Download External Beam Radiotherapy for Prostate Cancer Patient Information

External Beam Radiotherapy
for Prostate Cancer
Patient Information
Genesis CancerCare treats all patients, referred to its service,
irrespective of their financial situation.
Across our centres, flexible fee arrangements are provided
on an individual patient basis to allow a rapid access to high
quality care.
Contents
Introduction 5
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Our RADIATION ONCOLOGISTS use the most advanced radiotherapy technology and proven medical techniques to care personalised treatment plan for each patient
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MEDICAL PHYSICISTS maintain rigorous quality assurance programs to ensure that the computer systems and x-ray equipment meet the highest standards
RADIATION THERAPISTS are tertiary trained healthcare professionals responsible for the simulation, calculation and delivery of each patients radiation treatment
RADIATION ONCOLOGY NURSES work with every member of the treatment team to care for patients and their family before, during and after treatment
PATIENT SERVICES OFFICERS provide coordination of support services and
referred medical appointments
ACCOUNTS ADMINISTRATION STAFF are available to explain how our
payment plans work
Radiation therapy planning and treatment 7
Side effects of radiotherapy 11
Looking after yourself during radiotherapy 14
Follow-up after treatment 16
Cost 18
Your team 20
Helpful sources of further information 24
Appendices
Hydrogel information 25
Insertion of Fiducial Markers 31
All enquiries and appointments:
Julia Hunter
Area Radiotherapy Cancer Care Co-ordinator
[email protected]
The Poche Centre
Suite 4, L2, 40 Rocklands Rd North Sydney, NSW 2060
Tel: +61 437 462 206 | Fax: +61 (0)2 9929 2687
prostateradiotherapy.com.au
Bladder and rectal preparation for prostate
radiotherapy 35
Dose Escalated IMRT/VMAT
Reduced side effects from treatment with excellent
results at 5 years 39
Urology related publications by A/Professor Andrew
Kneebone and A/Professor Thomas Eade 44
3
Introduction
Foreword
A diagnosis of prostate cancer will be confronting for not just our patients, but their
family, friends and workmates. We can reassure men that with the use of the most
modern radiotherapy techniques available in Australia, Professors Eade and Kneebone
combined with Genesis Care at the Mater and Macquarie University Hospitals, are
dedicated to not only providing the highest rates of cure for men with prostate cancer,
but also to keep the risk of unwanted side effects to an absolute minimum. Professors’
Eade and Kneebone established an image guided IMRT prostate radiotherapy
programme in 2007 and have had an overwhelming success in both these objectives.
When we analysed our results in early 2014 of more than 450 patients treated with high
dose IMRT radiation, we have had <0.5% of patients die from prostate cancer and only a
3% incidence of late rectal bleeding and a 13% rate where patients reported late urinary
difficulties at some stage following treatment. These are five year outcomes (which we
have attached as an appendix to this booklet) and we plan to continue to analyse and
update these figures over the years to come.
We hope that you find this booklet useful and encourage you to speak to us or one of
our team if you have any questions about any of the information enclosed. We would
like to thank all those who continue to support our Unit and our endeavours to provide
the best possible care to our patients.
A/Professor Thomas Eade and
A/Professor Andrew Kneebone
This booklet is designed to provide you with general information about what to expect
when undergoing radiation therapy to the prostate. In some cases, the information
contained in the booklet may not apply to you. If you have any doubts or concerns,
please ask any member of the Radiotherapy team.
Intensity Modulated Radiotherapy
(IMRT) and Volumetric Modulated Arc
Therapy (VMAT)
Both IMRT and VMAT are highly conformal
techniques for delivering radiation to the
prostate. Both techniques are offered at
the Mater Hospital and Macquarie
University Hospital. Your doctor may
suggest combining hormone therapy
with your course of radiotherapy,
especially if you have a more advanced
prostate cancer. Sometimes this hormone
therapy will be continued for a period of
time following your radiotherapy
treatment. Your doctor will explain the
reasons for the addition of this hormone
treatment and what it involves.
Information about hormone treatment
and the management of any subsequent
side effects is also available from Julia
Hunter, our Area Radiotherapy Cancer
Care Co-ordinator.
Why Radiotherapy and what is
involved?
Radiotherapy is designed to destroy
cancer cells in the designated treatment
area, while at the same time, trying to
limit damage to any surrounding normal
4
cells. The whole prostate gland is treated,
as well as the areas surrounding the gland.
High energy x-ray beams are directed at
the prostate from outside the body.
These beams damage the cancer cells and
stop them from dividing and growing.
The cancer cells are not able to recover
from this damage and subsequently die.
However, the normal healthy cells,
which mostly have the ability to repair
themselves, are left largely unaffected.
Should you have any questions about the
radiotherapy and the treatment field, your
doctor will happily explain this
information in more detail. IMRT and
VMAT are considered the most advanced
methods of radiation delivery currently
available for prostate cancer. They utilise
advanced computer technology to create
hundreds of small radiation beams of
varying strengths (modulated radiation)
coming from different directions or in a
continuous arc. This enables the radiation
dose to be shaped precisely around the
area that needs to be treated, while
missing the surrounding normal tissues.
IMRT and VMAT dramatically reduce the
high dose radiation exposure received by
the surrounding tissues.
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Radiation therapy planning and treatment
Radiation treatment to the prostate
generally involves 38 to 40 treatment
visits to the Radiotherapy Unit over a
period of approximately eight to nine
weeks. In selected cases, a shorter
treatment approach (20 treatments)
may be offered.
Medical
Information
It generally takes between three and five
weeks to organise your radiation
treatment. IMRT / VMAT are very precise
treatments and it is extremely important
to be accurate with the delivery of this
radiation treatment. All patients are
treated with ‘image guided radiotherapy’.
This means that the actual prostate
position is checked daily prior to each
treatment with special X-rays taken while
on the treatment couch. Your doctor will
offer to arrange fiducial markers (three
gold seeds) and hydrogel to be inserted
into your prostate (see appendix 1 and 2).
If fiducial markers are not possible
(e.g. because of blood thinning
medication) we can use an alternative
method to determine the daily position
of the prostate (e.g. cone beam CT
technology). The procedure to insert the
fiducial markers and hydrogel can be
performed by urologists or
A/Professor Eade usually at North Shore
Private Hospital (NSPH). Julia will discuss
the cost of hydrogel when performed by
A/Professor Eade. Please let your Radiation
An X-Ray image, showing the three gold seeds in the prostate which will guide the radiotherapy treatment.
6
Radiation therapy planning and treatment
Oncologist know if you do not have
private health insurance or would prefer
not to have hydrogel and fiducials.
After you have seen your doctor (and
before the treatment starts) you will need
to have a further three appointments:
1. Insertion of the fiducial markers and
hydrogel at NSPH (see Appendix 1)
2. MRI scan which is usually done at
North Shore Radiology (North Shore
Private Hospital, St Leonards)
3. Planning appointment at the hospital
that you are being treated (the Mater
Hospital or Macquarie University Hospital)
The planning appointment
At the planning appointment you will
have a CT scan (simulation) of your pelvis.
The CT scan (simulation) is performed
in the Radiotherapy Unit within the
Radiotherapy department of your treating
Hospital. You will also require a MRI pelvis
which is usually done at North Shore
Radiology, North Shore Private Hospital,
St Leonards.
N.B. Because the position of the prostate
can vary according to the fullness of the
bladder and rectum, we require that
you have a comfortably ‘full’ bladder and
empty rectum before the planning scans
and for each of your radiotherapy
treatments.
8
The MRI scans will help us determine the
position of the prostate and the
surrounding tissues, in order to more
accurately direct the radiation beams and
thereby reducing side effects.
CT scan
One hour before your CT scan, we would
like you to go to the toilet to empty your
bladder and bowel. After going to toilet,
please drink 500ml of water over a 15
minute period. The 45 minutes between
the drink and the scan will allow your
bladder to fill up to be comfortably full.
If you are feeling that your bladder is
uncomfortably full during this process,
please speak with one of the nursing or
radiotherapy staff.
the skin. We will also use some temporary
texta ink marks on your skin.
These texta marks can be washed away
after the planning appointment.
After the CT scan is taken, you will be
given a short tour of the unit to show you
where to go on your first day of treatment.
You should estimate that you will be at
the hospital for approximately two hours
on this day. Please take this into
consideration when parking your car if
you are driving.
Your treatment schedule
The Radiation Therapists will provide you
with a tentative start date and time at the
planning appointment. It is important
that you discuss any concerns with your
treatment schedule with the Radiation
Therapist at this time.
You will be able to drive yourself to the
hospital for treatment and continue with
your usual daily activities, such as
working. If you have difficulties organising
transport to the hospital for treatment,
please inform radiotherapy staff as
Volumetric Modulated Arc Therapy (VMAT) plan for prostate cancer. This patient has been treated to
80GY to the prostate and 85Gy to a dominant nodule of cancer (as defined by MRI). The yellow circle
around the patient indicates the continuous arc angles used for treatment.
When your bladder is an appropriate
size you will be taken to the CT scanning
room by a radiation therapist to begin
your CT scan. You will be positioned on
the CT bed as you will be for treatment.
If your bladder is too small you will be
required to drink some more water. If your
rectum is full, you may be given an enema
to help empty your rectum. You will then
be rescanned.
Three permanent skin tattoos are used as
reference points to mark the area we plan
to treat. They are the size of a small freckle
and are given with a small needle into
9
Radiation therapy planning and treatment
Side effects of radiotherapy
community transport may be available.
Please be aware that there is generally a
cost involved with community transport.
Radiotherapy works by killing cancer cells
using high energy x-rays. The normal cells
in the area being treated might also be
affected and this can cause side effects.
Normal tissue cells have a greater ability
to recover from the radiation than cancer
cells. The gap between each day of
treatment allows the normal cells to
recover. The following is a list of possible
side effects that you may experience.
Undergoing radiation therapy
treatment
The Radiation Therapists (RTs) give the
actual radiation therapy treatment. Each
treatment session takes about 10 minutes;
however, you are likely to be at the
hospital approximately 30 minutes
(depending upon the number of patients
waiting and if the machines are on
schedule). Please ensure that you have
followed the instructions for having a full
bladder and empty rectum
(see Appendix 2).
Treatment days and other
appointments
Radiation therapy treatment is given daily,
on weekdays only. There is no treatment
offered on weekends or public holidays.
You will also be asked to attend the
Poche centre every fortnight on a Friday
morning, so that your treatment can be
reviewed by your doctor. They will discuss
with you any side effects or concerns you
may have with treatment.
The ‘Dose Volume Histogram’ is used to determine the quality of the plan. This shows the rectal dose
(yellow) remains low despite the very high doses to the prostate (red, pink and blue).
Early side effects
Though great care is taken to minimise
the exposure of the tissues surrounding
the prostate, there is no way of avoiding
the exposure of small amounts of the
bladder and rectum tissue.
You may experience some bladder or
bowel symptoms (see below for more
details) at about two to three weeks after
starting treatment. However, be
reassured that in the majority of cases,
such symptoms will settle within
several weeks of ceasing treatment.
The main side effects during treatment
may include:
Urinary Problems
Many men find they need to pass urine
more frequently, especially at night. There
may also be a burning sensation when
passing urine. However, this symptom is
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likely to improve again, after treatment
ends. It is rare for radiation to cause
incontinence.
Skin
The skin around the anus may become
uncomfortable and some men may lose
some of their pubic hair in the weeks
following treatment. This is temporary and
the hair should grow back over several
months.
Sexual function
Sexually active men do NOT need to
refrain from sexual activity either during
or after treatment. Having sexual relations
during radiation treatment will NOT harm
your partner. Occasionally though, a
man may feel a slight ‘burning’ on orgasm
during the treatment phase.
It is usual following radiotherapy for your
ejaculation to dry up.
Tiredness, Fatigue & General
Symptoms
Tiredness and fatigue are common side
effects of treatment, although most men
continue to work and lead a normal life.
It is very rare to be sick during this
treatment and you will NOT lose your hair.
Bowel irritation
Although relatively uncommon, changes
to your bowel habits may occur during
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Side effects of radiotherapy
treatment. You may notice that you need
to go to the toilet more frequently, pass a
lot of wind, or have a feeling of urgency
and develop discomfort when passing a
motion. Some people may also
experience bleeding from the rectum
(especially if they have haemorrhoids) or
notice a mucus discharge, though this
last symptom is rare.
Long term side effects
Almost all patients make a good recovery
from their radiation treatment and do not
experience side effects that are a bother
to them in the long term.
Occasionally, however, some patients may
experience some side effects that may
persist, or even start, many months after
the radiation treatment has finished.
Some of these possible longer term/
late side effects may include:
Bowel (or rectal) injury
The most common symptom of late
radiation bowel damage can be rectal
bleeding. Though our advanced IMRT/
VMAT techniques have significantly
reduced such problems, approximately
5% of patients will require further
treatment for this condition. Such
treatments may include laser therapy or
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formalin applications to settle the
bleeding.
N.B. If you do develop rectal bleeding
after radiation treatment, a
colonoscopy is recommended to
determine the exact cause of the
bleeding.
Sometimes patients with bowel
damage may experience greater urgency
in having to go to the toilet. Patients may
also notice mucous (a slimy substance)
coming from the rectum which can stain
underpants. On rare occasions, a patient
might experience an ‘accident’, if they
do not find a toilet quickly enough. The
use of Metamucil can often help these
symptoms.
Urinary problems
For the majority of patients, urinary
function returns to normal within 2-3
months.
Occasionally, radiotherapy may also result
in blood in the urine. Should this occur,
you should advise your doctor, so it can
be further investigated.
Sexual functioning
Sexual function following prostate
radiotherapy is variable. In general,
approximately 70% of men will retain their
erections. There are medications available
by prescription that may help with your
sexual function. You can also be referred
to a doctor who specialises in erectile
dysfunction for further treatment.
Following radiotherapy, you will notice
that when you ejaculate very little fluid
comes out. This is due to the prostate
gland being destroyed.
It is also important to know that there
is absolutely NO risk of transferring the
prostate cancer from one person to
another and that having sexual
intercourse does NOT increase the risk
of the prostate cancer coming back.
functioning with your doctor. Assistance
can also be obtained from our Clinical
Psychologist, who is available to discuss
any relationship or sexuality adjustment
issues you may experience.
Hip injury
Our advanced radiotherapy techniques
dramatically lower the radiation dose to
the hips as compared to traditional ones,
therefore reducing the risk of damage to
the hips.
If you have any concerns or questions
about late radiation damage, please
discuss this with your doctor.
Please feel free to discuss ANY concerns
you may have about your sexual
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Looking after yourself during radiotherapy
General health and diet
In general, we encourage people to lead
a normal life as possible during their
radiotherapy. Many people continue to
work as normal during their treatment.
While undergoing radiotherapy, bath or
shower as usual using warm water but
avoid scrubbing at the skin in the treated
area.
It is important to maintain a well-balanced
diet during treatment. Please ask one of
our staff members if you would like to
speak to a dietician appointment for you.
On a regular basis you will undertake a
special scan, called a ‘cone beam’ CT scan.
This will provide accurate information on
the size of your bladder and rectum in
order to identify any changes in size.
Your doctor and Radiation Therapist will
Cone beam scans reveal whether your rectum and bladder are the right size throughout the treatment
schedule and are used regularly during your course of treatment.
give you feedback on the scan results
and may wish to discuss dietary changes
if changes in size are a problem. The
diagram below is an example of a ‘cone
beam’ scan.
Bowel side effects
If you develop diarrhoea, we may adjust
the amount of fibre in your diet or
recommend the use of medication. If
the skin around your anus becomes sore,
take care not to wipe too hard with toilet
paper. Occasionally your doctor will give
you creams or suppositories that can help
with this problem.
Bladder filling
You should have your bladder
comfortably full for the planning
appointment and each day for your
radiotherapy treatment.
500
ml
Your doctor will review this with you
during treatment and adjust the amount
of water and timing as required. If you are
feeling uncomfortable, please speak with
one of the treatment team as soon as you
arrive.
Bladder side effects
Generally we like people to drink plenty
of fluids. You may notice a ‘burning’
sensation when you are passing urine.
If you experience this, please talk to your
doctor as there may be medications that
can help.
Cranberry juice, purchased from the
supermarket, can also be used.
Approximately one
hour before your
appointment:
Empty your bladder
and bowels and
then drink 500 mls of
water in 15 minutes.
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Follow-up after treatment
General
Information
Success of the treatment is usually assessed using the PSA blood test. The first hurdle
is for the PSA level to come down post treatment and the second is for the PSA level
to stay down.
In order to monitor ongoing PSA levels, you will need to see your doctor periodically
after completing the full course of treatment.
An appointment will be made for you to come back to the clinic to see the doctor
six weeks to three months after the last treatment session. We recommend that you
have a check-up at least every six months for first five years following treatment and
then once yearly from then on. We can organise phone call follow-ups if you prefer.
Please contact Julia Hunter to arrange an appointment.
A blood test (PSA) is generally performed prior to each checkup.
Your follow up may be alternated between the Urologist who referred you and your
Radiation Oncologist.
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Cost
Understanding the costs for radiation treatment
Your first invoice is larger because it includes the costs for simulation and planning
that ensures the delivery of high-quality personal treatment. Simulation involves a
scan to measure your treatment site. Planning is behind-the-scenes-work your doctor
and Radiation Therapist do to design your personal treatment plan.
All you need is pay your invoice in full and Medicare reimburses you directly within
24-48 hours.
Understanding the Medicare Safety Net
The Medicare Safety Net provides financial assistance for outpatient medical expenses
for all Medicare card holders after you have reached the threshold amount.
Before
Safety Net
Gap
Understanding radiation treatment billing
• GenesisCare offers affordable, timely, personalised, high quality care
• Radiation treatment is typically an outpatient service, there is a cost
associated with your care
• Medicare offers approximately 80-90% of the costs of radiation treatment
• Most Private Health Funds do not cover outpatient services
• Our patient services team are here to help you understand the costs and
payment options for your treatment
After
Safety Net
Gap
Your
out-of-pocket
expenses
Safety
Net
Refund
Covered by
Medicare
Medicare
Safety
Net
Medicare
Safety
Net
Our patient services team will discuss Medicare reimbursement, the costs and
payment options together with you at your next appointment.
2015 Safety Net thresholds
Your
out-ofpocket
Threshold
amount
Covered by Medicare
Medicare
Safety
Net
Costs are lower in following weeks during treatment as we follow
a plan developed in week 1.
Medicare
Standard
Benefit
Week 1
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Week 2
Week 3
Week 4
Who is it for?
Benefit detail
80% out-of pocket costs
for outpatient
services
80% out-of pocket costs
for outpatient
services
Extended Safety
Net Concessional
and FTB (A)
$638
Concessional
cardholders and
families eligible
for FTB (A)
Extended Safety
Net General
$2000
Non-concession
Medicare cardholders
Week 5
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Your team
Associate Professor
Thomas Eade
Radiation Oncologist
Email: [email protected]
Your Team
A/Professor Thomas Eade returned to RNSH in January 2007, after time spent working
as the Thomas Baker Fellow at the Fox Chase Cancer Center in Philadelphia, USA. Fox
Chase, which specialises in the treatment of prostate cancer, is one of the leading
Radiation Oncology Centres in the USA. While in America, A/Professor Eade trained in
the latest radiation therapy techniques, including IMRT, intraoperative real-time seed
brachytherapy and high dose rate brachytherapy.
A/Professor Eade is now recognised across the country for his expertise in the IMRT/
VMAT and IGRT techniques for the treatment of prostate cancer. A/Professor Eade has
pioneered some of the most advanced prostate cancer ‘external beam’ treatments in
Australia. In 2008, A/Professor Eade also established a permanent seed brachytherapy
programme and high dose rate brachytherapy programme.
A/Professor Eade is also one of a few specialists in Australia able to offer intraoperative
real time seed brachytherapy treatment for prostate cancer. A/Professor Eade has been
a guest speaker at state, national and international meetings on advanced radiation
techniques.
In addition to his strong patient care and outcome focus, A/Professor Eade is also a
committed researcher. A/Professor Eade is the Director of Research in the Northern
Sydney Cancer Centre and also developed the prospective database for prostate cancer
radiotherapy, which is in use across the North Shore and Central Coast campus. A key
area of interest for A/Professor Eade is in researching and evaluating the delivery of new
technology in radiotherapy. He is the Principle Investigator for the first Australian study
of Stereotactic Radiotherapy (five treatments) for prostate cancer, which is currently
recruiting (HEAT study).
A/Professor Eade has authored articles on dose escalation and IMRT for prostate cancer
publications in major international oncology journals.
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Your team
Associate Professor
Andrew Kneebone
Radiation Oncologist
Email: [email protected]
A/Professor Andrew Kneebone has nearly 20 years experience as a prostate cancer
specialist and is committed to a caring, and honest relationship with his patients. For
more than 10 years he has been an integral member of the national Radiation Oncology
Genitourinary executive and has been an author on multiple guidelines for definitive
and post prostatectomy radiotherapy.
A/Professor Kneebone frequently sees patients from across Sydney for second opinions.
He regularly publishes Australian results on prostate cancer radiotherapy and continues
to collect prospective outcome and toxicity data on all prostate cancer patients, so as to
ensure he can provide his patients with the best level of care.
Due to his high profile, A/Professor Kneebone is on numerous state and national
committees related to the treatment of prostate cancer. In addition to being the
Convener for seven past national conferences on urological cancer, A/Professor
Kneebone was for six years the Secretary of the NSW Genitourinary Oncology Group.
A/Professor Kneebone remains a committed teacher to medical students and junior
doctors. He is attached to and lectures at the University of Sydney and is the Director of
Registrar Training at Royal North Shore Hospital. A/Professor Kneebone’s has a strong
interest in research and has been a Chief Investigator in trials attracting more than $4
million in competitive grants. He was the Principal Investigator, in 2 randomised
Australian trials, which were looking at methods to reduce bowel damage arising from
prostate radiotherapy and ways to better keep patients still during radiotherapy
treatment.
A/Professor Kneebone is currently the Australian Chair for a multi centre randomised
trial which is trying to ascertain the optimal timing for post prostatectomy radiotherapy.
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This is called the RAVES trial and with a secured $2.1 million to fund ongoing
investigation. Further, A/Professor Kneebone has also been listed as an author on more
than 70 peer reviewed publications and has been invited speaker at more than 80
conferences or meetings.
Julia Hunter
Area Radiotherapy Cancer Care Co-ordinator
Email: [email protected]
Julia is one of our specialist cancer nurses. Her
role is to provide co-ordinated and supportive
care to radiation oncology cancer patients.
Julia is the key point of contact for the patient
and their family. Julia’s aim is to help make the
patient’s journey through the treatment process
as smooth as possible.
Radiation Oncology Nurses
The team of nurses within Radiation Oncology deliver expert nursing advice and care
for you and your family. They can provide you with information about your radiotherapy
including bladder and bowel education as well as providing emotional support for you
and your family.
Prostate Cancer Planning Team: Radiation Therapists
This specialised team of Radiation Therapists (RTs) are responsible for co-ordinating all
aspects of your care. From the planning scan and all the preparation in between, our RTs
will be happy to discuss any aspects of the preparation for your treatment, should you
have questions or concerns about.
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Helpful sources of further information
If you feel you require further information about your cancer
or the treatment, please don’t hesitate to contact your doctor
or our Area Radiotherapy Cancer Care Co-ordinator.
Appendix 1
Websites and Organisations
that may be helpful:
Hydrogel Information
Prostate Radiotherapy
www.prostateradiotherapy.com.au
NSW Cancer Council
www.cancercouncil.com.au
Cancer Institute, NSW
www.cancerinstitute.org.au
Prostate Cancer Foundation of Australia
www.prostate.org.au
Andrology Australia
www.andrologyaustralia.org
Continence Foundation of Australia www.continence.org.au
Impotence Australia
www.impotenceaustralia.com.au
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Hydrogel information
Radiotherapy treatment will treat your prostate cancer but it can also affect other
healthy tissues situated nearby, specifically your rectum.
Timetable for radiotherapy with hydrogel
Day of Hydrogel
Insertion
The rectum is the last 7 to 10 centimetres of the bowel and stores solid waste until it
leaves the body through the anus (see diagram 1.0 opposite). As the rectum is located
close to the prostate gland it can also receive radiation when the prostate is been
treated. In some patients this can cause it harm, in particular a condition called
proctitis. Proctitis is an inflammation of the rectum that causes discomfort and or pain,
bleeding and occasionally a discharge of mucus.
NORTH SHORE PRIVATE HOSPITAL
Insertion of Gold Fiducial Seeds
Gold fiducial seeds will be inserted into the prostate via an
injection through the skin whilst you are asleep, under general
anaesthetic. This is part of standard treatment if you have
radiotherapy to the prostate.
Insertion of Hydrogel
Whilst under general anaesthetic, and after the gold seeds
have been inserted into the prostate, the temporary gel will
be injected in to the space between your prostate and rectum
(see diagram 2.0 on the next page). This will be done under
ultrasound guidance to ensure the gel is delivered into the
right place. The gel is water based and will dissolve in
approximately 4 to 5 months. The gel will increase the distance
between the rectum and prostate which it is expected will
reduce the radiation dose to the rectum, and potentially
reduce side effects from the treatment.
Other side effects can include an urgency to go to the toilet, more frequent bowel
movements and/or diarrhoea. Hydrogel is a temporary gel that is injected into the space
between your prostate and rectum before the start of your treatment.
The aim is to reduce the dose of radiation received by the rectum by increasing the
distance between the prostate gland and the rectum so that any potential side effects
will be reduced.
Diagram 1.0 Anatomy of the Rectum and Prostate, Image © 2008 WebMD, LLC
You will not be required to stay in hospital overnight,
but you will need to ensure you have transport to get
home as you will not be able to drive.
1 Week after the Insertion
of the Hydrogel
MRI
A Magnetic Resonance Imaging (MRI) scan of the pelvis will be
done one week after the hydrogel insertion to assist with the
planning of your treatment. It is usually done in the North
Shore Radiology, North Shore Private Hospital. The hydrogel is
easily seen on an MRI scan but not on a CT scan.
CT scan
A pelvic CT scan will be done in the radiotherapy department
of your treating hospital. The scan will be used to plan the
delivery of your radiotherapy treatment now the gel is in place.
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Insertion of hydrogel into the prostate
MRI scans of patient with and without hydrogel
Prostate
Hydrogel
US Probe
Normally the prostate (pink circle)
rests right against the rectum
(blue circle). The red circle is the
area that is receiving the full dose
of radiation.
This means that in the majority of
cases, the front wall of the rectum
receives the full dose of radiation.
Rectum
Space OAR Gel
You are not under any obligation to have the hydrogel insertion in order to have
radiotherapy at the Mater Hospital or Macquarie University Hospital. If you decide not
have hydrogel, you will still receive the standard treatment available for your prostate
cancer.
Costs of Hydrogel Insertion
There are costs involved with the hydrogel procedure.
This is the same patient after some
hydrogel (white area) has been
inserted between the prostate and
the rectum.
This means that the front wall of
the rectum no longer receives the
full dose of radiation.
•
•
The cost is covered by your private health insurance
The procedure is done at North Shore Private Hospital as a day procedure
You may have to pay an excess for the hospital stay
Please check with your health fund regarding your excess fees
• You will get a bill for the Anaethestist. There may be a gap. A/Professor Eade
can let you know which Anaethestist he will be using to enable you to get a
quote from them prior to the procedure
28
29
Risks of hydrogel
All medical procedures involve some risk of injury.
1. Insertion of Hydrogel
There have been three previous studies, with a total of 27 patients, using a similar gel
treatment. No adverse events were observed in this small population. However, in spite
of all reasonable precautions, you might develop medical complications from the
insertion of the gel but these would be considered as rare.
The possible risks associated with the insertion of the hydrogel are:
•
•
•
•
•
•
•
Infection (you will be provided with antibiotics to help prevent this)
Allergic reactions such as itching
Injection site reactions including bleeding and pain
Difficulty passing urine
Pressure in your bowel or a sensation of your bowel feeling full
Systemic embolisation if the gel or air is injected into a blood vessel
Needle penetration of the rectal wall or urethra during injection and injection
of the hydrogel into the rectum, prostate or bladder
Appendix 2
Insertion of Fiducial Markers
2. Insertion of Gold Fiducial Seeds
The possible risks associated with the insertion of the Gold Fiducial Seeds are:
•
•
•
Infection (you will be provided with antibiotics to help prevent this)
Bleeding from the injection site
Bleeding from the prostate which would show up in the urine and/or faeces
lasting 2-3 days in duration
• Urinary retention (unable to go to the toilet and pass water, for more than 8 hours)
If you have questions regarding the hydrogel procedure, costs or the radiotherapy
treatment, please do not hesitate to contact A/Professor Thomas Eade or
A/Professor Andrew Kneebone. Alternately, you can contact Julia Hunter,
Area Radiotherapy Cancer Care Co-ordinator.
30
31
Insertion of Fiducial Markers
Implantation of Gold Seeds into the prostate
Introduction and background
The aim of your prostate cancer treatment is to deliver radiation therapy as precisely
as possible to the prostate and spare the surrounding structures such as the bladder
and rectum. However, even when lying still, the prostate continually moves due to the
bladder and rectum constantly changing size and position. This means that the radiotherapy ‘margins’ around the prostate need to be generous and even then, we are not
always certain that all of the prostate cancer is being treated every day. To overcome this
problem, we have to establish a system of
placing gold seeds (fiducial markers) into the prostate and monitoring the position of
the prostate every day during treatment.
Gold markers are small gold beads measuring 3 x 1.5mm in size that when inserted into
the prostate can be seen on special X-rays taken by your radiotherapy
machine just prior to your treatment being given. We can then make movements to
ensure that your prostate is in exactly the right position during your treatment. These
corrections are only possible because the change in the position of the gold markers
indicates movement of the prostate. Reports have shown that radiation therapy treatments using gold markers have been much more precise than the traditional approach
of relying on the position of bony structures.
The implantation of the gold markers into the prostate can be an uncomfortable procedure and is be very similar to your biopsy experience though only 3 needles will be
inserted. As with the prostate biopsy, this procedure has shown to be safe and reliable.
The gold markers are placed in the prostate, under general
anaesthesia, by A/Professor Thomas Eade under ultrasound guidance. Patients are
required to take antibiotics on the day of the procedure to reduce the risk of
potential infection. The fiducial markers stay in the prostate permanently but
cannot be felt and are not known to cause any long term complications.
32
Potential Risks
Gold seed marker implantation is an invasive technique with a less than 5% risk of
infection. However in some cases the infection can spread to the blood (septicaemia)
which can be very serious. To minimise the risk of infection, you will take some
antibiotics on the morning of the procedure.
Minimal bruising that lasts for one to two days that might be experienced by gold seed
implantation can be treated with paracetamol. You may notice some blood in your
ejaculate or urine which in rare cases can require treatment (this is why blood thinning
medication such as aspirin needs to be stopped).
How is the procedure performed?
The procedure is done with a general anaesthetic (you are asleep during the procedure)
at North Shore Private Hospital. A probe with an ultrasound device about the size of a
finger is inserted through the anus to visualise the prostate. Using a probe, a very fine
needle, with a gold seed marker at its tip, can be directed into the prostate. When the
needle is in the correct position the gold seed marker is implanted from the needle tip.
Three gold seed markers will be inserted into your prostate.
What must you do before the procedure?
If you are currently taking blood-thinning agents e.g. Warfarin, clopidgrel or Aspirin
please inform your Radiation Oncologist. If your medications are unable to be safely
stopped, your doctor will discuss cancelling the fiducial marker procedure and using
Conebeam CT for your radiation treatment. If it is safe to do so your specialist may ask
you to stop the medications prior to your procedure. These need to be ceased for 10
days prior to the fiducial markers insertion. Please also avoid anti-inflammatory
medications for 10 day prior to procedure.
You do not need to fast as you would for an operation. On the morning of the
procedure, however you should not eat any solid foods. Fluids such as jellies and soups
are fine. On arrival to the Radiation Oncology department, you will be asked to take
an oral antibiotic. You may also be given an intravenous antibiotic (via a needle in your
arm). A nurse will then give you a fleet enema to empty your bowels.
33
Insertion of Fiducial Markers
Side Effects
One of the advantages of performing the procedure under ultrasound guidance is to
decrease the risk of damage to adjacent organs, however side effects and complications
may still occur from this procedure.
For a day or so following the procedure you may notice MINOR pelvic discomfort or
pain. MINOR blood staining of your urine/bowel motions may last for up to a week or so.
For a month or so following the procedure, you may notice blood staining of your
ejaculate.
Possible Complications
If any of the following main complications develop:
• Severe infection (symptoms include feeling generally unwell, raised
temperature, shivers etc most commonly manifested in the first 24-72 hours)
• Urinary retention (inability to pass urine for 8 hours)
• Profuse bleeding from the rectum or penis
contact your Radiation Oncologist IMMEDIATELY and proceed to the Emergency
Department, Royal North Shore Hospital or your local hospital without delay, as
you may need urgent admission to hospital for intravenous antibiotics or other
treatment.
Infection develops in approximately 1 in 100 procedures and urinary retention/profuse
bleeding occur in less than 1 in 1000. Spread of infection to the spine and death from
infection is rare.
Appendix 3
Bladder and Rectal Preparation for
Prostate Radiotherapy
After the procedure
1. Drink plenty of fluids
2. You will probably notice some blood in your urine, your bowel motion or in your
semen. Do not be alarmed, this should settle down within a few days.
3. Problems are uncommon but you must go to the Emergency Department at your nearest hospital if you experience any of the following :
a. Excessive bleeding
b. Increased difficulty passing urine
c. Fever above 37.5°C, rigors, shivers or shakes
4. If you have any concerns or questions, contact our Radiation Oncologist
34
35
Bladder and rectal preparation for prostate radiotherapy
Why is this preparation important?
The rectum lies behind the prostate. Changes in the shape and size of the rectum alter
the position of the prostate. If there are significant changes during radiotherapy
treatment, the prostate can potentially receive a reduced amount of radiation than
intended. We, therefore, would like to have your rectum approximately the same size at
the planning appointment and each day during treatment.
Your doctor has suggested a course of radiotherapy for the
treatment of your prostate cancer. You will need to have a
comfortably full bladder and empty rectum at your planning
appointment and each day during treatment.
This information sheet will explain the process you will
need to go through to do this and help keep your bladder
and bowel a consistent size during treatment.
The bladder lies in front and above the prostate and below the small bowel. When the
bladder gets bigger it pushes the small bowel up and away from the prostate. By having
a comfortably full bladder, your small bowel will receive less radiation and reduced side
effects.
How should you prepare for your planning appointment?
Prior to radiotherapy, you will be required to attend an MRI which is usually done at
North Shore Radiology, North Shore Private Hospital and a planning appointment
involving a CT scan in the radiotherapy department of your treating hospital.
Bladder and rectal preparation
One hour before both scans, please go to the toilet and empty your bowels and bladder.
You should then drink 500mls of water within 15 minutes and not empty your bladder
until after your scans. If you are feeling that your bladder is uncomfortably full during
this process, please speak with one of the nursing or radiotherapy staff.
Planning CT scan
During the CT scan, you will be positioned on the CT bed as you will be for treatment.
If your rectum is full, the staff may give you an enema to help empty your bowels. You
will then be rescanned.
After the CT scan is taken you will be given a short tour to show you where to go on
your first day of treatment and given a tentative start date and time. The staff will call
you once the start date is confirmed. You should estimate that you will be in the unit for
approximately two hours. Please take this into consideration when parking your car if
you are driving.
36
37
Bladder and rectal preparation for prostate radiotherapy
How should you prepare for your treatment?
Your treatment will begin 2-3 weeks after your planning appointment. Each day you are
having treatment, you will need to have your rectum and bladder the same size as they
were at your planning appointment.
One hour before your treatment appointment time, you will need to empty your rectum
and bladder. You then should drink 500ml of water over 15 minutes. This will help you
get your bladder to the same size it was at the planning appointment.
Please feel free to arrive at the department earlier than your treatment appointment and
go through this preparation here.
How do you know if your preparation is working?
For the first three treatments and then once a week during your treatment you will
have a CT scan in the treatment room just prior to beginning your treatment. This gives
us information on the treatment area and shows us the rectum and bladder. From this
the radiotherapy staff and you doctor will feedback information regarding your rectum
and bladder. They will advise you if you need to drink more or less water and if any
adjustments to your diet or medications are needed.
Appendix 4
Dose Escalated IMRT/VMAT –
Reduced side effects from treatment with
excellent results at 5 years
1L
Tips to help you with the preparation
•
•
•
38
Keep hydrated during the day so the water you drink before your appointment will go to your bladder. Try to drink at least 1 litre of water throughout the day.
Minimise drinking caffeine drinks such as coffee, tea or caffeinated soft drinks.
These make you feel like your bladder is too full when it isn’t.
If you are having difficulties emptying your rectum and feel you are constipated, please speak with the radiation therapy staff and they can advise you on what can be done to help you.
39
Dose Escalated IMRT/VMAT – Reduced side effects from
treatment with excellent results at 5 years
The following graphs show the quality of life outcomes of 415 patients, using a validated
international scoring system – EPIC. All patients were treated with advanced
radiotherapy for prostate cancer by Professors Eade and Kneebone, using daily image
guidance (IGRT) and either IMRT of VMAT. Average dose to the prostate was 82Gy.
40
The graphs show the pre-treatment scores (ie prior to radiation) and the post treatment
scores to five years. With modern advanced radiotherapy the side effects are now much
reduced. As the graphs show, on average there is very little impact on patient quality of
life in bowel or bladder function following radiotherapy.
41
Dose Escalated IMRT/VMAT – Reduced side effects
from treatment with excellent results at 5 years
42
43
Urology related publications by A/Professor Andrew Kneebone
and A/Professor Thomas Eade
Keall PJ, Aun Ng J, O’Brien R, Colvill E, Huang CY, Rugaard Poulsen P, Fledelius W, Juneja P, Simpson E, Bell L,
Alfieri F, Eade T, Kneebone A, Booth JT.
THE FIRST CLINICAL TREATMENT WITH KILOVOLTAGE INTRAFRACTION MONITORING (KIM):
A REAL-TIME IMAGE GUIDANCE METHOD.
MED PHYS. 2015 JAN;42(1):354. DOI: 10.1118/1.4904023. PMID: 25563275 [PUBMED - IN PROCESS]
Su MZ, Kneebone AB, Woo HH.
ADJUVANT VERSUS SALVAGE RADIOTHERAPY FOLLOWING RADICAL PROSTATECTOMY: DO THE
AUA/ASTRO GUIDELINES HAVE ALL THE ANSWERS?
EXPERT REV ANTICANCER THER. 2014 NOV;14(11):1265-70. DOI: 10.1586/14737140.2014.972381. PMID:
25367321 [PUBMED - IN PROCESS]
Appendix 5
Urology related publications by
A/Professor Andrew Kneebone and A/Professor Thomas Eade
Forde E, Bromley R, Kneebone A, Eade T.
“A CLASS SOLUTION FOR VOLUMETRIC-MODULATED ARC THERAPY PLANNING IN
POSTPROSTATECTOMY RADIOTHERAPY.”
MED DOSIM. 2014 AUTUMN;39(3):261-5.
Bell LJ, Cox J, Eade T, Rinks M, Kneebone A.
“THE IMPORTANCE OF PROSTATE BED TILT DURING POSTPROSTATECTOMY INTENSITY-MODULATED
RADIOTHERAPY.”
Med Dosim. 2014 Autumn;39(3):235-41
Stanley K, Eade T, Kneebone A, Booth JT.
INVESTIGATION OF AN ADAPTIVE TREATMENT REGIME FOR PROSTATE RADIATION THERAPY.
PRACT RADIAT ONCOL. 2015 JAN-FEB;5(1):E23-9. DOI: 10.1016/J.PRRO.2014.03.015. EPUB 2014 MAY 15.
PMID: 25413422 [PUBMED - IN PROCESS]
Brown BB, Young J, Smith DP, Kneebone AB, Brooks AJ, Xhilaga M, Dominello A, O’Connell DL, Haines M.
“CLINICIAN-LED IMPROVEMENT IN CANCER CARE (CLICC) – TESTING A MULTIFACETED
IMPLEMENTATION STRATEGY TO INCREASE EVIDENCE-BASED PROSTATE CANCER CARE:
PHASED RANDOMISED CONTROLLED TRIAL – STUDY PROTOCOL.”
IMPLEMENT SCI. 2014 MAY 29;9:64.
Pearse M, Fraser-Browne C, Davis ID, Duchesne GM, Fisher R, Frydenberg M, Haworth A, Jose C, Joseph DJ, Lim
TS, Matthews J, Millar J, Sidhom M, Spry NA, Tang CI, Turner S, Williams SG, Wiltshire K, Woo HH, Kneebone A.
“A PHASE III TRIAL TO INVESTIGATE THE TIMING OF RADIOTHERAPY FOR PROSTATE CANCER WITH
HIGH-RISK FEATURES: BACKGROUND AND RATIONALE OF THE RADIOTHERAPY – ADJUVANT VERSUS
EARLY SALVAGE (RAVES) TRIAL.”
BJU INT. 2014 MAR;113 SUPPL 2:7-12.
44
45
Urology related publications by A/Professor Andrew Kneebone
and A/Professor Thomas Eade
Sundaresan P, Turner S, Kneebone A, Pearse M, Fraser-Browne C, Woo HH.
“DO SCREENING TRIAL RECRUITMENT LOGS ACCURATELY REFLECT THE ELIGIBILITY CRITERIA OF A
GIVEN CLINICAL TRIAL? EARLY LESSONS FROM THE RAVES 0803 TRIAL.”
CLIN ONCOL (R COLL RADIOL). 2014 MAR 27.
Forde E, Kneebone A, Bromley R, Guo L, Hunt P, Eade T.
“VOLUMETRIC-MODULATED ARC THERAPY IN POSTPROSTATECTOMY RADIOTHERAPY PATIENTS:
A PLANNING COMPARISON STUDY.”
MED DOSIM. 2013 APR 23.
van Gysen K, Kneebone A, Alfieri F, Guo L, Eade T.
“FEASIBILITY OF AND RECTAL DOSIMETRY IMPROVEMENT WITH THE USE OF SPACEOAR® HYDROGEL
FOR DOSE-ESCALATED PROSTATE CANCER RADIOTHERAPY.”
J MED IMAGING RADIAT ONCOL. 2014 MAR 3. DOI: 10.1111/1754-9485.12152. [EPUB AHEAD OF PRINT]
Van Gysen KL, Kneebone AB, Guo L, Vaux KJ, Lazzaro EM, Eade TN.
“HEALTH-RELATED QUALITY OF LIFE USING INTENSITY-MODULATED RADIATION THERAPY FOR
POST-PROSTATECTOMY RADIOTHERAPY.”
J MED IMAGING RADIAT ONCOL. 2013 FEB;57(1):89-96.
Bell LJ, Cox J, Eade T, Rinks M, Kneebone A.
“THE IMPACT OF RECTAL AND BLADDER VARIABILITY ON TARGET COVERAGE DURING
POST-PROSTATECTOMY INTENSITY MODULATED RADIOTHERAPY.”
RADIOTHER ONCOL. 2014 FEB;110(2):245-50. DOI: 10.1016/J.RADONC.2013.10.042. EPUB 2014 FEB 20.
Stricker PD, Frydenberg M, Kneebone A, Chopra S.
“INFORMED PROSTATE CANCER RISK-ADJUSTED TESTING: A NEW PARADIGM.”
BJU INT. 2012 DEC;110 SUPPL 4:30-4.
Keall PJ, Colvill E, O’Brien R, Ng JA, Poulsen PR, Eade T, Kneebone A, Booth JT
“THE FIRST CLINICAL IMPLEMENTATION OF ELECTROMAGNETIC TRANSPONDER-GUIDED
MLC TRACKING.”
MED PHYS. 2014 FEB;41(2):020702. DOI: 10.1118/1.4862509.
Brown BB, Young J, Kneebone AB, Brooks AJ, Dominello A, Haines M.
KNOWLEDGE, ATTITUDES AND BELIEFS TOWARDS MANAGEMENT OF MEN WITH LOCALLY ADVANCED PROSTATE CANCER FOLLOWING RADICAL PROSTATECTOMY: AN AUSTRALIAN SURVEY
OF UROLOGISTS.
BJU INT. 2015 JAN 14. DOI: 10.1111/BJU.13037. [EPUB AHEAD OF PRINT] PMID: 25585989
[PUBMED - AS SUPPLIED BY PUBLISHER]
Sydes MR, Vale C, Kneebone A, Pearse M, Richaud P, Tierney JF, Parker CC.
“RE: ANDREW J. STEPHENSON, MICHEL BOLLA, ALBERTO BRIGANTI, ET AL. POSTOPERATIVE
RADIATION THERAPY FOR PATHOLOGICALLY ADVANCED PROSTATE CANCER AFTER RADICAL
PROSTATECTOMY.”
EUR UROL 2012;61:443-51. EUR UROL. 2012 SEP 11
Ng J, Booth J, Poulsen P, Eade T, Hegi F, Kneebone A, Kuncic Z, Keall P.
“TH-E-BRA-11: REAL-TIME TUMOR LO”CALIZATION WITH KILOVOLTAGE INTRAFRACTION
MONITORING: FIRST CLINICAL IMPLEMENTATION FOR PROSTATE INTENSITY MODULATED ARC
THERAPY.”
MED PHYS. 2012 JUN;39(6):4014.
Lehman M, Sidhom M, Kneebone AB, Hayden AJ, Martin JM, Christie D, Skala M, Tai KH.
“FROGG HIGH-RISK PROSTATE CANCER WORKSHOP: PATTERNS OF PRACTICE AND LITERATURE
REVIEW. PART II POST-RADICAL PROSTATECTOMY.”
J MED IMAGING RADIAT ONCOL. 2013 DEC 18. DOI: 10.1111/1754-9485.12139. [EPUB AHEAD OF
PRINT]
Hindson BR, Turner SL, Millar JL, Foroudi F, Gogna NK, Skala M, Kneebone A, Christie DR, Lehman M, Wiltshire
KL, Tai KH; on behalf of the RANZCR Faculty of Radiation Oncology Genito-Urinary Group (FROGG).
“AUSTRALIAN & NEW ZEALAND FACULTY OF RADIATION ONCOLOGY GENITO-URINARY GROUP:
2011 CONSENSUS GUIDELINES FOR CURATIVE RADIOTHERAPY FOR UROTHELIAL CARCINOMA OF
THE BLADDER.”
J MED IMAGING RADIAT ONCOL. 2012 FEB;56(1):18-30.
Lehman M, Hayden AJ, Martin JM, Christie D, Kneebone AB, Sidhom M, Skala M, Tai KH.
“FROGG HIGH-RISK PROSTATE CANCER WORKSHOP: PATTERNS OF PRACTICE AND LITERATURE
REVIEW: PART I: INTACT PROSTATE.”
J MED IMAGING RADIAT ONCOL. 2013 DEC 5. DOI: 10.1111/1754-9485.12142. [EPUB AHEAD OF PRINT]
Sundaresan P, Turner S, Kneebone AB, Pearse M, Butow P.
“EVALUATING THE UTILITY OF A PATIENT DECISION AID FOR POTENTIAL PARTICIPANTS OF A
PROSTATE CANCER TRIAL (RAVES-TROG 08.03).”
RADIOTHER ONCOL. 2011 DEC;101(3):521-4. EPUB 2011 OCT 8.
Bell LJ, Cox J, Eade T, Rinks M, Kneebone A.
“PROSTATE BED MOTION MAY CAUSE GEOGRAPHIC MISS IN POST-PROSTATECTOMY IMAGE-GUIDED
INTENSITY-MODULATED RADIOTHERAPY.”
J MED IMAGING RADIAT ONCOL. 2013 DEC;57(6):725-32. DOI: 10.1111/1754-9485.12089. EPUB 2013
JUL 9.
Eade TN, Guo L, Forde E, Vaux K, Vass J, Hunt P, Kneebone A.
“IMAGE-GUIDED DOSE-ESCALATED INTENSITY-MODULATED RADIATION THERAPY FOR
PROSTATE CANCER: TREATING TO DOSES BEYOND 78GY.”
BJU INT. 2011 OCT 28
46
47
Urology related publications by A/Professor Andrew Kneebone
and A/Professor Thomas Eade
Kench, J. G., D. R. Clouston, W. Delprado, T. Eade, D. Ellis, L. G. Horvath, H. Samaratunga, J. Stahl,
A. M. Stapleton, L. Egevad, J. R. Srigley and B. Delahunt (2011).
“PROGNOSTIC FACTORS IN PROSTATE CANCER. KEY ELEMENTS IN STRUCTURED
HISTOPATHOLOGY REPORTING OF RADICAL PROSTATECTOMY SPECIMENS.”
PATHOLOGY 43(5): 410-419.
Johnston, M. L., P. Vial, K. L. Wiltshire, L. J. Bell, S. Blome, Z. Kerestes, G. W. Morgan, D. O’Driscoll, T. P. Shakespeare
and T. N. Eade (2011).
“DAILY ONLINE BONY CORRECTION IS REQUIRED FOR PROSTATE PATIENTS WITHOUT FIDUCIAL
MARKERS OR SOFT-TISSUE IMAGING.”
CLIN ONCOL (R COLL RADIOL) 23(7): 454-459.
Martin, J. M., J. Frantzis, T. Eade and P. Chung (2010).
“CLINICIAN’S GUIDE TO PROSTATE IMRT PLAN ASSESSMENT AND OPTIMISATION.”
J MED IMAGING RADIAT ONCOL 54(6): 569-575.
Bell, L. J., L. Oliver, P. Vial, T. N. Eade, M. Rinks, E. Hammond, G. W. Morgan, M. Back and K. L. Wiltshire (2010).
“IMPLEMENTATION OF AN IMAGE-GUIDED RADIATION THERAPY PROGRAM: LESSONS LEARNT
AND FUTURE CHALLENGES.”
J MED IMAGING RADIAT ONCOL 54(1): 82-89.
Hayden AJ, Martin JM, Kneebone A., Lehman M, Wiltshire KL, Skala M, Christie D, Vial P, McDowall R, Tai KH;
Australian & New Zealand Faculty of Radiation Oncology Genito-Urinary Group.
“AUSTRALIAN & NEW ZEALAND FACULTY OF RADIATION ONCOLOGY GENITO-URINARY GROUP:
2010 CONSENSUS GUIDELINES FOR DEFINITIVE EXTERNAL BEAM RADIOTHERAPY FOR PROSTATE
CARCINOMA.”
J MED IMAGING RADIAT ONCOL. 2010 DEC;54(6):513-25. DOI: 10.1111/J.1754-9485.2010.02214.X
Boxer M, Forstner D, Kneebone A, Delaney G, Koh ES, Fuller M, Kaadan N.
“IMPACT OF A REAL-TIME PEER REVIEW AUDIT ON PATIENT MANAGEMENT IN A RADIATION
ONCOLOGY DEPARTMENT.”
J MED IMAGING RADIAT ONCOL. 2009 AUG;53(4):405-11
Hovey E., Marx G., Kneebone A., Patel M., Shapiro J.
“AN AUSTRALIAN CLINICAL PERSPECTIVE: MANAGEMENT OF HORMONE REFRACTORY (ANDROGEN
INDEPENDENT) PROSTATE CANCER.”
ASIA PACIFIC JOURNAL OF ONCOLOGY AND HAEMATOLOGY 2009; 1 :(1) MARCH
Sidhom M, Kneebone A, Lehman M, Wiltshire K, Millar J, Mukherjee R, Shakespeare T, Tai KH.
“POST PROSTATECTOMY RADIATION THERAPY: CONSENSUS GUIDELINES OF THE AUSTRALIAN AND
NEW ZEALAND RADIATION ONCOLOGY GENITO-URINARY GROUP”
RADIOTHER ONCOL. 2008 JUL;88(1):10-9
48
Lin C, Turner S, Mai T, Kneebone A, Gebski V
“LATE RECTAL AND URINARY TOXICITY FROM CONFORMAL, DOSE-ESCALATED RADIATION THERAPY
FOR PROSTATE CANCER: A PROSPECTIVE STUDY OF 402 PATIENTS.”
AUSTRALAS RADIOL. 2007 DEC;51(6):578-83
Wiltshire KL, Brock KK, Haider MA, Zwahlen D, Kong V, Chan E, Moseley J, Bayley A, Catton C, Chung PW,
Gospodarowicz M, Milosevic M, Kneebone A, Warde P, Ménard C.
“ANATOMIC BOUNDARIES OF THE CLINICAL TARGET VOLUME (PROSTATE BED) AFTER RADICAL
PROSTATECTOMY”
INT J RADIAT ONCOL BIOL PHYS. 2007 NOV 15;69(4):1090-9
Contributing author (steering committee member)
“LOCALISED PROSTATE CANCER - A GUIDE FOR MEN AND THEIR FAMILIES”
AUSTRALIAN PROSTATE CANCER COLLABORATION ISBN 0 9579938-1-1 DECEMBER 2001 AND
JULY 2006 EDITION
Chong CCW, Austen L., Kneebone A., Berry M., Lalak A., Moylan E.
“PATTERNS OF PRACTICE IN THE MANAGEMENT OF PROSTATE CANCER: RESULTS FROM
MULTIDISCIPLINARY SURVEYS OF CLINICIANS IN AUSTRALIA AND NEW ZEALAND IN 1995 AND
2000. “
BRITISH JOURNAL UROLOGY INTERNATIONAL 2006; 97: 975-980
Skala M, Holloway L, Bailey M, Kneebone A
“AUSTRALIA-WIDE COMPARISON OF IMRT PROSTATE PLANS”
AUSTRALAS RADIOL. 2005 JUN;49(3):222-9.
Skala M, Berry M, Duchesne G, Gogna K, Tai KH, Turner S, Kneebone A, Rolfo A, Haworth
A AUSTRALIAN AND “NEW ZEALAND 3D CONFORMAL RADIATION THERAPY (3DCRT) CONSENSUS
GUIDELINES FOR PROSTATE CANCER”
AUSTRALAS RADIOL. 2004 DEC;48(4):493-501.
Tai KH, Duchesne G, Turner S, Kneebone A, See A, Gogna K, Berry M
“THREE-DIMENSIONAL CONFORMAL RADIOTHERAPY IN THE TREATMENT OF PROSTATE CANCER IN
AUSTRALIA AND NEW ZEALAND: REPORT ON A SURVEY OF RADIOTHERAPY CENTRES AND THE
PROCEEDINGS OF A CONSENSUS WORKSHOP.”
AUSTRALAS RADIOL. 2004 DEC;48(4):502-8.
Kneebone A, Mameghan H, Bolin T, Berry M, Turner S, Kearsley J, Graham P, Fisher R, Delaney G.
“EFFECT OF ORAL SUCRALFATE ON LATE RECTAL INJURY ASSOCIATED WITH RADIOTHERAPY FOR
PROSTATE CANCER: A DOUBLE-BLIND, RANDOMIZED TRIAL.”
INT J RADIAT ONCOL BIOL PHYS. 2004 NOV 15;60(4):1088-97.
49
Urology related publications by A/Professor Andrew Kneebone
and A/Professor Thomas Eade
Jacob S, Berry M, Kneebone A, Delaney G, Fowler A, Behan S, Barton M.
“COMPUTERISED SCREENING FOR ANXIETY, DEPRESSION AND RADIATION TOXICITY IN
CANCER PATIENTS.”
CANCER FORUM 2004, VOLUME 28 (3): 143 – 146.
Kneebone A., Turner S., Berry M., Cakir, B. Gebski, V.
“PROSPECTIVE REVIEW OF OUTCOME FOLLOWING RADICAL IRRADIATION FOR CLINICALLY
LOCALISED PROSTATE CANCER”
AUSTRALASIAN RADIOLOGY 2003 DEC;47(4):422-7
Kneebone A., Hogendorn N.; Tramontana D.; Gapes L.; Turner S.; Gebski V.
“RANDOMISED TRIAL OF COMPLETE IMMOBILIZATION FOR PELVIC IRRADIATION”
INTERNATIONAL JOURNAL RADIATION ONCOLOGY BIOLOGY PHYSICS JULY 15;56(4):1105-11. 2003
Kneebone, A; Mameghan, H; Berry, M; Kearsley, J; Turner, S; Bolin, T; Fisher R; Graham P.; Delaney, G.
“A PHASE III RANDOMISED TRIAL TO ASSESS THE EFFECT OF ORAL SULCRALFATE ON THE ACUTE
PROCTITIS ASSOCIATED WITH PROSTATE RADIOTHERAPY”
INTERNATIONAL JOURNAL RADIATION ONCOLOGY BIOLOGY PHYSICS. 2001 NOV 1;51(3):628-35
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Genesis
Cancer Care
Consult Space
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Locations
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Mater
Hospital
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Transport
Public transport is available close by.
Bus stops are easily located on the corner of Rocklands Road and Pacific Highway.
North Sydney and St Leonards train stations are a 5-15 minute walk away.
Parking
Free parking available. Entry is located off 25 Rocklands Road. Free patient drop off
is available for 15 minutes at a time on neighbouring streets.
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WA
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Research Park Drive
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Transport
Macquarie University train station is
located two streets away on the corner
of Herring Road and Waterloo Road.
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Macquarie
University
Hospital
Parking
Parking is accessible on site in the marked bays at the front of the Clinic Building.
Alternative parking in the secure basement car park located off Research Park Drive.
cancer.com.au
prostateradiotherapy.com.au
St
Genesis
Cancer Care
Treatment
MATER HOSPITAL
Department of Radiation Oncology
Lower Ground Floor
40 Rocklands Road, North Sydney, NSW 2060
Tel: (02) 9458 8050 | Fax: (02) 9929 2687
MACQUARIE HOSPITAL
Hospital Building
Suite 1, Level B23 Technology Place
Macquarie University, NSW 2109
Tel: (02) 9812 3220 | Fax: (02) 9812 3389
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