Browsing by Author "Martell, Kevin"
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- ItemOpen AccessCatheter Placement Optimization using Hybrid Inverse Planning and Optimization for Focal High Dose Rate Brachytherapy in Patients with Pubic Arch Interference(2021-09-20) Martinez Fernandez, Pedro Enrique; Thind, Kundan; Meyer, Tyler; Martell, Kevin; McGeachy, Philip; Morrison, HaliPositive clinical outcomes are well correlated with an increase in dose delivered to the Dominant Intraprostatic Lesion (DIL) in prostate cancer radiotherapy treatments. The DIL represents a concentration of high-grade cancerous tissue and is the most common site of prostate cancer recurrence. One of the most promising tools to achieve dose escalation is via focal High Dose Rate Brachytherapy (FHDR-BT). Traditionally, HDR-BT is used along with External Beam Radiotherapy (EBRT) to deliver a whole prostate boost for unfavourable intermediate and high-risk patients or as a monotherapy alternative for low, very low, and favourable intermediate patients. However, with the introduction of new imaging techniques such as multiparametric Magnetic Resonance Imaging (mp-MRI), there is the potential to further escalate the dose to the DIL. Currently, there is limited information on the impact of Pubic Arch Interference (PAI) in dose escalation therapies such as FHDR-BT. In this work, we use Hybrid Inverse Planning and Optimization (HIPO) to simulate the planning of clinically representative scenarios built using a cohort of patients with Pubic Arch Interference (PAI), previously treated at our institution. We simulate varying levels of PAI by changing the location of the DIL. In addition, we also test the capability of HIPO to create clinically satisfactory plans under challenging anatomical conditions of PAI and prostate size. The results presented in this investigation show that HIPO can be used as an effective tool for dose escalation to the DIL in patients with PAI.
- ItemOpen AccessManagement delays in patients with squamous cell cancer of neck node(s) and unknown primary site: a retrospective cohort study(2017-05-08) Martell, Kevin; Mackenzie, Joanna; Kerney, Warren; Lau, Harold YAbstract Background We aim to characterize the workup received by and identify any delays to diagnosis or treatment in patients referred to a tertiary cancer centre with the diagnosis of squamous cell carcinoma in neck node(s) and no identifiable primary (SCCNIP). Methods Over 1 year, 68 patients were initially referred to the Head and Neck clinic with a label of “primary unknown”. After extensive workup, 29 of the 68 patients were found to have pathologically confirmed SCCNIP. For these 29 patients, imaging tests, biopsies, examinations and times to treatment were reviewed and compared to 145 patients referred for known primaries. Results In 21/29 (72%) patients, ultrasound was ordered prior to biopsy or referral. After referral, the first imaging test used was CT neck in 28 patients and PET/CT in 1 patient. Median time from referral to primary identification (n = 23) or workup completion (n = 6) were 16 (range: 0-48) and 36 (17-82) days respectively. Median time from referral to treatment was 55 (27-90; n = 26) days and was longer than those referred for known primaries (48 days; 20-162; p < 0.001). Across all patients, median time between first diagnostic imaging test and pathologic diagnosis were 20.5 and -8.0 days (p < 0.0001) in patients receiving ultrasound and CT, respectively. Conclusions In our cohort, delays to management were linked to community use of ultrasound and scheduling of both CT and PET/CT after thorough head and neck examination in patients with SCCNIP.