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Article ; Online: Linear accelerator maintenance cost analysis.

Carlone, Marco / Beckham, Wayne / Duzenli, Cheryl / Kohli, Kirpal / Tyldesley, Scott

Journal of applied clinical medical physics

2023 Volume 25, Issue 2, Page(s) e14246

Abstract: Purpose: Medical linear accelerators are the most costly standard equipment used in radiation oncology, however the service costs for these machines are not well understood. With an increasing demand for linear accelerators due to a global increase in ... ...

Abstract	Purpose: Medical linear accelerators are the most costly standard equipment used in radiation oncology, however the service costs for these machines are not well understood. With an increasing demand for linear accelerators due to a global increase in cancer incidence, it is important to understand the expected maintenance costs of a larger global installed base so that these costs can be incorporated into budgeting. The purpose of this investigation is to analyze the costs for medical linear accelerator service and maintenance at our institution, in order to estimate the service cost ratio. Methods: We collected the costs of parts used for all service work done on 32 medical linear accelerators over a two year period. The data was segregated by center, machine, linear accelerator type, and failure area in the machine. Results: We found the service cost ratio (excluding software support expenses) to be 3.13% [2.74%, 3.52%,]. We observed a variability of parts costs, and overall variability of the service cost ratio to be between 2.14% and 5.25%. This result is lower than other estimates for service costs for medical equipment in general and medical linear accelerators specifically. Two-thirds of the service costs were due to labor costs, which indicate the importance of a well-trained service technician workforce. Conclusions: We estimated the service cost ratio for medical linear accelerators to be 3.13% [3.52%, 2.74%] of the initial capital cost. This result was lower than other estimates of the service cost ratio.
MeSH term(s)	Humans ; Costs and Cost Analysis ; Software ; Radiation Oncology ; Particle Accelerators
Language	English
Publishing date	2023-12-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2010347-5
ISSN	1526-9914 ; 1526-9914
ISSN (online)	1526-9914
ISSN	1526-9914
DOI	10.1002/acm2.14246
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Case - Laparoscopic radical prostatectomy in a transgender woman after gender-affirming vaginoplasty.

Kumar, Sahil / Tyldesley, Scott / Poon, Christina I / Saunders, James T W / Hoag, Christopher C

Canadian Urological Association journal = Journal de l'Association des urologues du Canada

2023 Volume 18, Issue 3, Page(s) E98–E103

Language	English
Publishing date	2023-11-27
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2431403-1
ISSN	1911-6470
ISSN	1911-6470
DOI	10.5489/cuaj.8387
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Article ; Online: Cost-Effectiveness Analysis of Stereotactic Ablative Body Radiotherapy for the Treatment of Oligometastatic Tumors versus Standard of Care.

Raymakers, Adam J N / Cameron, David / Tyldesley, Scott / Regier, Dean A

Current oncology (Toronto, Ont.)

2021 Volume 28, Issue 3, Page(s) 1857–1866

Abstract: Background: Recent clinical trial results reported that stereotactic radiotherapy (SABR) may improve survival for patients with oligometastatic (OM) cancer. Given that these results come from a phase II trial, there remains considerable uncertainty ... ...

Abstract	Background: Recent clinical trial results reported that stereotactic radiotherapy (SABR) may improve survival for patients with oligometastatic (OM) cancer. Given that these results come from a phase II trial, there remains considerable uncertainty about this finding, and about the cost-effectiveness of SABR for patients with OM cancer. In this analysis, we estimate the cost-effectiveness of SABR for oligometastatic cancer patients. Methods: A probabilistic time-dependent Markov model was constructed to simulate treatment of oligometastatic cancer patients over five- and ten-year time horizons. The primary data source was the phase II, Stereotactic Ablative Radiotherapy for the Comprehensive Treatment of Oligometastases (SABR-COMET )trial and supplemented with data from the literature. We estimated the effect of SABR and the standard of care (SoC) using quality-adjusted life-years (QALYs). Costs were measured from a provincial payer perspective (2018 Canadian dollars). Results: In the reference case analysis (five-year time horizon), SABR was associated with additional incremental costs of CAD 38,487 and an incremental QALY gain of 0.84. This resulted in an incremental cost-effectiveness ratio (ICER) of CAD 45,726 per QALY gained. Over a ten-year time horizon, the increased uncertainty in the long-term effectiveness of SABR resulted in an ICER of CAD 291,544 per QALY gained. Estimates from the probabilistic analysis indicated that at a willingness-to-pay (WTP) threshold of CAD 50,000 and CAD 100,000 per QALY gained, there is 54% and 78% probability (respectively) that SABR would be cost-effective using the five-year time horizon. Conclusions: The adoption of SABR therapy requires a considerable upfront capital investment. Our results suggest that the cost-effectiveness of SABR is contingent on the uncertainty in the evidence base. Further clinical trials to confirm the effectiveness of SABR and research into the real-world costs associated with this treatment could reduce the uncertainty around implementation of the technology.
MeSH term(s)	Canada ; Cost-Benefit Analysis ; Humans ; Neoplasms ; Radiosurgery ; Standard of Care
Language	English
Publishing date	2021-05-13
Publishing country	Switzerland
Document type	Clinical Trial, Phase II ; Journal Article
ZDB-ID	1236972-x
ISSN	1718-7729 ; 1198-0052
ISSN (online)	1718-7729
ISSN	1198-0052
DOI	10.3390/curroncol28030172
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Article ; Online: Let "Whitmore's Principle" be the Guide.

Tyldesley, Scott / Schellenberg, Devin

International journal of radiation oncology, biology, physics

2017 Volume 99, Issue 4, Page(s) 766–767

Language	English
Publishing date	2017-11-15
Publishing country	United States
Document type	Letter
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2017.03.013
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Article ; Online: In Regard to Ciezki et al.

Morris, W James / Tyldesley, Scott

International journal of radiation oncology, biology, physics

2017 Volume 99, Issue 1, Page(s) 240–242

Language	English
Publishing date	2017-09-01
Publishing country	United States
Document type	Letter
ZDB-ID	197614-x
ISSN	1879-355X ; 0360-3016
ISSN (online)	1879-355X
ISSN	0360-3016
DOI	10.1016/j.ijrobp.2017.04.035
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Article: Real-world evaluation of access-driven Canadian treatment sequences in progressive prostate cancer (REACTIVATE).

Ko, Jenny J / Mbuagbaw, Lawrence / Tyldesley, Scott / Lowther, Jennifer / Sunderland, Katherine / Royer, Catherine / Faure, Mareva / MacPhail, Corin / Faizi, Shoaib / Cheung, Winson Y / Lee-Ying, Richard

Canadian Urological Association journal = Journal de l'Association des urologues du Canada

2024

Abstract: Introduction: The results of the phase 3 ALSYMPCA trial showed that Radium-223 (Ra-223) improves overall survival (OS) and delays onset of first symptomatic skeletal event vs. placebo in patients with metastatic castration-resistant prostate cancer ( ... ...

Abstract	Introduction: The results of the phase 3 ALSYMPCA trial showed that Radium-223 (Ra-223) improves overall survival (OS) and delays onset of first symptomatic skeletal event vs. placebo in patients with metastatic castration-resistant prostate cancer (mCRPC). The purpose of the REACTIVATE study was to inform the optimal placement of Ra-233 in the treatment sequence by evaluating clinical outcomes and healthcare resource utilization using real-world data from multiple Canadian provinces. Methods: This retrospective cohort study analyzed patient outcomes according to Ra-223 placement using administrative databases of four Canadian provinces, encompassing 4301 patients with mCRPC who received at least two lines of life-prolonging therapy (LPT) for mCRPC. Outcomes included OS, event-free survival (EFS), and healthcare resource utilization. Each province was analyzed separately. Results: OS, measured from the start of second-line LPT, differed between provinces: those in Ontario receiving second-line Ra-223 had a longer OS vs. those receiving it in third-line or later (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66-0.95). There was no difference between lines of therapy in patients in British Columbia (HR 1.165, 95% CI, 0.894-1.518, p=0.2576), and OS was numerically worse but not statistically significant in patients receiving Ra-223 in second-line in Quebec (HR 1.44, 95% CI, 0.93-2.24). Other outcomes also varied across provinces, with second-line use of Ra-223 being associated with longer EFS and reduced healthcare utilization vs. third-line use in Ontario but not in Quebec. Conclusions: Significant heterogeneity exists in the management and outcomes of mCRPC between provinces, particularly regarding the placement of Ra-223 in the treatment sequence.
Language	English
Publishing date	2024-03-01
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2431403-1
ISSN	1911-6470
ISSN	1911-6470
DOI	10.5489/cuaj.8620
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Article ; Online: Reply by Author.

St-Laurent, Marie-Pier / Acland, George / Hamilton, Sarah N / Hamm, Jeremy / Sunderland, Katherine / Black, Peter C / McKenzie, Michael / Keyes, Mira / Miller, Stacy / Gleave, Martin E / Tyldesley, Scott

The Journal of urology

2024 , Page(s) 101097JU0000000000004006

Language	English
Publishing date	2024-05-07
Publishing country	United States
Document type	Journal Article
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1097/JU.0000000000004006
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Ui VI Zs.91: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 2021: Bestellungen von Artikeln über das Online-Bestellformular ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Long-Term Second Malignancies in Prostate Cancer Patients Treated With Low-Dose-Rate Brachytherapy and Radical Prostatectomy.

The Journal of urology

2024 , Page(s) 101097JU0000000000003965

Abstract: Purpose: Second malignancy is a rare but potentially lethal event after prostate brachytherapy, but data remain scarce on its long-term risk. The objective of this study is to estimate the number of pelvic second malignancies following brachytherapy ... ...

Abstract	Purpose: Second malignancy is a rare but potentially lethal event after prostate brachytherapy, but data remain scarce on its long-term risk. The objective of this study is to estimate the number of pelvic second malignancies following brachytherapy compared to radical prostatectomy (RP). Materials and methods: We retrospectively reviewed patients treated with low-dose Results: Two thousand three hundred seventy-eight brachytherapy and 9089 RP patients were included. Median age was 66 years (interquartile range [IQR] 61-71) and 63 years (IQR 58-67), respectively. Median follow-up time to event or censured was 14 years (IQR 11.5-17.3). The Kaplan-Meier estimates for pelvic second malignancy at 15 and 20 years were 6.4% and 9.8%, respectively, after brachytherapy, and 3.2% and 4.2% after RP. Time to any second malignancy and time to death from any second malignancy were not significantly different ( Conclusions: After adjustment for age, post-RP adjuvant/salvage external beam radiation therapy status, and smoking status, numerically higher long-term HRs of pelvic and invasive pelvic second malignancy in patients treated with brachytherapy compared to RP were noted.
Language	English
Publishing date	2024-04-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	3176-8
ISSN	1527-3792 ; 0022-5347
ISSN (online)	1527-3792
ISSN	0022-5347
DOI	10.1097/JU.0000000000003965
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Article ; Online: After ASCENDE-RT: Biochemical and survival outcomes following combined external beam radiotherapy and low-dose-rate brachytherapy for high-risk and unfavourable intermediate-risk prostate cancer, a population-based analysis.

Oh, Justin / Morris, W James / Spadinger, Ingrid / Tyldesley, Scott / Keyes, Mira / Halperin, Ross / Crook, Juanita / Lapointe, Vincent / Pickles, Tom

Brachytherapy

2022 Volume 21, Issue 5, Page(s) 605–616

Abstract: Purpose: To evaluate the outcomes of unfavorable intermediate-risk (UIR) and high-risk (HR) prostate cancer patients treated with combined external beam radiation therapy (EBRT) and low-dose-rate prostate brachytherapy (LDR-PB).: Methods and materials! ...

Abstract	Purpose: To evaluate the outcomes of unfavorable intermediate-risk (UIR) and high-risk (HR) prostate cancer patients treated with combined external beam radiation therapy (EBRT) and low-dose-rate prostate brachytherapy (LDR-PB). Methods and materials: A population-based cohort of 568 prostate cancer patients treated with combined EBRT and LDR-PB from 2010 to 2016 was analyzed. All patients received EBRT followed by LDR-PB boost. Outcomes were compared with the results for the brachytherapy arm of the ASCENDE-RT trial. Results: The median followup was 4.5 years. Sixty-nine percent (N = 391) had HR disease. Ninety-four percent of the HR and 57% of UIR were treated with androgen deprivation therapy (ADT) with a median duration of 12 months. The 5-year K-M biochemical progression-free survival (b-PFS), metastasis-free survival (MFS), and overall survival (OS) were 84 ± 2%, 90 ± 2%, and 88 ± 2%, similar to 89 ± 5%, 94 ± 4%, and 92 ± 4% for the ASCENDE-RT LDR-PB arm. The likelihood of achieving a PSA ≤0.2 ng/mL at 4 years was 88%, similar to 86% in the ASCENDE-RT LDR-PB arm. Thirty-three men (5.8%) would have been ineligible for ASCENDE-RT due to high-risk features. The 5-year K-M b-PFS, MFS and OS estimates were 86 ± 2%, 92 ± 1% and 89 ± 2% for the ASCENDE-RT eligible versus 56 ± 10% (p < 0.001), 73 ± 8% (p < 0.001), and 77 ± 9% (p = 0.098) for the ineligible patients. Conclusions: In this population-based cohort, combining LDR-PB with pelvic EBRT (+/- ADT) achieves very favorable b-PFS that compares to the LDR-PB arm of the ASCENDE-RT, supporting the generalizability of those results. Men ineligible for ASCENDE-RT, based on prognostic features, have a much higher risk of biochemical recurrence and metastatic relapse.
MeSH term(s)	Androgen Antagonists/therapeutic use ; Brachytherapy/methods ; Humans ; Male ; Neoplasm Recurrence, Local/etiology ; Prostate-Specific Antigen ; Prostatic Neoplasms/pathology ; Radiotherapy Dosage ; Retrospective Studies
Chemical Substances	Androgen Antagonists ; Prostate-Specific Antigen (EC 3.4.21.77)
Language	English
Publishing date	2022-06-18
Publishing country	United States
Document type	Evaluation Study ; Journal Article
ZDB-ID	2098608-7
ISSN	1873-1449 ; 1538-4721
ISSN (online)	1873-1449
ISSN	1538-4721
DOI	10.1016/j.brachy.2022.05.002
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Article: Assessing Health Implications of the Potential Radiation Exposure in the Community During Pregnancy: A Case Study.

Wong, Jordan / Clark, Haley / Corns, Robert / Tyldesley, Scott

Cureus

2017 Volume 9, Issue 10, Page(s) e1770

Abstract: The unintentional radiation exposure can have significant implications. We present a case of a 30-year-old pregnant female who was exposed to a potentially radioactive rock for over a one week period during her ... ...

Abstract	The unintentional radiation exposure can have significant implications. We present a case of a 30-year-old pregnant female who was exposed to a potentially radioactive rock for over a one week period during her 13
Language	English
Publishing date	2017-10-12
Publishing country	United States
Document type	Case Reports
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.1770
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