Cancer: Radiation Oncology

• Appointment of department lead, A/Professor Madhavi Chilkuri, whose career highlights include previous Dean of RANZCR and IAEA projects in the Asia-Pacific region.
• Inaugural trial of the first Artificial Intelligence (AI) software, AI Contouring, at Barwon Health.
• Inaugural utilisation of a 3D Printer to manufacture personalised patient bolus material to customise the radiation beam.

Phase III studies are done to study the efficacy (that is, whether it works as intended) of a promising intervention in very large groups of trial participants by comparing the intervention to other standard or experimental care methods, and to collect information that will allow the intervention to be used safely.

Together with Peter MacCallum Cancer Centre, St Vincent’s Hospital, Western Health, Box Hill Hospital, Olivia Newton-John Cancer Wellness & Research Centre, we are recruiting people to participate in the EXPERT Trial, a phase III trial that is examining personalised radiation therapy for low-risk early breast cancer.

Radiation therapy (RT) after breast-conserving surgery is the current standard of care for patients with early breast cancer. However, breast cancer is a variable disease, which means the benefit of RT in preventing the cancer from returning to the area also varies between individual patients.

A priority in breast cancer management is to identify patients who are unlikely to benefit from RT, to avoid the associated side effects and over-treatment costs. A recent analysis of tumour specimens from over 1000 patients with early breast cancer has shown a link between the genes expressed in the tumours and the risk of the cancer returning to the area. This trial presents a unique opportunity to use gene expression to identify low-risk patients for whom RT after breast-conserving surgery can be safely omitted.

For more information visit the Barwon Health Clinical Trials site

Radiotherapy is an established treatment technique with guidelines based on historical clinical evidence. Globally, there is a vast amount of data available which can be computed and processed by data mining and machine learning to assist the clinicians in their decision-making.

Radiation Oncology has ethics approval to be involved with OzCat (The Australian Computer Assisted Theragnostics network) and the global consortium to mine clinical data to produce treatment information, such as the probability of toxicity and outcome based on a patient’s clinical profile, to assist in clinical decision making.

• Flavio Enrico Nelli: Simplified dosimetric characterization of 3D printed bolus material for electron beam radiation therapy. Engineering and Physical Sciences in Medicine Conference 2023
• Trang Pham: Shifted paradigm on linear accelerator jaw calibration: The TPS standard. Engineering and Physical Sciences in Medicine Conference 2023
• Jeffrey Harwood: Determination of representative reference and tolerance values for planar kV image quality for TrueBeams. Engineering and Physical Sciences in Medicine Conference 2022
• Flavio Enrico Nelli: What is wrong with Eclipse’s Dosimetric Leaf Gap parameter? Engineering and Physical Sciences in Medicine Conference 2020
• Investigating the changes in pH when irradiation phosphate- buffered saline and dulbecco’s modified eagles’ medium with ultra high dose FLASH radiotherapy at the Australian Synchrotron. Ffrench, T., Patterson, B., Lynch, R., Geso, M., Forrester, H. & Piva, T. Flash Radiotherapy and Particle Therapy, Toronto, Canada, 2023
• Cranial Stereotactic Radiation Therapy (SRT) Implementation – The Experience of a Regional standalone Radiotherapy Centre. MacCarthy, J, Hui, A, Pitson, G, Nelli, F, Moloney, P et al. ASMIRT, Cairns, 2022
• PSMA‐PET‐ seeing what others can’t. Bowe S, Glenn C. 12th Annual Scientific Meeting of Medical Imaging and Radiation Therapy, Perth, Australia, 24-26 March 2017.
• VMAT-FFF Lung-SBRT QA: A Method for Routinely Assessing the Dosimetric Impact of the Interplay Effect. Nelli, F., Harwood, J. In:  Engineering and Physics Science in Medicine, Sydney Australia, 2016.
• VMAT 5 years on ‐ the Geelong experience. Chandler S, Bowe S. InL 11th Annual Scientific Meeting of Medical Imaging and Radiation Therapy, Brisbane, Australia, 22‐24 April 2016.
• SBRT for Medically Inoperable Lung Cancer Using VMAT with FFF Beams: Early Experience at the Andrew Love Cancer Centre. Hui AC, Francis MP, Chandler S, Nelli FE, Pitson G. Australian Lung Cancer Conference [Details Unknown].
• Impact of Altered Radiotherapy Fractionation Schedules on Acute Skin Toxicity in Breast Cancer. Nguyen K, Pitson G, French T. Clinical Oncology Society of Australia Conference [Details Unknown].

Radiation therapy uses a controlled dose of radiation to kill cancer cells, or damage them so they cannot grow, multiply or spread. The therapy is targeted to ensure that the cancer cells receive the full dose of radiation, while as little radiation as possible reaches the normal body tissue near the cancer.

For specialists to know they are delivering the correct clinical dose of radiation to the correct site in the body, it is vital that they first calibrate the radiation against a standard reference dose. Calculation of a reference dose is performed under strict conditions set by international codes of practice, however there may be specific limitations in different reference systems that users must take into account when calibrating doses.

This research, conducted by Sadia Aftab of Barwon Health at Calvary Mater Hospital, set out to test the impact of a metal rail found in the SNC 3D scanner water tank reference system, on the delivery of a reference dose of radiation.

By setting up an experimental system and varying factors such as radiation type and the location of the metal rail, the researchers found that:

For low energy radiation, which tends to be used to treat superficial cancers, the metal rail did obstruct the dose of radiation in some conditions.
This effect was not observed when high energy radiation, which is used to treat cancers deeper within the body, was tested.
These results provide a warning that in some cases, adjustments need to be considered to the reference dose calculation to ensure that the correct clinical dose of low energy radiation is delivered to the patient. Findings such as these are vital contributors to the safe and effective delivery of radiation therapy.

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