Recent Student Peer-Reviewed Publications

Gram VR, Gram D, Persson GF, Suppli MH, Barrett S Reduction of oesophageal toxicity with VMAT dose-sparing radiotherapy in thoracic metastatic spinal cord compression: A feasibility study. Tech Innov Patient Support Radiat Oncol. 2022 Jul 16;23:8-14.

The purpose of this dosimetric study was to establish the feasibility and potential benefits of dose sparing of the oesophagus. 30 patients receiving radiotherapy of 30 Gy/10# for MSCC were retrospectively included and the oesophagus delineated. Two new dose plans were created for each patient (eso-crop and PTV-crop) with the intention of optimising the oesophageal dose. The mean achievable oesophageal dose reduction was 29.1% and 50.4% for the eso-crop and PTV crop plans, respectively. This study demonstrated the possibility of significant dose sparing of the oesophageal dose using single arc VMAT without impacting on CTV coverage.

Naidoo W, Leech Feasibility of surface guided radiotherapy for patient positioning in breast radiotherapy versus conventional tattoo-based setups- a systematic review. Tech Innov Patient Support Radiat Oncol. 2022 Apr 16;22:39-49.

Surface guided radiotherapy (SGRT) enables improvements in the accuracy and reproducibility of patient isocentric and postural alignment, enhanced efficiency, and safety in breast radiotherapy. he aim of this review was to compare the accuracy and reproducibility of SGRT to conventional tattoo-based setups in free-breathing breast radiotherapy and to determine if SGRT can reduce the frequency of routine image guided radiotherapy (IGRT). A review of 13 full papers suggests SGRT improves the accuracy and reproducibility of patient setup in breast radiotherapy with consistent reductions in the residual errors. The reliance on tattoos in breast radiotherapy are likely to become obsolete with positive implications for both patients and clinical practice.

Skelly A, O'Donovan A. Recognizing Frailty in Radiation Oncology Clinical Practice: Current Evidence and Future Directions.

Semin Radiat Oncol. 2022 Apr;32(2):115-124.

In this review, the current scientific evidence regarding screening tools and that have been tested in radiation oncology are described, as well as how they have been combined (or not) with CGA. 

Clarke E, Eriksen JG, Barrett S. The effects of PD-1/PD-L1 checkpoint inhibitors on recurrent/metastatic head and neck squamous cell carcinoma: a critical review of the literature and meta-analysis.

Acta Oncol. 2021 Nov;60(11):1534-1542.

This study tested the hypothesis that immunotherapy improves treatment outcomes for R/M HNSCC patients.  Thirteen studies (n = 1798) were included. Based on the observed safety and efficacy, this work concluded that PD-1/PD-L1 inhibitors significantly prolonged survival and reduced toxicity compared to the standard of care, however further randomised trials are needed to investigate their role in HNSCC.

Barry R, Forde E, Barrett S. Improving organ at risk sparing in oropharyngeal treatment planning by increasing target dose heterogeneity: A feasibility study.

Med Dosim. 2021 Autumn;46(3):304-309.

This study sought to determine the feasibility of allowing an increase in target dose heterogeneity in oropharyngeal VMAT plans, and to examine the dosimetric impact this has on target coverage and OARs such as the parotid glands, spinal cord, brainstem and mandible. Nineteen oropharyngeal patients' plans were created with homogeneous dose distributions specified in the London Cancer Head and Neck Radiotherapy Protocol.  The OAR sparing effect was promising for most organs, however further research with a larger dataset is necessary surrounding the effect on organs that overlap with the PTV.

Zhang B and Leech M.  A review of stereotactic body radiation therapy in the management of oligometastatic prostate cancer.  Anticancer Research. 2020. 40(5): 2419-2428.

This article reviews the current management of oligometastatic prostate cancer with stereotactic body radiation therapy.  From 14 SBRT-specific studies, the progression free survival was reported as being between 7.36 and 24 months.  Median ADT-free survival was 12.3-39.7 months and local control rate varied with some reports of 100% at 6 months and others of 92% at 5 years.  Although the local control rate is excellent compared to standard care therapies, the PFS rate is significantly inferior to standard of care therapies.

Yeo Li Wen and Leech M. Review of the role of radiomics in tumour risk classification and prognosis of cancer.  Anticancer Research 2020.  In press.

Radiomics, an emerging field in radiation therapy, is hypothesised to improve classification of tumour risk and prognosis. Despite encouraging results, there are issues of practicality and interpretation of radiomic data. This study investigates the emerging role of radiomics in tumour risk classification and prognosis of breast and prostate cancer. A literature search was conducted using predefined terms to retrieve studies related to radiomics. Studies were evaluated and selected upon meeting the criteria defined. A total of 19 relevant publications were selected from 63 publications identified. Data from studies revealed significant area under the curve (AUC) values and high discriminative power. Significant AUC values for biochemical recurrence of disease and disease-free survival were reported for prognosis. Radiomics show promising potential in discriminating tumour risk and predicting prognosis of cancer using specified features. It is an alternative to conventional predictive tools and has the ability to improve with the use of existing tools

Shane Minogue, Charles Gillham, Maeve Kearney, Laura Mullaney, Intravenous contrast media in radiation therapy planning computed tomography scans-Current practice in Ireland. Technical Innovations & Patient Support in Radiation Oncology. 2019. 12:3 – 15.

The study aims to examine the patterns of practice in relation to the use of IVC in RT planning scans in Ireland and to determine the level of compliance with international guidelines. Radiation Therapists (RTT) IVC training will also be investigated.

Ní Fhoghlú M., Barrett S., A review of Radiation Induced Lymphocyte Apoptosis as a predictor of late toxicity following breast radiotherapy, Journal of Medical Imaging and Radiation Sciences. 2019. 50(2): 337-344.
This review summarises the evidence around the use of RILA (Radiation-induced lymphocyte apoptosis) as a biomarker assay to predict breast cancer patients at higher risk of developing late toxicity, particularly fibrosis.
The current evidence indicates it is an effective biomarker, but other confounding factors need to be considered before clinical implementation.

Mangan S and Leech M.  Proton therapy-the modality of choice for future radiation therapy management of prostate cancer?  Technical Innovations and Patient Support in Radiation Oncology. 2019. 11:1-13.

This article reviews the current evidence for the management of prostate cancer with proton therapy.  With the expansion of proton therapy facilities throughout Europe, maximising its impact in specific cancer sites is timely.  This review found that proton therapy, despite its improve dosimetry, does not translate to improved GI/GU toxicities for patients and that it is not a cost effective option for all prostate cancer patients.

Orlaith Lynch, Anita O'Donovan, Patrick Murphy, Addressing treatment-related sexual side effects among cancer patients: Sub-optimal practice in radiation therapy, European Journal of Cancer Care, 2019 (in press). http://dx.doi.org/10.1111/ecc.13006

Sexual side effects of treatment are common among cancer patients receiving radiation therapy. Little attention has been given to the role of radiation therapists (RTs) in managing sexual issues. The current study sought to address this by assessing the provision of care for sexual issues by RTs in Ireland.

Wong Yuzhen N., Barrett S., A review of automatic lung tumour segmentation in the era of 4DCT, Reports of Practical Oncology & Radiotherapy, 2019, 24 (2) 208-220, https://doi.org/10.1016/j.rpor.2019.01.003

Manual delineation of lung tumour on 4DCT has been the gold standard in clinical practice. However, it is resource intensive due to the high volume of data which results in longer contouring duration and uncertainties in defining target. Auto-contouring may present as an attractive alternative by decreasing manual inputs required, thus improving the contouring process. This review aims to assess the accuracy, variability and contouring duration of automatic contouring compared with manual contouring in lung cancer on 4DCT datasets.

Flood, J., O’Hanlon, S., Gibb, M. and O’Donovan, A. Caring for patients with dementia undergoing radiation therapy – a national audit, Journal of Geriatric Oncology, 2019 (Accepted).

The number of people with dementia is increasing in conjunction with the rapid growth of the older population in many countries worldwide. More people with dementia will also be diagnosed with cancer and may require radiotherapy at some stage of their disease trajectory.

It is therefore necessary that care is taken to ensure that the Radiation Therapy (RT) department practice environment is optimised to deal with people with dementia, in order to limit distress whenever practically possible.

The primary aim of this national audit was to investigate Irish radiation therapy departments, with regard to dementia care in the areas of the department environment, clinical practice and staff training.

Ní Fhoghlú M., Barrett S., A review of Radiation Induced Lymphocyte Apoptosis as a predictor of late toxicity following breast radiotherapy, Journal of Medical Imaging and Radiation Sciences, 2019 (Accepted).

Radiation induced lymphocyte apoptosis (RILA), a predictive assay, could offer a novel approach in in predicting patients at a higher risk of developing this late toxicity and therefore improving informed decision making. This review investigates RILA as a predictor of late breast fibrosis following radiotherapy.

Frewen H, Brown E, Jenkins M, O'Donovan A., Failure mode and effects analysis in a paperless radiotherapy department., Journal of medical imaging and radiation oncology, 2018 Oct;62(5):707-15. http://dx.doi.org/10.1111/1754-9485.12762

The international move towards digital healthcare record keeping has seen an increase in the number of radiotherapy departments moving towards a paperless framework. With the recent transition to a paperless radiation oncology framework at the Princess Alexandra Hospital Brisbane, it was crucial to perform a prospective risk assessment to quantify the most significant sources of risk in the electronic environment.

Caulfield, S., Menezes, G., Marignol, L., Poole, C. Nomograms are key decision-making tools in prostate cancer radiation therapy, Urologic Oncology:Seminars and Original Investigations, 36, 2018, p283 - 292

The aim of the review was to discuss if nomograms can accurately predict tumour control and functional outcomes for prostate cancer patients following radiation therapy and brachytherapy.

Collins SD, Leech MM. A review of plan library approaches in adaptive radiotherapy of bladder cancer. Acta Oncologica. 2018; 3:1-8.
https://doi.org/10.1080/0284186X.2017.1420908 
Large variations in the shape and size of the bladder volume are commonly observed in bladder cancer radiotherapy (RT). The clinical target volume (CTV) is therefore frequently inadequately treated and large isotropic margins are inappropriate in terms of dose to organs at risk (OAR); thereby making adaptive radiotherapy (ART) attractive for this tumour site. There are various methods of ART delivery, however, for bladder cancer, plan libraries are frequently used. This review provides an update on the literature in this area.

Cvetkova J, O’Donovan T, Craig A, Mullaney L. Radiation therapists’ compliance to a palliative imaging protocol: a case report. Journal of Radiotherapy in Practice. 2018; Jan:1-4.
doi:10.1017/S1460396917000723 
Imaging protocols are implemented to identify and minimise set-up errors. A crucial component to the success of these protocols is staff compliance. This is case report describing a retrospective review of radiation therapists’ compliance to a palliative imaging protocol in a single large institution in one calendar year.

Percival C, Landy M, Poole C and Mullaney L, The role of Prophylactic Cranial Irradiation for Non- small Cell Lung Cancer, Anticancer Research 2018; 38 (1): 7 – 14
The use of prophylactic cranial irradiation (PCI) to treat brain metastases (BM) in non-small cell lung cancer (NSCLC) is restricted due to the potential associated toxicity and lack of survival benefit. BM can have a negative impact on neurocognitive function (NF) and quality of life (QOL). The aim of this review was to assess the impact of PCI on disease-specific and NF and QOL outcomes. 

Linney H and Barrett S, Stereotactic Body Radiation Therapy for Patients with Early-stage Prostate Cancer, Anticancer Research, 2018; 38, (3): 1231 – 1240
Stereotactic body radiation therapy (SBRT) is emerging as a new treatment option for early-stage prostate cancer, theoretically providing clinical and economic benefits compared to conventionally fractionated external-beam radiation therapy (CF-EBRT). This review aimed to evaluate available published data to determine if the proposed theoretical benefits translate clinically.

Leonard S, O'Donovan A. Measuring safety culture: Application of the Hospital Survey on Patient Safety Culture to radiation therapy departments worldwide. Practical radiation oncology. 2018;8(1):17-26.
https://doi.org/10.1016/j.prro.2017.08.005 
Minimizing errors and improving patient safety has gained prominence worldwide in high-risk disciplines such as radiation therapy. Patient safety culture has been identified as an important factor in reducing the incidence of adverse events and improving patient safety in the health care setting. The aim of this study was to distribute the Hospital Survey on Patient Safety Culture (HSPSC) to radiation therapy departments worldwide in order to assess the current status of safety culture, identify areas for improvement and areas that excel, examine factors that influence safety culture, and raise staff awareness.

Collery A and Forde E. Daily rectal DVH variation in prostate IMRT: Is it clinically significant in the era of image guidance? JMIRS. 2017; 48(4): 346-351 https://doi.org/10.1016/j.jmir.2017.04.003

Interfraction motion and variation in rectal volume during prostate radiotherapy may result in the rectum receiving a larger dose than predicted at treatment planning. This study aimed

to quantify the variation in daily rectal dose-volume histograms (DVHs) from the treatment plan and to discuss the potential clinical significance of this variation.

Lipsett A, Barrett S, Haruna F, Mustian K, O'Donovan A. The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: A systematic review and meta-analysis. Breast. 2017 Apr;32:144-155. 
doi: 10.1016/j.breast.2017.02.002. Epub 2017 Feb 9.
The aim of this study was to assess the effect of exercise (and different exercise prescription parameters) during adjuvant RT on fatigue among breast cancer patients. Quality of life was a secondary outcome. Nine studies (802 participants) were included. The meta-analysis revealed that exercise was statistically more effective at reducing fatigue than the control intervention. Therefore, exercise during adjuvant RT should be encouraged in breast cancer patients. 

Glynn A, Forde E, Marignol L, Focal therapy: A treatment option for localized prostate cancer? Advances in Modern Oncology Research 2017; 3(6): 244–260 
Therapeutic options for localised prostate cancer (PCa) include active surveillance or radical whole-gland therapy. Men with localised PCa and the physicians who advise them are posed with a difficult therapeutic dilemma: which one? The former requires intensive surveillance causing possible psychological distress. The latter maximises chance of cure but with near certainty of genitourinary toxicity. Focal therapy (FT) is a technique by which only the known disease is targeted while preserving normal tissue. Early reports of FT outcomes are encouraging; however apprehension still exists over its standardised use in localised PCa. This review discusses the evidence regarding the oncologic and functional outcomes of focal therapies for localised prostate cancer

Duffy O, Forde E, Leech M, The dilemma of parotid gland and pharyngeal constrictor muscles preservation-Is daily online image guidance required? A dosimetric analysis. Medical Dosimetry 2017; 42 (1): 24-30
https://doi.org/10.1016/j.meddos.2016.10.003 
With margin reduction common in head and neck radiotherapy, it is critical that the dosimetric effects of setup deviations are quantified. With past studies focusing on the quantification of positional and volumetric changes of organs at risk (OARs), this study aimed to measure the dose delivered to these the parotid gland (PG) and pharyngeal constrictor muscles (PCMs) using cone beam computed tomography (CBCT). Furthermore, this investigation sought to establish a potential time trend of change in dose delivered to target volumes secondary to ascertaining the need for daily image guidance (IG) to reduce the dose burden to these important OARs. 

Lawler G, Leech M. Dose Sparing Potential of Deep Inspiration Breath-hold Technique for Left Breast Cancer Radiotherapy Organs-at-risk. Anticancer research. 2017 ;37 (2):883-90.
The aim of this study is to assess if deep inspiration breath-hold (DIBH) technique achieved dose sparing for organs-at-risk in left breast radiotherapy patients in order to reduce long-term complications.

Moore A and Forde E, A Dosimetric Evaluation of Threshold Bladder Volumes for Prostate Cancer Radiotherapy, Journal of Medical Imaging and Radiation Sciences 2017:48(3):270-275
https://doi.org/10.1016/j.jmir.2017.03.003 
An interfraction variation in bladder filling results in uncertainties of dose received and also has workflow implications for busy departments. This study aims to examine the dosimetric impact of a reduced bladder volume while determining a suitable threshold for treatment.

Ho E. S. Q., Barrett S & Mullaney L, A review of dosimetric and toxicity modeling of proton versus photon craniospinal irradiation for pediatrics medulloblastoma, Acta Oncologica, 56, (8), 2017, p1031 – 1042
https://doi.org/10.1080/0284186X.2017.1324207 
Craniospinal irradiation (CSI) is the standard radiation therapy treatment for medulloblastoma. Conventional CSI photon therapy (Photon-CSI) delivers significant dose to surrounding normal tissue (NT). Research into pediatric CSI with proton therapy (Proton-CSI) has increased, with the aim of exploiting the potential to reduce NT dose and associated post-treatment complications. This review aims to compare treatment outcomes of pediatric medulloblastoma patients between Proton- and Photon-CSI treatments.

Dowling K, Barrett S, Mullaney L and Poole C, A nationwide investigation of radiation therapy event reporting-and- learning systems: Can standards be improved? Radiography 2017; 23 (4): 279 – 286
 https://doi.org/10.1016/j.radi.2017.06.004 
Variation exists between event reporting-and-learning systems utilised in radiation therapy. Due to the impact of errors associated with this field of medicine, evidence-based and rigorous systems are imperative. The implementation of such systems facilitates the reactive enhancement of patient safety following an event. The purpose of this study was to evaluate Irish event reporting-and-learning procedures against the current literature using a developed evidence-based process map, and to propose recommendations as to how the national standard could be improved.

Stritch MA, Forde E, Leech M. The impact of intensity-modulated radiation therapy plan normalization in the postprostatectomy setting—does it matter? Medical Dosimetry 2017 ;42(4):368-74.
https://doi.org/10.1016/j.meddos.2017.07.010 
The International Commission on Radiation Units & Measurements -83 recommends prescribing intensity-modulated radiation therapy (IMRT) in a dose-volume manner. Despite this, clinical variation still exists in how prostate IMRT plans are prescribed. This study aims to investigate the impact of different plan normalization methods for postprostatectomy IMRT.

Mohan A and Forde E. Adherence to ICRU-83 reporting recommendations is inadequate in prostate dosimetry studies. Practical Radiation Oncology. 2018; 8(3):e133-e128 doi: 10.1016/j.prro.2017.08.006

This study aimed to investigate if the International Commission on Radiation Units and Measurements (ICRU) 83 recommendations for reporting dosimetric endpoints are followed in published prostate studies using modulated techniques

Hutchinson, J., Marignol, L. , Clinical Potential of Statins in Prostate Cancer Radiation Therapy. Anticancer research 2017;37(10):5363-5372
Statins are cholesterol- lowering drugs that have been shown to possess anti-tumour properties. Observational studies have shown that 3-hydroxy-3-methlyglutaryl coenzyme A reductase inhibitor (statin) use may be associated with reduced prostate cancer risk. Preclinical studies suggest that statins possess anticancer and radiosensitising properties. This review aims to determine the impact of statin use in the efficacy of radiation therapy and the therapeutic window in prostate cancer. 

Haruna, F., Lipsett, A., Marignol, L. , Topical Management of Acute Radiation Dermatitis in Breast Cancer Patients: A Systematic Review and Meta-Analysis. Anticancer research 2017;37(10):5343-5353
The aim of this review was to evaluate the efficacy of topical corticosteroids in managing acute radiation dermatitis (RD) in female breast cancer patients. 

Fitzpatrick C, Lynch O, Marignol L., 68Ga-PSMA-PET/CT Has a Role in Detecting Prostate Cancer Lesions in Patients with Recurrent Disease. Anticancer research 2017;37 (6): 2753-2760
Early detection of recurrent prostate cancer (PCa) lesions is paramount to allow patients to avail of localised salvage therapy options. The most significant reason for failure of salvage therapy is undetected metastatic disease. This demonstrates the need for a more accurate monitoring tool. The prostate-specific membrane antigen (PSMA) is increasingly investigated as a novel tracer for gallium 68 PET/CT to detect PCa lesions in patients with recurrent disease.