC58-0342 ,Clinics: GI, GU, BreastPTC58-0237 ,Physics: Dose Calculation and OptimisationPTC58-0711 ,Biology: Mathematical Modelling and SimulationPTC58-0581 ,Clinics: GI, GU, BreastPTC58-0114 ,Clinics: Base of SkullPTC58-0730 ,Clinics: Head and neckPTC58-0383 ,Clinics: CNS / Skull BasePTC58-0559 ,Clinics: Base of SkullPTC58-0613 ,General: New HorizonsPTC58-0691 ,Biology: Biological Differences between Carbon, Proton and Photons Poster Discussion SessionsPTC58-0054 ,General: New HorizonsPTC58-0210 ,Clinics: BreastPTC58-0729 ,General: New HorizonsPTC58-0574 ,Clinics: GI, GU, BreastPTC58-0239 ,Scientific: RTTPTC58-0637 ,General: New HorizonsPTC58-0579 ,Clinics: Lung / Sarcoma / LymphomaPTC58-0176 ,General: New HorizonsPTC58-0699 ,Clinics: CNS / Pediatrics / Lung Poster Discussion SessionsPTC58-0156 ,Biology: Mathematical Modelling and SimulationPTC58-0333 ,Biology: Translational and BiomarkersPTC58-0345 ,Physics: Image GuidancePTC58-0369 ,Physics: Commissioning New FacilitiesPTC58-0509 ,Biology: Mathematical Modelling SimulationPTC58-0658 ,Biology: Biological Differences between Carbon, Proton and Photons Poster Discussion SessionsPTC58-0051 ,General: New Investigator SessionPTC58-0548 ,Clinics: GI, GU, BreastPTC58-0241 ,Clinics: Eye / Breast / Pelvis Poster Discussion SessionsPTC58-0412 ,Clinics: GI / Sarcoma Poster Discussion SessionsPTC58-0024 ,Clinics: LungPTC58-0226 ,Biology: Biological Differences between Carbon, Proton and Photons Poster Discussion SessionsPTC58-0069 ,General: New HorizonsPTC58-0562 ,General: New HorizonsPTC58-0561 ,General: New HorizonsPTC58-0201 ,Biology: Mathematical Modelling and SimulationPTC58-0439 ,General: New HorizonsPTC58-0445 ,General: New HorizonsPTC58-0324 ,Physics: Image GuidancePTC58-0031 ,Biology: Mathematical Modelling and SimulationPTC58-0558 ,Physics: Image GuidancePTC58-0392 ,Biology: Mathematical Modelling and SimulationPTC58-0678 ,Physics: Beam Delivery and Nozzle DesignPTC58-0090 ,General: New Investigator SessionPTC58-0630 ,Biology: Biological Differences between Carbon / Proton and Photons Carbons / Proton and PhotonPTC58-0524 ,Physics: Commissioning New FacilitiesPTC58-0713 ,Clinics: GI, GU, BreastPTC58-0139 ,Clinics: CNS / Pediatrics / Lung Poster Discussion SessionsPTC58-0248 ,Clinics: CNS / Pediatrics / Lung Poster Discussion SessionsPTC58-0368 ,Biology: Enhanced Biology in Treatment PlanningPTC58-0519 ,General: New Horizons SessionPTC58-0720 ,Physics: Quality Assurance and VerificationPTC58-0083 ,General: New HorizonsPTC58-0311 ,General: New HorizonsPTC58-0674 ,General: New HorizonsPTC58-0553 ,Physics: Image GuidancePTC58-0023 ,Scientific: RTTPTC58-0612 ,General: New HorizonsPTC58-0677 ,Biology: Mathematical Modelling and SimulationPTC58-0545 ,Physics: Dose Calculation and OptimisationPTC58-0601 ,Physics: Dose Calculation and OptimisationPTC58-0725 ,Physics: Quality Assurance and VerificationPTC58-0098 ,Physics: Dose Calculation and OptimisationPTC58-0605 ,Biology: Biological Differences between Carbon / Proton and Photons Carbons / Proton and PhotonPTC58-0517 ,Biology: Translational and Biomarkers Poster Discussion SessionsPTC58-0618 ,Physics: Monitoring and Modelling MotionPTC58-0481 ,Clinics: GI / Sarcoma Poster Discussion SessionsPTC58-0071 ,Physics: Adaptive TherapyPTC58-0351 ,Physics: 4D Treatment and DeliveryPTC58-0702 ,Physics: Image GuidancePTC58-0734 ,Physics: Image GuidancePTC58-0611 ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0486 ,Physics: Absolute and Relative Dosimetry Poster Discussion SessionsPTC58-0442 ,Biology: Drug and Immunotherapy CombinationsPTC58-0327 ,Clinics: Head and Neck / EyePTC58-0096 ,Clinics: LungPTC58-0159 ,Physics: Treatment PlanningPTC58-0708 ,General: New HorizonsPTC58-0097 ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0350 ,Biology: Biological Differences between Carbon / Proton and Photons Carbons / Proton and PhotonPTC58-0016 ,Physics: Adaptive TherapyPTC58-0104 ,Physics: Absolute and Relative Dosimetry Poster Discussion SessionsPTC58-0433 ,Physics: Image GuidancePTC58-0608 ,Biology: Translational and Biomarkers Poster Discussion SessionsPTC58-0610 ,Clinics: Head and neckPTC58-0058 ,Physics: Treatment PlanningPTC58-0715 ,Clinics: Head and neckPTC58-0298 ,Clinics: EyePTC58-0099 ,General: New HorizonsPTC58-0086 ,General: New HorizonsPTC58-0089 ,Clinics: Lung / Sarcoma / LymphomaPTC58-0200 ,Poster AbstractsClinics: CNSPTC58-0157 ,Clinics: LungPTC58-0141 ,Clinics: LungPTC58-0260 ,Clinics: LungPTC58-0264 ,Physics: Image GuidancePTC58-0513 ,Physics: Image GuidancePTC58-0631 ,Clinics: Eye / Breast / Pelvis Poster Discussion SessionsPTC58-0469 ,Biology: BNCT Poster Discussion SessionsPTC58-0384 ,Physics: Image GuidancePTC58-0639 ,Clinics: PediatricsPTC58-0700 ,Clinics: LungPTC58-0136 ,Clinics: BreastPTC58-0706 ,General: New HorizonsPTC58-0079 ,Biology: Drug and Immunotherapy Combinations Poster Discussion SessionsPTC58-0406 ,Clinics: Base of SkullPTC58-0382 ,Physics: Image GuidancePTC58-0624 ,Physics: Beam Delivery and Nozzle DesignPTC58-0173 ,Biology: Drug and Immunotherapy CombinationsPTC58-0358 ,Poster AbstractsClinics: CNSPTC58-0690 ,General: New HorizonsPTC58-0061 ,Clinics: Lung / Sarcoma / LymphomaPTC58-0580 ,Physics: Monitoring and Modelling MotionPTC58-0162 ,Physics: Adaptive TherapyPTC58-0550 ,Physics: Adaptive TherapyPTC58-0430 ,Clinics: Lung / Sarcoma / LymphomaPTC58-0103 ,General: New Investigator SessionPTC58-0252 ,Physics: Quality Assurance and VerificationPTC58-0704 ,Physics: Image GuidancePTC58-0418 ,Clinics: Base of SkullPTC58-0572 ,Clinics: Lung / Sarcoma / LymphomaPTC58-0106 ,Physics: Beam Delivery and Nozzle DesignPTC58-0022 ,Physics: Monitoring and Modelling MotionPTC58-0279 ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0447 ,Physics: Treatment PlanningPTC58-0622 ,Clinics: PediatricsPTC58-0644 ,Biology: Biology and Clinical InterfacePTC58-0490 ,Clinics: CNS / Skull BasePTC58-0716 ,General: New HorizonsPTC58-0292 ,Biology: Biological Differences between Carbon / Proton and Photons Carbons / Proton and PhotonPTC58-0570 ,General: New HorizonsPTC58-0059 ,Physics: Quality Assurance and VerificationPTC58-0710 ,Biology: Biological Differences between Carbon / Proton and Photons Carbons / Proton and PhotonPTC58-0216 ,Physics: Image GuidancePTC58-0404 ,Physics: Image GuidancePTC58-0525 ,Physics: Image GuidancePTC58-0526 ,Poster AbstractsClinics: CNSPTC58-0328 ,Clinics: LungPTC58-0070 ,Clinics: Eye / Breast / Pelvis Poster Discussion SessionsPTC58-0135 ,Biology: BNCT Poster Discussion SessionsPTC58-0391 ,Physics: Treatment PlanningPTC58-0510 ,Physics: Treatment PlanningPTC58-0636 ,Physics: Treatment PlanningPTC58-0638 ,Physics: Image GuidancePTC58-0408 ,Physics: Absolute and Relative Dosimetry Poster Discussion SessionsPTC58-0632 ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0318 ,Biology: Enhanced Biology in Treatment PlanningPTC58-0246 ,Clinics: PediatricsPTC58-0504 ,General: New HorizonsPTC58-0160 ,Physics: Image Guidance Poster Discussion SessionsPTC58-0076 ,Physics: Monitoring and Modelling MotionPTC58-0143 ,Biology: Mathematical Modelling and SimulationPTC58-0718 ,Physics: Image GuidancePTC58-0671 ,Clinics: LungPTC58-0183 ,Physics: Image GuidancePTC58-0670 ,Report ,Physics: Treatment Planning Poster Discussion SessionsPTC58-0422 ,Biology: Biological Differences between Carbon / Proton and Photons Carbons / Proton and PhotonPTC58-0129 ,Physics: Adaptive Therapy Poster Discussion SessionsPTC58-0705 ,Biology: Enhanced Biology in Treatment PlanningPTC58-0258 ,General: New HorizonsPTC58-0030 ,General: New HorizonsPTC58-0150 ,Biology: Biology and Clinical InterfacePTC58-0479 ,General: New HorizonsPTC58-0153 ,Clinics: PediatricPTC58-0087 ,General: New HorizonsPTC58-0152 ,General: New HorizonsPTC58-0155 ,General: New HorizonsPTC58-0033 ,General: New HorizonsPTC58-0158 ,Physics: Image GuidancePTC58-0429 ,Biology: Translational and BiomarkersPTC58-0287 ,Physics: Adaptive TherapyPTC58-0403 ,Physics: Image GuidancePTC58-0309 - Published
- 2020
18. Hearing loss in survivors of childhood head and neck rhabdomyosarcoma: a long-term follow-up study
- Author
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Schoot, R. A., Theunissen, E. A.R., Slater, O., Lopez-Yurda, M., Zuur, C. L., Gaze, M. N., Chang, Y.-C., Mandeville, H. C., Gains, J. E., Rajput, K., Pieters, B. R., Fajardo, R. Davila, Talwar, R., Caron, H. N., Balm, A. J.M., Dreschler, W. A., and Merks, J. H.M.
- Published
- 2016
- Full Text
- View/download PDF
19. Experiences and barriers to accessing mental health support in mothers of children with a disability
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Gilson, K-M, Davis, E, Gains, J, Brunton, S, Williams, K, Reddihough, D, Gilson, K-M, Davis, E, Gains, J, Brunton, S, Williams, K, and Reddihough, D
- Abstract
BACKGROUND: Despite evidence for high levels of mental health problems in mothers of children with a disability and the potential impact on caring for their child, very little is known about mothers' experience in accessing professional mental health support. This study aimed to explore mothers' views and experience on seeking help for their mental health. METHODS: Semi-structured interviews were conducted with 25 mothers of children with a disability. Thematic analysis was completed. RESULTS: Mothers experienced significant barriers when accesing support at the personal, professional and system level. Personal barriers included the need for competency and stigma about mental illness: professional barriers included the lack of discussions about mental health and interpersonal factors that hindered disclosure. System barriers included feeling invisible to the health services, paediatric care focusing on the child rather than the family and limitations to the type of mental health support available. CONCLUSION: Mothers perceive substantial barriers in accessing support for their mental health. It is important that strategies are designed so the importance of mentally healthy mothers is understood and to normalize a need for assistance when you are the mother of a child with additional support needs. Strategies are also needed to encourage mothers to seek help and to assist professionals having discussions about maternal wellbeing. Improvements are also required in the accessibility of service supports.
- Published
- 2021
20. Contouring Variability in Pediatric Abdominal Neuroblastoma: Results of a National Quality Assurance Exercise
- Author
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Smyth, G., primary, Mandeville, H.C., additional, Gains, J., additional, Miles, E., additional, Stacey, C., additional, and Gaze, M.N., additional
- Published
- 2020
- Full Text
- View/download PDF
21. PO-1313: Population-based virtual phantoms for paediatric radiotherapy applications – initial developments
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Veiga, C., primary, Moinuddin, S., additional, and Gains, J., additional
- Published
- 2020
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- View/download PDF
22. Quality of applesauces processed by pulsed electric fields and HTST pasteurisation†
- Author
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Jin, Z. T., Zhang, H. Q., Li, S. Q., Kim, M., Dunne, C. P., Yang, T., Wright, A. O., and Venter-Gains, J.
- Published
- 2009
- Full Text
- View/download PDF
23. Insulin Allergy In Secondary Diabetes Requiring Prolonged Desensitisation
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SENIOR, P A, GAINS, J, SUTTON, S, McNAMARA, C, and RUTTER, M K
- Published
- 2001
24. Mental health care needs and preferences for mothers of children with a disability
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Gilson, K-M, Davis, E, Johnson, S, Gains, J, Reddihough, D, Williams, K, Gilson, K-M, Davis, E, Johnson, S, Gains, J, Reddihough, D, and Williams, K
- Abstract
BACKGROUND: Mothers of children with a disability are at increased risk of poor mental health compared with mothers of typically developing children. The aim of the study was to describe the mental health care needs and preferences for support of mothers of children and young people aged 0-25 years with a disability. METHODS: A cross-sectional study was used, using an online survey with 294 mothers of children with a disability. Questions were asked about mental health, perceived need for support, barriers to accessing mental health care, and preferences for support. Descriptive and chi-squared analyses were performed. RESULTS: High rates of mental ill health were self-identified in the previous 12 months, with reported clinically significant depression (44%), anxiety (42%), and suicidality (22%). Nearly half (48%) of the mothers reported high to very high psychological distress. Although 75% of mothers perceived a need for professional support, only 58% attempted to access this. Key barriers to accessing support were caregiving duties making it difficult to schedule appointments (45%) and not perceiving the mental health problem as serious enough to require help (36%). Individual counselling was the preferred type of support (66%) followed by professionally guided relaxation (49%) and education about mental health (47%). Support was considered most critical at the time of diagnosis and during medical intervention for their child. CONCLUSIONS: Although mental health problems were common and mothers perceived the need for professional help, several key barriers were preventing mothers from accessing help. Our study suggests that improving mothers' knowledge of when and where to seek help (mental health literacy) may encourage their access to support. There also needs to be more accessible treatment to mothers given the high care demands that are placed upon them.
- Published
- 2018
25. Mental health care needs and preferences for mothers of children with a disability
- Author
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Gilson, K.-M., primary, Davis, E., additional, Johnson, S., additional, Gains, J., additional, Reddihough, D., additional, and Williams, K., additional
- Published
- 2018
- Full Text
- View/download PDF
26. Radiation exposure to comforters and carers during paediatric molecular radiotherapy
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Gains, J. E., primary, Walker, C., additional, Sullivan, T. M., additional, Waddington, W. A., additional, Fersht, N. L., additional, Sullivan, K. P., additional, Armstrong, E., additional, D'Souza, D. P., additional, Aldridge, M. D., additional, Bomanji, J. B., additional, and Gaze, M. N., additional
- Published
- 2014
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- View/download PDF
27. 256 TARGETED RADIONUCLIDE THERAPY FOR METASTATIC PITUITARY CARCINOMA
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Maclean, J., primary, Walker, C., additional, Gaze, M., additional, Bomanji, J., additional, Gains, J., additional, Short, S., additional, Powell, M., additional, and Fersht, N., additional
- Published
- 2012
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28. 958 poster LUTETIUM-177 DOTATATE THERAPY FOR NEUROENDOCRINE TUMOURS – THE UCLH EXPERIENCE.
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Hadaki, M., primary, Walker, C., additional, Bomanji, J., additional, Gains, J., additional, and Gaze, M., additional
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- 2011
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29. Radiation exposure to comforters and carers during paediatric molecular radiotherapy.
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Gains, J. E., Walker, C., Sullivan, T. M., Waddington, W. A., Fersht, N. L., Sullivan, K. P., Armstrong, E., D'Souza, D. P., Aldridge, M. D., Bomanji, J. B., and Gaze, M. N.
- Published
- 2015
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30. Electronic Mail - A New Style of Communication or Just a New Medium?: An Investigation into the Text Features of E-mail
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Gains, J.
- Published
- 1999
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31. A diagnosis of Noonan syndrome through routine whole genome sequencing in a child with an intracranial nongerminomatous germ cell tumor.
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Mahmood S, Leiter SM, Phyu P, Craven C, Horan G, Gains J, Briggs M, Blanco E, Behjati S, Watkins J, Tadross JA, Roberts T, Trotman J, Tarpey P, Armstrong R, and Murray MJ
- Published
- 2024
- Full Text
- View/download PDF
32. A Randomised Phase II Trial to Evaluate the Feasibility of Radiotherapy Dose Escalation, Facilitated by Intensity-Modulated Arc Radiotherapy Techniques, in High-Risk Neuroblastoma.
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Gains JE, Patel A, Chang YC, Mandeville HC, Smyth G, Stacey C, Talbot J, Wheatley K, and Gaze MN
- Subjects
- Humans, Male, Female, Child, Preschool, Child, Infant, Radiotherapy Planning, Computer-Assisted methods, Organs at Risk radiation effects, Neuroblastoma radiotherapy, Radiotherapy, Intensity-Modulated methods, Feasibility Studies, Radiotherapy Dosage
- Abstract
Background and Purpose: For high-risk neuroblastoma, planning target volume coverage is often compromised to respect adjacent kidney tolerance. This trial investigated whether intensity-modulated arc radiotherapy techniques (IMAT) could facilitate dose escalation better than conventional techniques., Materials and Methods: Children with high-risk abdominal neuroblastoma referred for radiotherapy to the primary tumour site and involved regional lymph nodes were randomised to receive either standard dose (21 Gy in 14 fractions) or escalated dose (36 Gy in 24 fractions) radiotherapy. Dual planning with both a conventional anterior-posterior parallel opposed pair radiotherapy technique and an IMAT technique was performed. The quality of target volume and organ-at-risk delineation, and dosimetric plans, were externally reviewed. Dosimetric parameters were used to judge the superior technique for treatment. This feasibility trial was not powered to detect improvement in outcome with dose escalation., Results: Between 2017 and 2020, 50 patients were randomised and dual-planned. The IMAT technique was judged more favourable in 48 patients. In all patients randomised to receive 36 Gy, IMAT would have permitted delivery of the full dose (median D50% 36.0 Gy, inter-quartile range 36.0-36.1 Gy) to the target volume, whereas dose compromise would have been required with conventional planning (median D50% 35.6 Gy, inter-quartile range 28.7-35.9 Gy)., Conclusion: IMAT facilitates safe dose escalation to 36 Gy in patients receiving radiotherapy for neuroblastoma. The value of dose escalation is now being evaluated in a current prospective phase III randomised trial., (Copyright © 2024. Published by Elsevier Ltd.)
- Published
- 2024
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33. Radiation Reveal: Moving from research engagement to involvement.
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Whittaker L, Dean JA, Veiga C, Langdon S, Drake R, Taylor D, Williams MC, Masters H, Britton A, Cumbo M, Burdis N, Mason K, Fay G, Smith E, Benson S, Halil A, Lambert S, Gaze MN, Gains J, Spencer B, Taylor-Gee A, and Terry SYA
- Subjects
- Humans, Young Adult, Adult, Adolescent, Female, Male, Biomedical Research, Neoplasms radiotherapy
- Abstract
Here, we report on the process of a highly impactful and successful creative, collaborative, and multi-partner public engagement project, Radiation Reveal. It brought together ten young adults aged 17-25-year-olds with experience of radiotherapy with researchers at Cancer Research UK RadNet City of London across three 2-hour online workshops. Our aims were to 1) initiate discussions between young adults and radiation researchers, and 2) identify what people wish they had known about radiotherapy before or during treatment. These aims were surpassed; other benefits included peer support, participants' continued involvement in subsequent engagement projects, lasting friendships, creation of support groups for others, and creation and national dissemination of top ten tips for medical professionals and social media resources. A key learning was that this project required a dedicated and (com)passionate person with connections to national cancer charities. When designing the project, constant feedback is also needed from charities and young adults with and without radiotherapy experience. Finally, visually capturing discussions and keeping the door open beyond workshops further enhanced impact. Here, we hope to inform and inspire people to help project the patient voice in all we do., (© 2024. The Author(s).)
- Published
- 2024
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34. Facial deformation following treatment for pediatric head and neck rhabdomyosarcoma; the difference between treatment modalities. Results of a trans-Atlantic, multicenter cross-sectional cohort study.
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Hol MLF, Indelicato DJ, Slater O, Kolb F, Hewitt RJ, Ong J, Becking AG, Gains J, Bradley J, Sandler E, Gaze MN, Pieters B, Mandeville H, Fajardo RD, Schoot R, Merks JHM, Hammond P, Smeele LE, and Suttie M
- Subjects
- Child, Humans, Infant, Cross-Sectional Studies, Cohort Studies, Combined Modality Therapy, Head and Neck Neoplasms radiotherapy, Rhabdomyosarcoma, Embryonal, Rhabdomyosarcoma radiotherapy, Rhabdomyosarcoma pathology
- Abstract
Background: The four different local therapy strategies used for head and neck rhabdomyosarcoma (HNRMS) include proton therapy (PT), photon therapy (RT), surgery with radiotherapy (Paris-method), and surgery with brachytherapy (AMORE). Local control and survival is comparable; however, the impact of these different treatments on facial deformation is still poorly understood. This study aims to quantify facial deformation and investigates the differences in facial deformation between treatment modalities., Methods: Across four European and North American institutions, HNRMS survivors treated between 1990 and 2017, more than 2 years post treatment, had a 3D photograph taken. Using dense surface modeling, we computed facial signatures for each survivor to show facial deformation relative to 35 age-sex-ethnicity-matched controls. Additionally, we computed individual facial asymmetry., Findings: A total of 173 HNRMS survivors were included, survivors showed significantly reduced facial growth (p < .001) compared to healthy controls. Partitioned by tumor site, there was reduced facial growth in survivors with nonparameningeal primaries (p = .002), and parameningeal primaries (p ≤.001), but not for orbital primaries (p = .080) All patients were significantly more asymmetric than healthy controls, independent of treatment modality (p ≤ .001). There was significantly more facial deformation in orbital patients when comparing RT to AMORE (p = .046). In survivors with a parameningeal tumor, there was significantly less facial deformation in PT when compared to RT (p = .009) and Paris-method (p = .007)., Interpretation: When selecting optimal treatment, musculoskeletal facial outcomes are an expected difference between treatment options. These anticipated differences are currently based on clinicians' bias, expertise, and experience. These data supplement clinician judgment with an objective analysis highlighting the impact of patient age and tumor site between existing treatment options., (© 2023 The Authors. Pediatric Blood & Cancer published by Wiley Periodicals LLC.)
- Published
- 2023
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35. Image guidance and interfractional anatomical variation in paediatric abdominal radiotherapy.
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Taylor S, Lim P, Cantwell J, D'Souza D, Moinuddin S, Chang YC, Gaze MN, Gains J, and Veiga C
- Subjects
- Humans, Child, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted methods, Abdomen diagnostic imaging, Cone-Beam Computed Tomography methods, Radiotherapy, Image-Guided methods
- Abstract
Objectives: To identify variables predicting interfractional anatomical variations measured with cone-beam CT (CBCT) throughout abdominal paediatric radiotherapy, and to assess the potential of surface-guided radiotherapy (SGRT) to monitor these changes., Methods: Metrics of variation in gastrointestinal (GI) gas volume and separation of the body contour and abdominal wall were calculated from 21 planning CTs and 77 weekly CBCTs for 21 abdominal neuroblastoma patients (median 4 years, range: 2 - 19 years). Age, sex, feeding tubes, and general anaesthesia (GA) were explored as predictive variables for anatomical variation. Furthermore, GI gas variation was correlated with changes in body and abdominal wall separation, as well as simulated SGRT metrics of translational and rotational corrections between CT/CBCT., Results: GI gas volumes varied 74 ± 54 ml across all scans, while body and abdominal wall separation varied 2.0 ± 0.7 mm and 4.1 ± 1.5 mm from planning, respectively. Patients < 3.5 years ( p = 0.04) and treated under GA ( p < 0.01) experienced greater GI gas variation; GA was the strongest predictor in multivariate analysis ( p < 0.01). Absence of feeding tubes was linked to greater body contour variation ( p = 0.03). GI gas variation correlated with body ( R = 0.53) and abdominal wall ( R = 0.63) changes. The strongest correlations with SGRT metrics were found for anterior-posterior translation ( R = 0.65) and rotation of the left-right axis ( R = -0.36)., Conclusions: Young age, GA, and absence of feeding tubes were linked to stronger interfractional anatomical variation and are likely indicative of patients benefiting from adaptive/robust planning pathways. Our data suggest a role for SGRT to inform the need for CBCT at each treatment fraction in this patient group., Advances in Knowledge: This is the first study to suggest the potential role of SGRT for the management of internal interfractional anatomical variation in paediatric abdominal radiotherapy.
- Published
- 2023
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36. Deep learning based synthetic CT from cone beam CT generation for abdominal paediatric radiotherapy.
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Szmul A, Taylor S, Lim P, Cantwell J, Moreira I, Zhang Y, D'Souza D, Moinuddin S, Gaze MN, Gains J, and Veiga C
- Subjects
- Humans, Child, Image Processing, Computer-Assisted methods, Tomography, X-Ray Computed, Cone-Beam Computed Tomography methods, Radiotherapy Planning, Computer-Assisted methods, Abdomen, Deep Learning
- Abstract
Objective . Adaptive radiotherapy workflows require images with the quality of computed tomography (CT) for re-calculation and re-optimisation of radiation doses. In this work we aim to improve the quality of on-board cone beam CT (CBCT) images for dose calculation using deep learning. Approach . We propose a novel framework for CBCT-to-CT synthesis using cycle-consistent Generative Adversarial Networks (cycleGANs). The framework was tailored for paediatric abdominal patients, a challenging application due to the inter-fractional variability in bowel filling and small patient numbers. We introduced to the networks the concept of global residuals only learning and modified the cycleGAN loss function to explicitly promote structural consistency between source and synthetic images. Finally, to compensate for the anatomical variability and address the difficulties in collecting large datasets in the paediatric population, we applied a smart 2D slice selection based on the common field-of-view (abdomen) to our imaging dataset. This acted as a weakly paired data approach that allowed us to take advantage of scans from patients treated for a variety of malignancies (thoracic-abdominal-pelvic) for training purposes. We first optimised the proposed framework and benchmarked its performance on a development dataset. Later, a comprehensive quantitative evaluation was performed on an unseen dataset, which included calculating global image similarity metrics, segmentation-based measures and proton therapy-specific metrics. Main results . We found improved performance for our proposed method, compared to a baseline cycleGAN implementation, on image-similarity metrics such as Mean Absolute Error calculated for a matched virtual CT (55.0 ± 16.6 HU proposed versus 58.9 ± 16.8 HU baseline). There was also a higher level of structural agreement for gastrointestinal gas between source and synthetic images measured using the dice similarity coefficient (0.872 ± 0.053 proposed versus 0.846 ± 0.052 baseline). Differences found in water-equivalent thickness metrics were also smaller for our method (3.3 ± 2.4% proposed versus 3.7 ± 2.8% baseline). Significance . Our findings indicate that our innovations to the cycleGAN framework improved the quality and structure consistency of the synthetic CTs generated., (Creative Commons Attribution license.)
- Published
- 2023
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37. Developments in the Surgical Approach to Staging and Resection of Rhabdomyosarcoma.
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Terwisscha van Scheltinga S, Rogers T, Smeulders N, deCorti F, Guerin F, Craigie R, Burrieza GG, Smeele L, Hol M, van Rijn R, Fuchs J, Seitz G, Schmidt A, Timmermann B, Tunn PU, Chargari C, Dávila Fajardo R, Slater O, Gains J, and Merks H
- Abstract
Although survival after rhabdosarcoma treatment has improved over the years, one third of patients still develop locoregional relapse. This review aims to highlight developments pertaining to staging and local treatment of specific RMS tumor sites, including head and neck, chest/trunk, bladder-prostate, female genito-urinary, perianal, and extremity sites.
- Published
- 2023
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38. Experiences and barriers to accessing mental health support in mothers of children with a disability.
- Author
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Gilson KM, Davis E, Gains J, Brunton S, Williams K, and Reddihough D
- Subjects
- Child, Female, Humans, Mental Health, Mothers, Qualitative Research, Social Stigma, Mental Disorders therapy, Mental Health Services
- Abstract
Background: Despite evidence for high levels of mental health problems in mothers of children with a disability and the potential impact on caring for their child, very little is known about mothers' experience in accessing professional mental health support. This study aimed to explore mothers' views and experience on seeking help for their mental health., Methods: Semi-structured interviews were conducted with 25 mothers of children with a disability. Thematic analysis was completed., Results: Mothers experienced significant barriers when accesing support at the personal, professional and system level. Personal barriers included the need for competency and stigma about mental illness: professional barriers included the lack of discussions about mental health and interpersonal factors that hindered disclosure. System barriers included feeling invisible to the health services, paediatric care focusing on the child rather than the family and limitations to the type of mental health support available., Conclusion: Mothers perceive substantial barriers in accessing support for their mental health. It is important that strategies are designed so the importance of mentally healthy mothers is understood and to normalize a need for assistance when you are the mother of a child with additional support needs. Strategies are also needed to encourage mothers to seek help and to assist professionals having discussions about maternal wellbeing. Improvements are also required in the accessibility of service supports., (© 2021 John Wiley & Sons Ltd.)
- Published
- 2021
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39. Risk of radiation-induced second malignant neoplasms from photon and proton radiotherapy in paediatric abdominal neuroblastoma.
- Author
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Taylor S, Lim P, Ahmad R, Alhadi A, Harris W, Rompokos V, D'Souza D, Gaze M, Gains J, and Veiga C
- Abstract
Background and Purpose: State-of-the-art radiotherapy modalities have the potential of reducing late effects of treatment in childhood cancer survivors. Our aim was to investigate the carcinogenic risk associated with 3D conformal (photon) radiation (3D-CRT), intensity modulated arc therapy (IMAT) and pencil beam scanning proton therapy (PBS-PT) in the treatment of paediatric abdominal neuroblastoma., Materials and Methods: The risk of radiation-induced second malignant neoplasm (SMN) was estimated using the concept of organ equivalent dose (OED) for eleven organs (lungs, rectum, colon, stomach, small intestine, liver, bladder, skin, central nervous system (CNS), bone, and soft tissues). The risk ratio (RR) between radiotherapy modalities and lifetime absolute risks (LAR) were reported for twenty abdominal neuroblastoma patients (median, 4y; range, 1-9y) historically treated with 3D-CRT that were also retrospectively replanned for IMAT and PBS-PT., Results: The risk of SMN due to primary radiation was reduced in PBS-PT against 3D-CRT and IMAT for most patients and organs. The RR across all organs ranged from 0.38 ± 0.22 (bladder) to 0.98 ± 0.04 (CNS) between PBS-PT and IMAT, and 0.12 ± 0.06 (rectum and bladder) to 1.06 ± 0.43 (bone) between PBS-PT and 3D-CRT. The LAR for most organs was within 0.01-1% (except the colon) with a cumulative risk of 21 ± 13%, 35 ± 14% and 35 ± 16% for PBS-PT, IMAT and 3D-CRT, respectively., Conclusions: PBS-PT was associated with the lowest risk of radiation-induced SMN compared to IMAT and 3D-CRT in abdominal neuroblastoma treatment. Other clinical endpoints and plan robustness should also be considered for optimal plan selection., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2021 The Author(s).)
- Published
- 2021
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40. Predicting outcome in childhood diffuse midline gliomas using magnetic resonance imaging based texture analysis.
- Author
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Szychot E, Youssef A, Ganeshan B, Endozo R, Hyare H, Gains J, Mankad K, and Shankar A
- Subjects
- Child, Diffusion Magnetic Resonance Imaging, Humans, Magnetic Resonance Imaging, Retrospective Studies, Brain Stem Neoplasms, Glioma diagnostic imaging
- Abstract
Background: Diffuse midline gliomas (DMG) are aggressive brain tumours, previously known as diffuse intrinsic pontine gliomas (DIPG), with 10% overall survival (OS) at 18 months. Predicting OS will help refine treatment strategy in this patient group. MRI based texture analysis (MRTA) is novel image analysis technique that provides objective information about spatial arrangement of MRI signal intensity (heterogeneity) and has potential to be imaging biomarker., Objectives: To investigate MRTA in predicting OS in childhood DMG., Methods: Retrospective study of patients diagnosed with DMG, based on radiological features, treated at our institution 2007-2017. MRIs were acquired at diagnosis and 6 weeks after radiotherapy (54Gy in 30 fractions). MRTA was performed using commercial available TexRAD research software on T2W sequence and Apparent Diffusion Coefficient (ADC) maps encapsulating tumour in the largest single axial plane. MRTA comprised filtration-histogram technique using statistical and histogram metrics for quantification of texture. Kaplan-Meier survival analysis determined association of MRI texture parameters with OS., Results: In all, 32 children 2-14 years (median 7 years) were included. MRTA was undertaken on T2W (n=32) and ADC (n=22). T2W-MRTA parameters were better at prognosticating than ADC-MRTA. Children with homogenous tumour texture, at medium scale on diagnostic T2W MRI, had worse prognosis (Mean of Positive Pixels (MPP): P=0.005, mean: P=0.009, SD: P=0.011, kurtosis: P=0.037, entropy: P=0.042). Best predictor MPP was able to stratify patients into poor and good prognostic groups with median survival of 7.5 months versus 17.5 months, respectively., Conclusions: DMG with more homogeneous texture on diagnostic MRI is associated with worse prognosis. Texture parameter MPP is the most predictive marker of OS in childhood DMG., (Copyright © 2020. Published by Elsevier Masson SAS.)
- Published
- 2021
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41. Atlas construction and spatial normalisation to facilitate radiation-induced late effects research in childhood cancer.
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Veiga C, Lim P, Anaya VM, Chandy E, Ahmad R, D'Souza D, Gaze M, Moinuddin S, and Gains J
- Subjects
- Algorithms, Child, Humans, Pelvis, Tomography, X-Ray Computed, Neoplasms diagnostic imaging, Neoplasms radiotherapy, Radiotherapy Planning, Computer-Assisted
- Abstract
Reducing radiation-induced side effects is one of the most important challenges in paediatric cancer treatment. Recently, there has been growing interest in using spatial normalisation to enable voxel-based analysis of radiation-induced toxicities in a variety of patient groups. The need to consider three-dimensional distribution of doses, rather than dose-volume histograms, is desirable but not yet explored in paediatric populations. In this paper, we investigate the feasibility of atlas construction and spatial normalisation in paediatric radiotherapy. We used planning computed tomography (CT) scans from twenty paediatric patients historically treated with craniospinal irradiation to generate a template CT that is suitable for spatial normalisation. This childhood cancer population representative template was constructed using groupwise image registration. An independent set of 53 subjects from a variety of childhood malignancies was then used to assess the quality of the propagation of new subjects to this common reference space using deformable image registration (i.e. spatial normalisation). The method was evaluated in terms of overall image similarity metrics, contour similarity and preservation of dose-volume properties. After spatial normalisation, we report a dice similarity coefficient of 0.95 ± 0.05, 0.85 ± 0.04, 0.96 ± 0.01, 0.91 ± 0.03, 0.83 ± 0.06 and 0.65 ± 0.16 for brain and spinal canal, ocular globes, lungs, liver, kidneys and bladder. We then demonstrated the potential advantages of an atlas-based approach to study the risk of second malignant neoplasms after radiotherapy. Our findings indicate satisfactory mapping between a heterogeneous group of patients and the template CT. The poorest performance was for organs in the abdominal and pelvic region, likely due to respiratory and physiological motion and to the highly deformable nature of abdominal organs. More specialised algorithms should be explored in the future to improve mapping in these regions. This study is the first step toward voxel-based analysis in radiation-induced toxicities following paediatric radiotherapy., (Creative Commons Attribution license.)
- Published
- 2021
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42. Pencil Beam Scanning Proton Therapy Case Selection for Paediatric Abdominal Neuroblastoma: Effects of Tumour Location and Bowel Gas.
- Author
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Lim PS, Rompokos V, Bizzocchi N, Gillies C, Gosling A, Royle G, Chang YC, Gaze MN, and Gains JE
- Subjects
- Child, Colon, Humans, Organs at Risk, Radiotherapy Dosage, Radiotherapy Planning, Computer-Assisted, Neuroblastoma diagnostic imaging, Neuroblastoma radiotherapy, Proton Therapy, Radiotherapy, Intensity-Modulated
- Abstract
Aims: Pencil beam scanning (PBS) proton therapy is an increasingly used radiation modality for childhood malignancies due to its ability to minimise dose to surrounding organs. However, the dosimetry is extremely sensitive to anatomical and density changes. The aims of this study were to investigate if there is a dosimetric benefit or detriment with PBS for paediatric abdominal neuroblastoma, assess gastrointestinal air variability and its dosimetric consequences, plus identify if there are factors that could assist case selection for PBS referral., Materials and Methods: Twenty neuroblastoma cases were double-planned with PBS and intensity-modulated arc therapy (IMAT). Cases were divided into unilateral, midline unilateral and midline bilateral locations in relation to the kidneys. Plans were recalculated after the gastrointestinal volume was simulated as air (Hounsfield Units -700) and water (Hounsfield Units 0), then compared with nominal plans (recalculated - nominal, ΔD). Forty-three weekly cone beam computed tomography scans were analysed to quantify gastrointestinal air variability during treatment., Results: PBS reduced the mean dose to normal tissues at all tumour locations, particularly unilateral tumours. However, 15% had better dosimetry with IMAT, all of which were midline tumours. Increased gastrointestinal air caused significant compromises to PBS versus IMAT plans for midline tumours [median/maximum ΔD95% clinical target volume (CTV) -2.4%/-15.7% PBS versus 1.4%/0% IMAT, P = 0.003], whereas minimal impact was observed for unilateral tumours (ΔD95% CTV -0.5%/-1.9% PBS versus 0.5%/-0.5% IMAT, P = 0.008). D95% CTV was significantly decreased in PBS plans if planning target volume (PTV) ≥400 cm
3 (median -4.1%, P = 0.001) or PTV extension ≥60% anterior to vertebral body (-2.1%, P = 0.002). A larger variation in gastrointestinal air was observed in patients treated under general anaesthesia (median 38.4%) versus awake (11.5%); P = 0.004., Conclusion: In this planning study, tumours at the unilateral location consistently showed improved dose reductions to normal tissue with minimal dose degradation from increased gastrointestinal air with PBS plans. Tumour location, PTV volume and anterior extension of PTV are useful characteristics in facilitating patient selection for PBS., (Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)- Published
- 2021
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43. Spectrum of neuroimaging findings post-proton beam therapy in a large pediatric cohort.
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Bhattacharya D, Chhabda S, Lakshmanan R, Tan R, Warne R, Benenati M, Michalski A, Aquilina K, Jacques T, Hargrave D, Chang YC, Gains J, and Mankad K
- Subjects
- Child, Cohort Studies, Humans, Neuroimaging, Retrospective Studies, Brain Neoplasms diagnostic imaging, Brain Neoplasms radiotherapy, Proton Therapy adverse effects
- Abstract
Purpose: Proton beam therapy (PBT) is now well established for the treatment of certain pediatric brain tumors. The intrinsic properties of PBT are known to reduce long-term negative effects of photon radiotherapy (PRT). To better understand the intracranial effects of PBT, we analyzed the longitudinal imaging changes in a cohort of children with brain tumors treated by PBT with clinical and radiotherapy dose correlations., Materials and Methods: Retrospective imaging review of 46 patients from our hospital with brain tumors treated by PBT. The imaging findings were correlated with clinical and dose parameters., Results: Imaging changes were assessed by reviewing serial magnetic resonance imaging (MRI) scans following PBT over a follow-up period ranging from 1 month to 7 years. Imaging changes were observed in 23 patients undergoing PBT and categorized as pseudoprogression (10 patients, 43%), white matter changes (6 patients, 23%), parenchymal atrophy (6 patients, 23%), and cerebral large vessel arteriopathy (5 patients, 25%). Three patients had more than one type of imaging change. Clinical symptoms attributable to PBT were observed in 13 (28%) patients., Conclusion: In accordance with published literature, we found evidence of varied intracranial imaging changes in pediatric brain tumor patients treated with PBT. There was a higher incidence (10%) of large vessel cerebral arteriopathy in our cohort than previously described in the literature. Twenty-eight percent of patients had clinical sequelae as a result of these changes, particularly in the large vessel arteriopathy subgroup, arguing the need for angiographic and perfusion surveillance to pre-empt any morbidities and offer potential neuro-protection.
- Published
- 2021
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44. Paediatric Molecular Radiotherapy: Challenges and Opportunities.
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Aldridge MD, Peet C, Wan S, Shankar A, Gains JE, Bomanji JB, and Gaze MN
- Subjects
- Breast Neoplasms, Child, Female, Humans, Iodine Radioisotopes, Radiometry, Radiotherapy, Adjuvant, Thyroid Neoplasms radiotherapy
- Abstract
The common contemporary indications for paediatric molecular radiotherapy (pMRT) are differentiated thyroid cancer and neuroblastoma. It may also have value in neuroendocrine cancers, and it is being investigated in clinical trials for other diseases. pMRT is the prototypical biomarker-driven, precision therapy, with a unique mode of delivery and mechanism of action. It is safe and well tolerated, compared with other treatments. However, its full potential has not yet been achieved, and its wider use faces a number of challenges and obstacles. Paradoxically, the success of radioactive iodine as a curative treatment for metastatic thyroid cancer has led to a 'one size fits all' approach and limited academic enquiry into optimisation of the conventional treatment regimen, until very recently. Second, the specialised requirements for the delivery of pMRT are available in only a very limited number of centres. This limited capacity and geographical coverage results in reduced accessibility. With few enthusiastic advocates for this treatment modality, investment in research to improve treatments and broaden indications from both industry and national and charitable research funders has historically been suboptimal. Nonetheless, there is now an increasing interest in the opportunities offered by pMRT. Increased research funding has been allocated, and technical developments that will permit innovative approaches in pMRT are available for exploration. A new portfolio of clinical trials is being assembled. These studies should help to move at least some paediatric treatments from simply palliative use into potentially curative protocols. Therapeutic strategies require modification and optimisation to achieve this. The delivery should be personalised and tailored appropriately, with a comprehensive evaluation of tumour and organ-at-risk dosimetry, in alignment with the external beam model of radiotherapy. This article gives an overview of the current status of pMRT, indicating the barriers to progress and identifying ways in which these may be overcome., (Copyright © 2020 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2021
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45. The Evidence for External Beam Radiotherapy in High-Risk Neuroblastoma of Childhood: A Systematic Review.
- Author
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Arumugam S, Manning-Cork NJ, Gains JE, Boterberg T, and Gaze MN
- Subjects
- Child, Humans, Prospective Studies, Treatment Outcome, Neuroblastoma radiotherapy, Radiotherapy methods
- Abstract
Aims: External beam radiotherapy is widely used in various ways in the management of neuroblastoma. Despite extensive clinical experience, the precise role of radiotherapy in neuroblastoma remains unclear. The purpose of this systematic review was to survey the published literature to identify, without bias, the evidence for the clinical effectiveness of external beam radiotherapy as part of the initial multimodality treatment of high-risk neuroblastoma. We considered four areas: treatment of the tumour bed and residual primary tumour, identification of any dose-response relationship, treatment of metastatic sites, identification of any technical advances that may be beneficial. We also aimed to define uncertainties, which may be clarified in future clinical trials., Materials and Methods: Bibliographic databases were searched for neuroblastoma and radiotherapy. Reviewers assessed 1283 papers for inclusion by title and abstract, with consensus achieved through discussion. Data extraction on 57 included papers was carried out by one reviewer and checked by another. Studies were assessed for their level of evidence and risk of bias, and a descriptive analysis of data was carried out., Results: Fifteen papers provided some evidence that radiotherapy to the tumour bed and residual tumour may possibly be of value. However, there is a significant risk of bias and no evidence that all subgroups will benefit. There is some suggestion from six papers that dose may be important, but no hard evidence. It remains unclear whether irradiation of metastatic sites is helpful. Technical advances may be of value in radiotherapy of high-risk neuroblastoma., Conclusions: There are data that show that radiotherapy is of some efficacy in the management of high-risk neuroblastoma, but there is no level one evidence that shows that it is being used in the best possible way. Prospective randomised trials are necessary to provide more evidence to guide development of optimal radiotherapy treatment schedules., (Copyright © 2018 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2019
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46. Optimization of molecular radiotherapy with [131I]-meta Iodobenzylguanidine for high-risk neuroblastoma.
- Author
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Gaze MN, Gains JE, Walker C, and Bomanji JB
- Subjects
- Clinical Trials as Topic, Dose-Response Relationship, Drug, Dose-Response Relationship, Radiation, Humans, Iodine Radioisotopes therapeutic use, Medical Oncology methods, Radiation-Sensitizing Agents therapeutic use, Radiometry methods, Radionuclide Imaging methods, Radiopharmaceuticals therapeutic use, Risk, Time Factors, Treatment Outcome, 3-Iodobenzylguanidine therapeutic use, Central Nervous System Neoplasms diagnostic imaging, Central Nervous System Neoplasms radiotherapy, Neuroblastoma diagnostic imaging, Neuroblastoma radiotherapy, Radiotherapy methods
- Abstract
Molecular radiotherapy with [131I]-meta Iodobenzylguanidine ([131I]-mIBG) for neuroblastoma has been in clinical use for nearly 30 years. In this time, its role has changed from being an exclusively palliative treatment to one where the intent of treatment is often curative. To achieve this, the treatment has been brought forward from the relapse setting, to the beginning as induction therapy, as a possibility for salvage of those with chemo-refractory disease or as part of consolidation schedules. With the routine use of hemopoietic support, higher than previously standard administered activities are now commonly used. Other attempts to improve outcomes include the concomitant use of chemotherapy and radiation sensitisers and novel formulations such as no-carrier added [131I]-mIBG. Unfortunately, none of these strategies has been evaluated in a randomized controlled trial, so whether the theoretical benefits of these innovative approaches are seen clinically remains a matter of conjecture. Despite the prevalent belief in using higher administered activities, dosimetry has been under-used, hampering the ability to detect the benefit of this strategy. To properly evaluate concepts aiming at the optimisation of molecular radiotherapy with [131I]-mIBG for high-risk neuroblastoma, careful dosimetry in well-designed randomized clinical trials is essential. Only in this way will it be possible for [131I]-mIBG to be used to its best advantage in the complex multimodality treatment schedules required for high-risk neuroblastoma.
- Published
- 2013
47. Ten challenges in the management of neuroblastoma.
- Author
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Gains J, Mandeville H, Cork N, Brock P, and Gaze M
- Subjects
- Adolescent, Age Factors, Antineoplastic Agents adverse effects, Antineoplastic Agents therapeutic use, Central Nervous System Neoplasms pathology, Central Nervous System Neoplasms therapy, Child, Child, Preschool, Combined Modality Therapy, Humans, Immunotherapy methods, Neoplasm Staging, Neuroblastoma epidemiology, Neuroblastoma mortality, Neutropenia etiology, Prognosis, Radiotherapy methods, Rare Diseases, Survival Rate, Treatment Outcome, Neuroblastoma pathology, Neuroblastoma therapy
- Abstract
Neuroblastoma is a complex disease with many contradictions and challenges. It is, by and large, a cancer of babies and preschool children, but it does occur, albeit increasingly rarely, in older children, adolescents and young adults. The prognosis is very variable, with outcome related to age, stage and molecular pathology. Neuroblastoma may behave in an almost benign way, with spontaneous regression in some infants, but the majority of older patients have high-risk disease, which is usually fatal, despite best current treatments. As a rare disease, international collaboration is essential to run clinical trials of adequate statistical power to answer important questions in a reasonable time frame. High-risk disease requires multimodality therapy including chemotherapy, surgery and radiotherapy as well as biological and immunological treatments for optimal outcomes. Innovative treatment approaches, sometimes associated with appreciable toxicity, offer hope for the future but, despite parental wishes, cannot be generally implemented without adequate assessment in clinical trials.
- Published
- 2012
- Full Text
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