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Article ; Online: Transforming cancer care in Australia: The dawn of particle therapy.

Gorayski, Peter / Saran, Frank

2024 Volume 71 Suppl 2, Page(s) 3–5

Abstract: The nearing completion of the Australian Bragg Centre for Proton Therapy and Research marks a transformative leap in cancer care in Australia. Highlighting the precision and potential of particle therapy in reducing long-term side effects, particularly ... ...

Abstract	The nearing completion of the Australian Bragg Centre for Proton Therapy and Research marks a transformative leap in cancer care in Australia. Highlighting the precision and potential of particle therapy in reducing long-term side effects, particularly in paediatric and rare cancers, this editorial underscores Australia's commitment to integrating this innovative modality into national healthcare, despite challenges in accessibility and cost.
MeSH term(s)	Humans ; Child ; Australia ; Delivery of Health Care ; Neoplasms/radiotherapy
Language	English
Publishing date	2024-04-01
Publishing country	United States
Document type	Editorial
ZDB-ID	2734841-6
ISSN	2051-3909 ; 2051-3909
ISSN (online)	2051-3909
ISSN	2051-3909
DOI	10.1002/jmrs.784
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Article ; Online: Proton beam therapy for clival chordoma: Optimising rare cancer treatments in Australia.

Mathew, Ashwathy / Gorayski, Peter / Candy, Nicholas / Saran, Frank / Le, Hien

Journal of medical radiation sciences

2024 Volume 71 Suppl 2, Page(s) 47–58

Abstract: With the anticipated launch of the Australian Bragg Centre for Proton Therapy and Research (ABCPTR) in Adelaide, Australia, proton therapy will become a significant addition to existing cancer treatment options for Australians. The anticipated benefits ... ...

Abstract	With the anticipated launch of the Australian Bragg Centre for Proton Therapy and Research (ABCPTR) in Adelaide, Australia, proton therapy will become a significant addition to existing cancer treatment options for Australians. The anticipated benefits will be particularly evident in rare cancers such as clival chordomas, a challenging tumour entity due to the anatomical relationship with critical structures, and proven radio-resistance to conventional radiation therapy. The article synthesises key findings from major studies and evaluates the current evidence supporting various management strategies for clival chordomas. It also considers the influence of institutional volume and multidisciplinary team management on patient outcomes and outlines how high-quality care can be effectively delivered within the Australian healthcare system, emphasising the potential impact of proton therapy on the treatment paradigm of clival chordomas in Australia.
MeSH term(s)	Humans ; Australia ; Chordoma/radiotherapy ; Chordoma/pathology ; Head and Neck Neoplasms/pathology ; Head and Neck Neoplasms/radiotherapy ; Proton Therapy ; Skull Base Neoplasms/radiotherapy ; Skull Base Neoplasms/pathology
Language	English
Publishing date	2024-03-19
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2734841-6
ISSN	2051-3909 ; 2051-3909
ISSN (online)	2051-3909
ISSN	2051-3909
DOI	10.1002/jmrs.774
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Article ; Online: Synthetic cranial MRI from 3D optical surface scans using deep learning for radiation therapy treatment planning.

Douglass, Michael / Gorayski, Peter / Patel, Sandy / Santos, Alexandre

Physical and engineering sciences in medicine

2023 Volume 46, Issue 1, Page(s) 367–375

Abstract: Background: Optical scanning technologies are increasingly being utilised to supplement treatment workflows in radiation oncology, such as surface-guided radiotherapy or 3D printing custom bolus. One limitation of optical scanning devices is the absence ...

Abstract	Background: Optical scanning technologies are increasingly being utilised to supplement treatment workflows in radiation oncology, such as surface-guided radiotherapy or 3D printing custom bolus. One limitation of optical scanning devices is the absence of internal anatomical information of the patient being scanned. As a result, conventional radiation therapy treatment planning using this imaging modality is not feasible. Deep learning is useful for automating various manual tasks in radiation oncology, most notably, organ segmentation and treatment planning. Deep learning models have also been used to transform MRI datasets into synthetic CT datasets, facilitating the development of MRI-only radiation therapy planning. Aims: To train a pix2pix generative adversarial network to transform 3D optical scan data into estimated MRI datasets for a given patient to provide additional anatomical data for a select few radiation therapy treatment sites. The proposed network may provide useful anatomical information for treatment planning of surface mould brachytherapy, total body irradiation, and total skin electron therapy, for example, without delivering any imaging dose. Methods: A 2D pix2pix GAN was trained on 15,000 axial MRI slices of healthy adult brains paired with corresponding external mask slices. The model was validated on a further 5000 previously unseen external mask slices. The predictions were compared with the "ground-truth" MRI slices using the multi-scale structural similarity index (MSSI) metric. A certified neuro-radiologist was subsequently consulted to provide an independent review of the model's performance in terms of anatomical accuracy and consistency. The network was then applied to a 3D photogrammetry scan of a test subject to demonstrate the feasibility of this novel technique. Results: The trained pix2pix network predicted MRI slices with a mean MSSI of 0.831 ± 0.057 for the 5000 validation images indicating that it is possible to estimate a significant proportion of a patient's gross cranial anatomy from a patient's exterior contour. When independently reviewed by a certified neuro-radiologist, the model's performance was described as "quite amazing, but there are limitations in the regions where there is wide variation within the normal population." When the trained network was applied to a 3D model of a human subject acquired using optical photogrammetry, the network could estimate the corresponding MRI volume for that subject with good qualitative accuracy. However, a ground-truth MRI baseline was not available for quantitative comparison. Conclusions: A deep learning model was developed, to transform 3D optical scan data of a patient into an estimated MRI volume, potentially increasing the usefulness of optical scanning in radiation therapy planning. This work has demonstrated that much of the human cranial anatomy can be predicted from the external shape of the head and may provide an additional source of valuable imaging data. Further research is required to investigate the feasibility of this approach for use in a clinical setting and further improve the model's accuracy.
MeSH term(s)	Adult ; Humans ; Deep Learning ; Tomography, X-Ray Computed/methods ; Brachytherapy ; Radiotherapy Planning, Computer-Assisted/methods ; Magnetic Resonance Imaging/methods
Language	English
Publishing date	2023-02-08
Publishing country	Switzerland
Document type	Journal Article
ISSN	2662-4737
ISSN (online)	2662-4737
DOI	10.1007/s13246-023-01229-4
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Article ; Online: Establishing a consumer advisory group at the Australian Bragg Centre for Proton Therapy and Research.

Penfold, Melanie / Gorayski, Peter / Green, Julia / Skelton, Kelly

Journal of medical radiation sciences

2023 Volume 71 Suppl 2, Page(s) 77–81

Abstract: The Australian Bragg Centre for Proton Therapy and Research (ABCPTR) established the Bragg Consumer Advisory Group (BCAG) in 2023. The ABCPTR, being the first of its kind in Australia, will offer proton therapy treatment for challenging solid tumours ... ...

Abstract	The Australian Bragg Centre for Proton Therapy and Research (ABCPTR) established the Bragg Consumer Advisory Group (BCAG) in 2023. The ABCPTR, being the first of its kind in Australia, will offer proton therapy treatment for challenging solid tumours with the potential to reduce radiation-induced side effects. With over 110 Proton Beam Therapy (PBT) centres globally, Australian patients currently can apply to access government funded treatment overseas, however, international travel for treatment presents various, significant challenges. Consumer engagement in healthcare plays a pivotal role in navigating the multifaceted journey of cancer treatment and can complement cancer control strategies by ensuring the practicalities of the cancer journey are realised. The ABCPTR aims to involve consumers in decision-making processes, especially as it prepares to open Australia's first national proton therapy centre. The aim of this commentary is to highlight the importance of involving consumers in cancer care, and to demonstrate how this was done in Australia's first proton therapy centre. To establish a consumer engagement team, ABCPTR utilised existing clinical staff. The team's formation and upskilling were integral to the project's success. The engagement framework was developed based on the five stages of commitment by the Australian Health Research Alliance and Western Australian Health Translation Network. The ABCPTR consumer engagement team successfully created a community engagement framework and upskilled in consumer engagement principles over 9-12 months. An Expression of Interest (EOI) was launched, resulting in the formation of the BCAG comprising of 10 members with diverse backgrounds and experiences. The BCAG has been actively involved in decision-making processes, with a consumer-led chair and co-chair in place. The group's feedback is expected to influence key performance indicators for the centre. The establishment of the BCAG at the ABCPTR emphasises the importance of integrating patient and community perspectives into clinical initiatives. This proactive approach ensures that processes remain patient-centred. The ongoing multi-level consumer engagement strategy aims to shape a more inclusive approach to cancer care in Australia, especially concerning PBT.
MeSH term(s)	Humans ; Australia ; Proton Therapy ; Delivery of Health Care
Language	English
Publishing date	2023-12-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	2734841-6
ISSN	2051-3909 ; 2051-3909
ISSN (online)	2051-3909
ISSN	2051-3909
DOI	10.1002/jmrs.746
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Article: A Systematic Review of LET-Guided Treatment Plan Optimisation in Proton Therapy: Identifying the Current State and Future Needs.

McIntyre, Melissa / Wilson, Puthenparampil / Gorayski, Peter / Bezak, Eva

Cancers

2023 Volume 15, Issue 17

Abstract: The well-known clinical benefits of proton therapy are achieved through higher target-conformality and normal tissue sparing than conventional radiotherapy. However, there is an increased sensitivity to uncertainties in patient motion/setup, proton range ...

Abstract	The well-known clinical benefits of proton therapy are achieved through higher target-conformality and normal tissue sparing than conventional radiotherapy. However, there is an increased sensitivity to uncertainties in patient motion/setup, proton range and radiobiological effect. Although recent efforts have mitigated some uncertainties, radiobiological effect remains unresolved due to a lack of clinical data for relevant endpoints. Therefore, RBE optimisations may be currently unsuitable for clinical treatment planning. LET optimisation is a novel method that substitutes RBE with LET, shifting LET hotspots outside critical structures. This review outlines the current status of LET optimisation in proton therapy, highlighting knowledge gaps and possible future research. Following the PRISMA 2020 guidelines, a search of the MEDLINE® and Scopus databases was performed in July 2023, identifying 70 relevant articles. Generally, LET optimisation methods achieved their treatment objectives; however, clinical benefit is patient-dependent. Inconsistencies in the reported data suggest further testing is required to identify therapeutically favourable methods. We discuss the methods which are suitable for near-future clinical deployment, with fast computation times and compatibility with existing treatment protocols. Although there is some clinical evidence of a correlation between high LET and adverse effects, further developments are needed to inform future patient selection protocols for widespread application of LET optimisation in proton therapy.
Language	English
Publishing date	2023-08-25
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15174268
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Article ; Online: Travelling overseas for proton beam therapy: A retrospective interview study.

Skelton, Kelly / Gorayski, Peter / Tee, Hui / Anderson, Nigel / Le, Hien

Journal of medical radiation sciences

2023 Volume 71 Suppl 2, Page(s) 10–18

Abstract: Introduction: Travelling for cancer treatment comes with unique challenges, particularly for a young patient and his or her family. The aims of this study were to (1) gain an understanding of the experiences of families and patients who travelled ... ...

Abstract	Introduction: Travelling for cancer treatment comes with unique challenges, particularly for a young patient and his or her family. The aims of this study were to (1) gain an understanding of the experiences of families and patients who travelled overseas (OS) from Australia for proton beam therapy (PBT) and (2) identify the supportive care needs patients and their families require when living away from home, while having PBT. Methods: This was a retrospective, qualitative study using semi-structured interviews, conducted with participants aged under 25 years and their families who travelled OS for PBT between 2017 and 2020. Data were analysed using Microsoft Excel Software, where key themes were identified and coded based on their responses. A total of 17 participants were included in interviews from seven Australian families who travelled to America or Europe for PBT. Results: The majority of participants reported a lack of coordination with travel and treatment arrangements prior to arrival OS. Families who stayed in hotel accommodation while OS reported greater feelings of isolation compared with those who stayed in share house-style accommodation. The acuity of cancer diagnosis played a significant part in patient experience, with those patients requiring the greatest amount of supportive care and availability of service provision at stand-alone centres reporting a lack of appropriate care provision. Conclusions: This study has identified services, accommodation provisions and care coordination requirements that are largely missing from the travel and treatment experience in patients travelling OS for PBT. Future use of consumer-led working groups or committees in creating models of care for families travelling for PBT treatment could be advantageous, with many families willing to share their experiences and provide support to others who are travelling for PBT.
MeSH term(s)	Humans ; Male ; Female ; Aged ; Proton Therapy ; Australia ; Retrospective Studies ; Travel ; Qualitative Research
Language	English
Publishing date	2023-08-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	2734841-6
ISSN	2051-3909 ; 2051-3909
ISSN (online)	2051-3909
ISSN	2051-3909
DOI	10.1002/jmrs.721
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Article: The Role of Hypofractionation in Proton Therapy.

Santos, Alexandre / Penfold, Scott / Gorayski, Peter / Le, Hien

Cancers

2022 Volume 14, Issue 9

Abstract: Hypofractionated radiotherapy is an attractive approach for minimizing patient burden and treatment cost. Technological advancements in external beam radiotherapy (EBRT) delivery and image guidance have resulted in improved targeting and conformality of ... ...

Abstract	Hypofractionated radiotherapy is an attractive approach for minimizing patient burden and treatment cost. Technological advancements in external beam radiotherapy (EBRT) delivery and image guidance have resulted in improved targeting and conformality of the absorbed dose to the disease and a reduction in dose to healthy tissue. These advances in EBRT have led to an increasing adoption and interest in hypofractionation. Furthermore, for many treatment sites, proton beam therapy (PBT) provides an improved absorbed dose distribution compared to X-ray (photon) EBRT. In the past 10 years there has been a notable increase in reported clinical data involving hypofractionation with PBT, reflecting the interest in this treatment approach. This review will discuss the reported clinical data and radiobiology of hypofractionated PBT. Over 50 published manuscripts reporting clinical results involving hypofractionation and PBT were included in this review, ~90% of which were published since 2010. The most common treatment regions reported were prostate, lung and liver, making over 70% of the reported results. Many of the reported clinical data indicate that hypofractionated PBT can be well tolerated, however future clinical trials are still needed to determine the optimal fractionation regime.
Language	English
Publishing date	2022-05-02
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14092271
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Article ; Online: Complete clinical response of a neglected cutaneous melanoma with combined radiotherapy and immunotherapy: A case report.

Gorayski, Peter / Dzienis, Marcin

Journal of medical radiation sciences

2020 Volume 68, Issue 1, Page(s) 91–95

Abstract: The treatment of patients with advanced melanoma has undergone a dramatic change over the past decade. Apart from refining the radiotherapy techniques, the repertoire of systemic treatments expanded from largely futile cytotoxic chemotherapy to ... ...

Abstract	The treatment of patients with advanced melanoma has undergone a dramatic change over the past decade. Apart from refining the radiotherapy techniques, the repertoire of systemic treatments expanded from largely futile cytotoxic chemotherapy to substantially more effective MAP kinase and immune checkpoint inhibitors (Immunotargets Ther, 7, 2018)
MeSH term(s)	Aged ; Combined Modality Therapy ; Humans ; Immunotherapy ; Male ; Melanoma/immunology ; Melanoma/radiotherapy ; Melanoma/therapy ; Skin Neoplasms/immunology ; Skin Neoplasms/radiotherapy ; Skin Neoplasms/therapy ; Melanoma, Cutaneous Malignant
Language	English
Publishing date	2020-09-09
Publishing country	United States
Document type	Case Reports
ZDB-ID	2734841-6
ISSN	2051-3909 ; 2051-3909
ISSN (online)	2051-3909
ISSN	2051-3909
DOI	10.1002/jmrs.427
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Article ; Online: Non-melanoma skin cancer in general practice: Radiotherapy is an effective treatment option.

Khong, Jeremy / Gorayski, Peter / Roos, Daniel

Australian journal of general practice

2020 Volume 49, Issue 8, Page(s) 496–499

Abstract: Background: Skin cancer is the most common malignancy that is managed in general practice, and non-melanoma skin cancer (NMSC) comprises the vast majority of presentations. Radiation therapy (RT) plays an important part in the management of NMSC and may ...

Abstract	Background: Skin cancer is the most common malignancy that is managed in general practice, and non-melanoma skin cancer (NMSC) comprises the vast majority of presentations. Radiation therapy (RT) plays an important part in the management of NMSC and may be used as definitive treatment for low-risk cancers, as an adjuvant treatment for high-risk disease or alone for inoperable cases. Objective: The aims of this article are to discuss: 1) types of RT; 2) role of RT, including its advantages and disadvantages; 3) side effects (toxicity) of RT; 4) outcomes from RT; 5) low- versus high-risk NMSCs and 6) some guidelines for general practitioners on when to refer patients for consideration of RT. Discussion: The primary goal of treatment for NMSC is to cure the patient, and a secondary goal is to provide the best cosmetic and functional result with the minimum impact on quality of life. In deciding what modality of treatment to use, clinicians will need to take into account the site of the tumour, clinical stage, histological subtype and any high-risk features, patient comorbidities as well as patient preferences. RT provides a safe and effective alternative to surgery in select cases and is particularly useful for the elderly or where surgery might have a negative impact on function or cosmesis.
MeSH term(s)	Carcinoma, Basal Cell/therapy ; Carcinoma, Squamous Cell/therapy ; Humans ; Radiotherapy/methods ; Radiotherapy/standards ; Radiotherapy/trends ; Skin Neoplasms/therapy ; Treatment Outcome
Language	English
Publishing date	2020-07-21
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2924889-9
ISSN	2208-7958 ; 2208-794X
ISSN (online)	2208-7958
ISSN	2208-794X
DOI	10.31128/AJGP-10-19-5130
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Article: Can We Compare the Health-Related Quality of Life of Childhood Cancer Survivors Following Photon and Proton Radiation Therapy? A Systematic Review.

Doig, Mikaela / Bezak, Eva / Parange, Nayana / Gorayski, Peter / Bedford, Victoria / Short, Michala

Cancers

2022 Volume 14, Issue 16

Abstract: Paediatric cancer patients have a risk of late side effects after curative treatment. Proton radiation therapy (PRT) has the potential to reduce the incidence and severity of toxicities produced by conventional photon radiation therapy (XRT), which may ... ...

Abstract	Paediatric cancer patients have a risk of late side effects after curative treatment. Proton radiation therapy (PRT) has the potential to reduce the incidence and severity of toxicities produced by conventional photon radiation therapy (XRT), which may improve the health-related quality of life (HRQoL) in children. This systematic review aimed to identify the evidence of HRQoL outcomes in childhood cancer survivors following XRT and PRT. Medline, Embase, and Scopus were systematically searched. Thirty studies were analysed, which described outcomes of 1986 childhood cancer survivors. Most studies (
Language	English
Publishing date	2022-08-15
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14163937
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