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Article ; Online: The use of radiotherapy, surgery and chemotherapy in the curative treatment of cancer: results from the FORTY (Favourable Outcomes from RadioTherapY) project.

Mee, Thomas / Kirkby, Norman F / Defourny, Noemie N / Kirkby, Karen Joy / Burnet, Neil G

2023 Volume 96, Issue 1152, Page(s) 20230334

Abstract: Objectives: Radiotherapy, surgery and chemotherapy play key roles in the curative treatment of cancer, alone and in combination. Quantifying their roles is essential for equipment provision and workforce planning. The estimate that 40% of cancer ... ...

Abstract	Objectives: Radiotherapy, surgery and chemotherapy play key roles in the curative treatment of cancer, alone and in combination. Quantifying their roles is essential for equipment provision and workforce planning. The estimate that 40% of cancer patients are cured by RT has been used extensively to inform and influence policy but is relatively old and warrants review. Methods: Patient, tumour and treatment event data was obtained for the 5 year period from 2009 to 2013, allowing a further 5 years for survival outcomes to be known. We analysed patient-level data on utilisation of surgery, radiotherapy, and chemotherapy in cancer patients in England. Data were sourced from Public Health England, using National Cancer Registrations, the National Radiotherapy Dataset (RTDS) and the Systemic Anti-Cancer Therapy Dataset (SACT). All tumour sites (excluding C44) and ages were included. We analysed three cohorts: all patients [ Results: Overall cancer-specific 5-year survival was 52%, and in those patients, surgery was the most common curative treatment, with 80% receiving surgery, alone or in combination; radiotherapy was delivered to 39% and chemotherapy to 29%; 45% received two and 13% all three modalities. Conclusions: The high proportion receiving multi-modality treatment emphasises the importance of integrated, resourced, multidisciplinary cancer care. Radiotherapy was delivered to almost 40% of patients who survived 5 years which underlines its importance in cancer management. Advances in knowledge: The results are essential in planning cancer services. They also inform the public health narrative.
MeSH term(s)	Humans ; Neoplasms/radiotherapy ; England/epidemiology
Language	English
Publishing date	2023-10-24
Publishing country	England
Document type	Journal Article
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20230334
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Article ; Online: The future of image-guided radiotherapy-is image everything?

Noble, David J / Burnet, Neil G

The British journal of radiology

2018 Volume 91, Issue 1087, Page(s) 20170894

Abstract: MR-based image-guided (IG) radiotherapy via all-in-one MR treatment units (MR-linacs) is one of the hottest topics in contemporary radiotherapy research. From ingenious engineering solutions to complex physical problems, researchers have developed ... ...

Abstract	MR-based image-guided (IG) radiotherapy via all-in-one MR treatment units (MR-linacs) is one of the hottest topics in contemporary radiotherapy research. From ingenious engineering solutions to complex physical problems, researchers have developed machines with the promise of superior image quality, and all the advantages this may confer. Benefits include better tumour visualisation, online adaptation and the potential for image biomarker-based personalised RT. However, it is important to remember that the technical challenges are real. In many instances, they are skillfully managed rather than abolished, a point illustrated by the wide variety of MR-linac designs. The proposed benefits also deserve careful inspection. Better visibility of the primary tumour on an IG scan cannot be bad, but does not automatically equate to better IG, which often depends on a more generalised match to daily anatomy. MR-linac will undoubtedly be a rich milieu to search for IMBs, but these will need to be carefully validated, and similar work with CT-based biomarkers using existing, cheaper, and more widely available hardware is currently ongoing. Online adaptation is an attractive concept, but practicalities are complex, and more work is required to understand which patients will benefit from plan adaptation, and when. Finally, the issue of cost cannot be overlooked, nor can the research community's responsibilities to global healthcare inequalities. MR-linac is an exciting and ingenious technology, which merits both investment and research. It may not, however, have the future to itself.
MeSH term(s)	Humans ; Magnetic Resonance Imaging ; Neoplasms/radiotherapy ; Particle Accelerators ; Radiotherapy Planning, Computer-Assisted ; Radiotherapy, Image-Guided
Language	English
Publishing date	2018-05-17
Publishing country	England
Document type	Journal Article ; Comment
ZDB-ID	2982-8
ISSN	1748-880X ; 0007-1285
ISSN (online)	1748-880X
ISSN	0007-1285
DOI	10.1259/bjr.20170894
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Article ; Online: Machine-learning with region-level radiomic and dosimetric features for predicting radiotherapy-induced rectal toxicities in prostate cancer patients.

Yang, Zhuolin / Noble, David J / Shelley, Leila / Berger, Thomas / Jena, Raj / McLaren, Duncan B / Burnet, Neil G / Nailon, William H

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2023 Volume 183, Page(s) 109593

Abstract: Background and purpose: This study aims to build machine learning models to predict radiation-induced rectal toxicities for three clinical endpoints and explore whether the inclusion of radiomic features calculated on radiotherapy planning computerised ... ...

Abstract	Background and purpose: This study aims to build machine learning models to predict radiation-induced rectal toxicities for three clinical endpoints and explore whether the inclusion of radiomic features calculated on radiotherapy planning computerised tomography (CT) scans combined with dosimetric features can enhance the prediction performance. Materials and methods: 183 patients recruited to the VoxTox study (UK-CRN-ID-13716) were included. Toxicity scores were prospectively collected after 2 years with grade ≥ 1 proctitis, haemorrhage (CTCAEv4.03); and gastrointestinal (GI) toxicity (RTOG) recorded as the endpoints of interest. The rectal wall on each slice was divided into 4 regions according to the centroid, and all slices were divided into 4 sections to calculate region-level radiomic and dosimetric features. The patients were split into a training set (75%, N = 137) and a test set (25%, N = 46). Highly correlated features were removed using four feature selection methods. Individual radiomic or dosimetric or combined (radiomic + dosimetric) features were subsequently classified using three machine learning classifiers to explore their association with these radiation-induced rectal toxicities. Results: The test set area under the curve (AUC) values were 0.549, 0.741 and 0.669 for proctitis, haemorrhage and GI toxicity prediction using radiomic combined with dosimetric features. The AUC value reached 0.747 for the ensembled radiomic-dosimetric model for haemorrhage. Conclusions: Our preliminary results show that region-level pre-treatment planning CT radiomic features have the potential to predict radiation-induced rectal toxicities for prostate cancer. Moreover, when combined with region-level dosimetric features and using ensemble learning, the model prediction performance slightly improved.
MeSH term(s)	Male ; Humans ; Prostatic Neoplasms/diagnostic imaging ; Prostatic Neoplasms/radiotherapy ; Rectum/diagnostic imaging ; Radiometry/methods ; Proctitis/diagnostic imaging ; Proctitis/etiology ; Radiation Injuries/diagnostic imaging ; Radiation Injuries/etiology ; Gastrointestinal Diseases ; Machine Learning
Language	English
Publishing date	2023-03-03
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2023.109593
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Article ; Online: Response to Letter to the Editor of Radiotherapy and Oncology regarding the paper entitled "50 years of radiotherapy research: Evolution, trends and lessons for the future" by Berger et al. (December 2021, volume 165).

Berger, Thomas / Noble, David J / Shelley, Leila E A / Hopkins, Kirsten I / McLaren, Duncan B / Burnet, Neil G / Nailon, William H

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2022 Volume 172, Page(s) 151–152

MeSH term(s)	Humans ; Medical Oncology ; Radiation Oncology ; Research
Language	English
Publishing date	2022-04-07
Publishing country	Ireland
Document type	Letter ; Comment
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2022.04.001
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Article: Radiotherapy intensification for atypical and malignant meningiomas: A systematic review.

Gaito, Simona / Goyal, Love / Rieu, Romelie / France, Anna / Burnet, Neil G / Barker, Claire / Pan, Shermaine / Colaco, Rovel J / Minniti, Giuseppe / Roncaroli, Federico / Smith, Ed / Aznar, Marianne / Whitfield, Gillian

Neuro-oncology practice

2023 Volume 11, Issue 2, Page(s) 115–124

Abstract: Background: The outcomes of nonbenign (WHO Grades 2 and 3 [G2, G3]) meningiomas are suboptimal and radiotherapy (RT) dose intensification strategies have been investigated. The purpose of this review is to report on clinical practice and outcomes with ... ...

Abstract	Background: The outcomes of nonbenign (WHO Grades 2 and 3 [G2, G3]) meningiomas are suboptimal and radiotherapy (RT) dose intensification strategies have been investigated. The purpose of this review is to report on clinical practice and outcomes with particular attention to RT doses and techniques. Methods: The PICO criteria (Population, Intervention, Comparison, and Outcomes) were used to frame the research question, directed at outlining the clinical outcomes in patients with G2-3 meningiomas treated with RT. The same search strategy was run in Embase and MEDLINE and, after deduplication, returned 1 807 records. These were manually screened for relevance and 25 were included. Results: Tumor outcomes and toxicities are not uniformly reported in the selected studies since different endpoints and time points have been used by different authors. Many risk factors for worse outcomes are described, the most common being suboptimal RT. This includes no or delayed RT, low doses, and older techniques. A positive association between RT dose and progression-free survival (PFS) has been highlighted by analyzing the studies in this review (10/25) that report the same endpoint (5y-PFS). Conclusions: This literature review has shown that standard practice RT leads to suboptimal tumor control rates in G2-3 meningiomas, with a significant proportion of disease recurring after a relatively short follow-up. Randomized controlled trials are needed in this setting to define the optimal RT approach. Given the increasing data to suggest a benefit of higher RT doses for high-risk meningiomas, novel RT technologies with highly conformal dose distributions are preferential to achieve optimal target coverage and organs at risk sparing.
Language	English
Publishing date	2023-12-18
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2768945-1
ISSN	2054-2585 ; 2054-2577
ISSN (online)	2054-2585
ISSN	2054-2577
DOI	10.1093/nop/npad077
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Article ; Online: 50 years of radiotherapy research: Evolution, trends and lessons for the future.

Berger, Thomas / Noble, David J / Shelley, Leila E A / Hopkins, Kirsten I / McLaren, Duncan B / Burnet, Neil G / Nailon, William H

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

2021 Volume 165, Page(s) 75–86

Abstract: Rapid and relentless technological advances in an ever-more globalized world have shaped the field of radiation oncology in which we practise today. These developments have drastically modified the ... ...

Abstract	Rapid and relentless technological advances in an ever-more globalized world have shaped the field of radiation oncology in which we practise today. These developments have drastically modified the habitus
MeSH term(s)	Databases, Factual ; Humans ; Neoplasms/radiotherapy ; Radiation Oncology ; Research
Language	English
Publishing date	2021-10-04
Publishing country	Ireland
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Review
ZDB-ID	605646-5
ISSN	1879-0887 ; 0167-8140
ISSN (online)	1879-0887
ISSN	0167-8140
DOI	10.1016/j.radonc.2021.09.026
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Article ; Online: Sub-regional analysis of the parotid glands: model development for predicting late xerostomia with radiomics features in head and neck cancer patients.

Berger, Thomas / Noble, David J / Yang, Zhuolin / Shelley, Leila Ea / McMullan, Thomas / Bates, Amy / Thomas, Simon / Carruthers, Linda J / Beckett, George / Duffton, Aileen / Paterson, Claire / Jena, Raj / McLaren, Duncan B / Burnet, Neil G / Nailon, William H

Acta oncologica (Stockholm, Sweden)

2023 Volume 62, Issue 2, Page(s) 166–173

Abstract: Background: The irradiation of sub-regions of the parotid has been linked to xerostomia development in patients with head and neck cancer (HNC). In this study, we compared the xerostomia classification performance of radiomics features calculated on ... ...

Abstract	Background: The irradiation of sub-regions of the parotid has been linked to xerostomia development in patients with head and neck cancer (HNC). In this study, we compared the xerostomia classification performance of radiomics features calculated on clinically relevant and de novo sub-regions of the parotid glands of HNC patients. Material and methods: All patients ( Results: In this study, radiomics-based models predicted xerostomia better than standard clinical predictors. Models combining dose to the parotid and xerostomia scores at baseline yielded an AUC Conclusion: Our results indicate that variations of radiomics features calculated on sub-regions of the parotid glands can lead to earlier and improved prediction of xerostomia in HNC patients.
MeSH term(s)	Head and Neck Neoplasms/radiotherapy ; Xerostomia/complications ; Humans ; Radiomics ; Parotid Gland/diagnostic imaging ; Parotid Gland/radiation effects ; Radiotherapy Dosage ; Image Processing, Computer-Assisted ; Male ; Female ; Middle Aged ; Aged
Language	English
Publishing date	2023-02-21
Publishing country	England
Document type	Journal Article
ZDB-ID	896449-x
ISSN	1651-226X ; 0349-652X ; 0284-186X ; 1100-1704
ISSN (online)	1651-226X
ISSN	0349-652X ; 0284-186X ; 1100-1704
DOI	10.1080/0284186X.2023.2179895
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Article ; Online: The suitability of micronuclei as markers of relative biological effect.

Heaven, Charlotte J / Wanstall, Hannah C / Henthorn, Nicholas T / Warmenhoven, John-William / Ingram, Samuel P / Chadwick, Amy L / Santina, Elham / Honeychurch, Jamie / Schmidt, Christine K / Kirkby, Karen J / Kirkby, Norman F / Burnet, Neil G / Merchant, Michael J

Mutagenesis

2022 Volume 37, Issue 1, Page(s) 3–12

Abstract: Micronucleus (MN) formation is routinely used as a biodosimeter for radiation exposures and has historically been used as a measure of DNA damage in cells. Strongly correlating with dose, MN are also suggested to indicate radiation quality, ... ...

Abstract	Micronucleus (MN) formation is routinely used as a biodosimeter for radiation exposures and has historically been used as a measure of DNA damage in cells. Strongly correlating with dose, MN are also suggested to indicate radiation quality, differentiating between particle and photon irradiation. The "gold standard" for measuring MN formation is Fenech's cytokinesis-block micronucleus (CBMN) cytome assay, which uses the cytokinesis blocking agent cytochalasin-B. Here, we present a comprehensive analysis of the literature investigating MN induction trends in vitro, collating 193 publications, with 2476 data points. Data were collected from original studies that used the CBMN assay to quantify MN in response to ionizing radiation in vitro. Overall, the meta-analysis showed that individual studies mostly have a linear increase of MN with dose [85% of MN per cell (MNPC) datasets and 89% of percentage containing MN (PCMN) datasets had an R2 greater than 0.90]. However, there is high variation between studies, resulting in a low R2 when data are combined (0.47 for MNPC datasets and 0.60 for PCMN datasets). Particle type, species, cell type, and cytochalasin-B concentration were suggested to influence MN frequency. However, variation in the data meant that the effects could not be strongly correlated with the experimental parameters investigated. There is less variation between studies when comparing the PCMN rather than the number of MNPC. Deviation from CBMN protocol specified timings did not have a large effect on MN induction. However, further analysis showed less variation between studies following Fenech's protocol closely, which provided more reliable results. By limiting the cell type and species as well as only selecting studies following the Fenech protocol, R2 was increased to 0.64 for both measures. We therefore determine that due to variation between studies, MN are currently a poor predictor of radiation-induced DNA damage and make recommendations for futures studies assessing MN to improve consistency between datasets.
MeSH term(s)	Cytokinesis ; DNA Damage ; Lymphocytes ; Micronucleus Tests/methods ; Radiation, Ionizing
Language	English
Publishing date	2022-02-09
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't
ZDB-ID	632903-2
ISSN	1464-3804 ; 0267-8357
ISSN (online)	1464-3804
ISSN	0267-8357
DOI	10.1093/mutage/geac001
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Article ; Online: Predicting radiotherapy-induced xerostomia in head and neck cancer patients using day-to-day kinetics of radiomics features.

Berger, Thomas / Noble, David J / Shelley, Leila E A / McMullan, Thomas / Bates, Amy / Thomas, Simon / Carruthers, Linda J / Beckett, George / Duffton, Aileen / Paterson, Claire / Jena, Raj / McLaren, Duncan B / Burnet, Neil G / Nailon, William H

Physics and imaging in radiation oncology

2022 Volume 24, Page(s) 95–101

Abstract: Background and purpose: The images acquired during radiotherapy for image-guidance purposes could be used to monitor patient-specific response to irradiation and improve treatment personalisation. We investigated whether the kinetics of radiomics ... ...

Abstract	Background and purpose: The images acquired during radiotherapy for image-guidance purposes could be used to monitor patient-specific response to irradiation and improve treatment personalisation. We investigated whether the kinetics of radiomics features from daily mega-voltage CT image-guidance scans (MVCT) improve prediction of moderate-to-severe xerostomia compared to dose/volume parameters in radiotherapy of head-and-neck cancer (HNC). Materials and methods: All included HNC patients (N = 117) received 30 or more fractions of radiotherapy with daily MVCTs. Radiomics features were calculated on the contra-lateral parotid glands of daily MVCTs. Their variations over time after each complete week of treatment were used to predict moderate-to-severe xerostomia (CTCAEv4.03 grade ≥ 2) at 6, 12 and 24 months post-radiotherapy. After dimensionality reduction, backward/forward selection was used to generate combinations of predictors.Three types of logistic regression model were generated for each follow-up time: 1) a pre-treatment reference model using dose/volume parameters, 2) a combination of dose/volume and radiomics-based predictors, and 3) radiomics-based predictors. The models were internally validated by cross-validation and bootstrapping and their performance evaluated using Area Under the Curve (AUC) on separate training and testing sets. Results: Moderate-to-severe xerostomia was reported by 46 %, 33 % and 26 % of the patients at 6, 12 and 24 months respectively. The selected models using radiomics-based features extracted at or before mid-treatment outperformed the dose-based models with an AUC Conclusion: Our results suggest that radiomics features calculated on MVCTs from the first half of the radiotherapy course improve prediction of moderate-to-severe xerostomia in HNC patients compared to a dose-based pre-treatment model.
Language	English
Publishing date	2022-11-04
Publishing country	Netherlands
Document type	Journal Article
ISSN	2405-6316
ISSN (online)	2405-6316
DOI	10.1016/j.phro.2022.10.004
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Article: Long-term tumour control in sacral chordoma following high-dose palliative image-guided intensity-modulated radiotherapy (IG-IMRT).

Jackson, Amy / Scott, Sarah / Romanchikova, Marina / Noble, David J / Burnet, Neil G

BJR case reports

2017 Volume 3, Issue 3, Page(s) 20160145

Abstract: Chordomas can present a challenge to the radiation oncologist and surgeon owing to the proximity to neurological structures. We describe a case of long-term tumour control in a chordoma of the lumbar spine following high-dose palliative radiotherapy. ... ...

Abstract	Chordomas can present a challenge to the radiation oncologist and surgeon owing to the proximity to neurological structures. We describe a case of long-term tumour control in a chordoma of the lumbar spine following high-dose palliative radiotherapy. Image-guided intensity-modulated radiotherapy with photons provided a good solution to deliver 65 Gy to the tumour in a technically challenging case, and local control has been sustained over a period of years.
Language	English
Publishing date	2017-04-12
Publishing country	England
Document type	Case Reports
ISSN	2055-7159
ISSN	2055-7159
DOI	10.1259/bjrcr.20160145
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