Pathmanathan, A.U., McNair, H.A., Schmidt, M.A., Brand, D.H., Delacroix, L., Eccles, C.L., Gordon, A., Herbert, T., van As, N.J., Huddart, R.A., et al.
(2019). Comparison of prostate delineation on multimodality imaging for MR-guided radiotherapy. Br j radiol,
OBJECTIVE:: With increasing incorporation of MRI in radiotherapy, we investigate two MRI sequences for prostate delineation in radiographer-led image guidance. METHODS:: Five therapeutic radiographers contoured the prostate individually on CT, T2 weighted (T2W) and T2* weighted (T2*W) imaging for 10 patients. Contours were analysed with Monaco ADMIRE (research v. 2.0) to assess interobserver variability and accuracy by comparison with a gold standard clinician contour. Observers recorded time taken for contouring and scored image quality and confidence in contouring. RESULTS:: There is good agreement when comparing radiographer contours to the gold-standard for all three imaging types with Dice similarity co-efficient 0.91-0.94, Cohen's κ 0.85-0.91, Hausdorff distance 4.6-7.6 mm and mean distance between contours 0.9-1.2 mm. In addition, there is good concordance between radiographers across all imaging modalities. Both T2W and T2*W MRI show reduced interobserver variability and improved accuracy compared to CT, this was statistically significant for T2*W imaging compared to CT across all four comparison metrics. Comparing MRI sequences reveals significantly reduced interobserver variability and significantly improved accuracy on T2*W compared to T2W MRI for DSC and Cohen's κ. Both MRI sequences scored significantly higher compared to CT for image quality and confidence in contouring, particularly T2*W. This was also reflected in the shorter time for contouring, measuring 15.4, 9.6 and 9.8 min for CT, T2W and T2*W MRI respectively. Conclusion: Therapeutic radiographer prostate contours are more accurate, show less interobserver variability and are more confidently and quickly outlined on MRI compared to CT, particularly using T2*W MRI. Advances in knowledge: Our work is relevant for MRI sequence choice and development of the roles of the interprofessional team in the advancement of MRI-guided radiotherapy..
Pathmanathan, A.U., Schmidt, M.A., Brand, D.H., Kousi, E., As, N.J. & Tree, A.C.
(2019). Improving fiducial and prostate capsule visualization for radiotherapy planning using
MRI. Journal of applied clinical medical physics,
Bashir, U., Tree, A., Mayer, E., Levine, D., Parker, C., Dearnaley, D. & Oyen, W.J.
(2019). Impact of Ga-68-PSMA PET/CT on management in prostate cancer patients with very early biochemical recurrence after radical prostatectomy. European journal of nuclear medicine and molecular imaging,
Patel, P.H., Palma, D., McDonald, F. & Tree, A.C.
(2019). The Dandelion Dilemma Revisited for Oligoprogression: Treat the Whole Lawn or Weed Selectively?. Clinical oncology,
De Bleser, E., Jereczek-Fossa, B.A., Pasquier, D., Zilli, T., Van As, N., Siva, S., Fodor, A., Dirix, P., Gomez-Iturriaga, A., Trippa, F., et al.
(2019). Metastasis-directed Therapy in Treating Nodal Oligorecurrent Prostate Cancer: A Multi-institutional Analysis Comparing the Outcome and Toxicity of Stereotactic Body Radiotherapy and Elective Nodal Radiotherapy. European urology,
Tree, A. & Dearnaley, D.
(2018). Randomised Controlled Trials Remain the Key to Progress in Localised Prostate Cancer. European urology,
Hanna, G.G., Murray, L., Patel, R., Jain, S., Aitken, K.L., Franks, K.N., van As, N., Tree, A., Hatfield, P., Harrow, S., et al.
(2018). UK Consensus on Normal Tissue Dose Constraints for Stereotactic Radiotherapy. Clinical oncology,
Pathmanathan, A.U., van As, N.J., Kerkmeijer, L.G., Christodouleas, J., Lawton, C.A., Vesprini, D., van der Heide, U.A., Frank, S.J., Nill, S., Oelfke, U., et al.
(2018). Magnetic Resonance Imaging-Guided Adaptive Radiation Therapy: A “Game Changer” for Prostate Treatment?. International journal of radiation oncology*biology*physics,
Tree, A.C., Jones, K., Hafeez, S., Sharabiani, M.T., Harrington, K.J., Lalondrelle, S., Ahmed, M. & Huddart, R.A.
(2018). Dose-limiting Urinary Toxicity With Pembrolizumab Combined With Weekly Hypofractionated Radiation Therapy in Bladder Cancer. International journal of radiation oncology*biology*physics,
Henderson, D.R., Murray, J.R., Gulliford, S.L., Tree, A.C., Harrington, K.J. & Van As, N.J.
(2018). An Investigation of Dosimetric Correlates of Acute Toxicity in Prostate Stereotactic Body Radiotherapy: Dose to Urinary Trigone is Associated with Acute Urinary Toxicity. Clinical oncology,
Grimwood, A., McNair, H.A., O'Shea, T.P., Gilroy, S., Thomas, K., Bamber, J.C., Tree, A.C. & Harris, E.J.
(2018). In Vivo Validation of Elekta's Clarity Autoscan for Ultrasound-based Intrafraction Motion Estimation of the Prostate During Radiation Therapy. International journal of radiation oncology*biology*physics,
Tree, A.C., Huddart, R. & Choudhury, A.
(2018). Magnetic Resonance-guided Radiotherapy — Can We Justify More Expensive Technology?. Clinical oncology,
Benjamin, L.C., Tree, A.C. & Dearnaley, D.P.
(2017). The Role of Hypofractionated Radiotherapy in Prostate Cancer. Curr oncol rep,
PURPOSE OF REVIEW: It is now accepted that prostate cancer has a low alpha/beta ratio, establishing a strong basis for hypofractionation of prostate radiotherapy. This review focuses on the rationale for hypofractionation and presents the evidence base for establishing moderate hypofractionation for localised disease as the new standard of care. The emerging evidence for extreme hypofractionation in managing localized and oligometastatic prostate cancer is reviewed. RECENT FINDINGS: The 5-year efficacy and toxicity outcomes from four phase III studies have been published within the last 12 months. These studies randomizing over 6000 patients to conventional fractionation (1.8-2.0 Gy per fraction) or moderate hypofractionation (3.0-3.4 Gy per fraction). They demonstrate hypofractionation to be non-inferior to conventional fractionation. Moderate hypofractionation for localized prostate cancer is safe and effective. There is a growing body of evidence in support of extreme hypofractionation for localized prostate cancer. Extreme hypofractionation may have a role in managing prostate oligometastases, but further studies are needed..
Bianchini, D., Lorente, D., Rescigno, P., Zafeiriou, Z., Psychopaida, E., O'Sullivan, H., Alaras, M., Kolinsky, M., Sumanasuriya, S., Sousa Fontes, M., et al.
(2017). Effect on Overall Survival of Locoregional Treatment in a Cohort of De Novo Metastatic Prostate Cancer Patients: A Single Institution Retrospective Analysis From the Royal Marsden Hospital. Clinical genitourinary cancer,
Patrikidou, A., Uccello, M., Tree, A., Parker, C., Attard, G., Eeles, R., Khoo, V., van As, N., Huddart, R., Dearnaley, D., et al.
(2017). Upfront Docetaxel in the Post-STAMPEDE World: Lessons from an Early Evaluation of Non-trial Usage in Hormone-Sensitive Prostate Cancer. Clinical oncology,
Ost, P., Jereczek-Fossa, B.A., As, N.V., Zilli, T., Muacevic, A., Olivier, K., Henderson, D., Casamassima, F., Orecchia, R., Surgo, A., et al.
(2016). Progression-free Survival Following Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Treatment-naive Recurrence: A Multi-institutional Analysis. European urology,
Henderson, D.R., Murray, J.R., Tree, A.C., Riley, U., Rosenfelder, N.A., Murray, D., Khoo, V.S. & van As, N.J.
(2016). Targeted Antibiotic Prophylaxis for Transrectal Fiducial Marker Insertion for Prostate Radiotherapy. Clinical oncology,
McPartlin, A.J., Li, X.A., Kershaw, L.E., Heide, U., Kerkmeijer, L., Lawton, C., Mahmood, U., Pos, F., van As, N., van Herk, M., et al.
(2016). MRI-guided prostate adaptive radiotherapy – A systematic review. Radiotherapy and oncology,
Tree, A.C., van As, N.J. & Dearnaley, D.P.
(2016). Re: Christopher J D Wallis, Refik Saskin, Richard Choo, et al Surgery Versus Radiotherapy for Clinically-localized Prostate Cancer: A Systematic Review and Meta-analysis Eur Urol 2016;70:21–30. European urology,
Bedford, J.L., Smyth, G., Hanson, I.M., Tree, A.C., Dearnaley, D.P. & Hansen, V.N.
(2016). Quality of treatment plans and accuracy of in vivo portal dosimetry in hybrid intensity-modulated radiation therapy and volumetric modulated arc therapy for prostate cancer. Radiotherapy and oncology,
Ost, P., Jereczek-Fossa, B.A., Van As, N., Zilli, T., Tree, A., Henderson, D., Orecchia, R., Casamassima, F., Surgo, A., Miralbell, R., et al.
(2016). Pattern of Progression after Stereotactic Body Radiotherapy for Oligometastatic Prostate Cancer Nodal Recurrences. Clinical oncology,
Pathmanathan, A.U., Alexander, E.J., Huddart, R.A. & Tree, A.C.
(2016). The delineation of intraprostatic boost regions for radiotherapy using multimodality imaging. Future oncol,
Dose escalation to the prostate improves tumor control but at the expense of increased rectal toxicity. Modern imaging can be used to detect the most common site of recurrence, the intraprostatic lesion (IPL), which has led to the concept of focusing dose escalation to the IPL in order to improve the therapeutic ratio. Imaging must be able to detect lesions with adequate sensitivity and specificity to accurately delineate the IPL. This information must be carefully integrated into the radiotherapy planning process to ensure the dose is targeted to the IPL. This review will consider the role and challenges of multiparametric MRI and PET computed tomography in delineating a tumor boost to be delivered by external beam radiotherapy..
Henderson, D., Murray, J., Tree, A., Riley, U., Murray, D. & van As, N.
(2015). Fiducial Marker Insertion for Image-guided Radiotherapy for Prostate Cancer: What is the Infection Rate and can Targeted Antibiotic Prophylaxis Reduce this?. Clinical oncology,
Henderson, D.R., Tree, A.C. & van As, N.J.
(2015). Stereotactic Body Radiotherapy for Prostate Cancer. Clinical oncology,
Aitken, K., Tree, A., Thomas, K., Nutting, C., Hawkins, M., Tait, D., Mandeville, H., Ahmed, M., Lalondrelle, S., Miah, A., et al.
(2015). Initial UK Experience of Stereotactic Body Radiotherapy for Extracranial Oligometastases: Can We Change the Therapeutic Paradigm?. Clinical oncology,
Tree, A., Ostler, P. & van As, N.
(2014). New Horizons and Hurdles for UK Radiotherapy: Can Prostate Stereotactic Body Radiotherapy Show the Way?. Clinical oncology,
Tree, A., Ostler, P., Hoskin, P., Dankulchai, P., Khoo, V. & van As, N.
(2014). First UK Cohort of Prostate Stereotactic Body Radiotherapy (SBRT): Acute Toxicity and Early Prostate-specific Antigen (PSA) Outcomes. Clinical oncology,
Tree, A.C., Khoo, V.S., van As, N.J. & Partridge, M.
(2014). Is Biochemical Relapse-free Survival After Profoundly Hypofractionated Radiotherapy Consistent with Current Radiobiological Models?. Clinical oncology,
Tree, A., Siu, B., Townsend-Thorn, D., Murray, D., Riley, U., Khoo, V. & van As, N.
(2014). The Incidence of Ciprofloxacin Resistance in Patients Undergoing Gold Seed Insertion for Image-guided Prostate Radiotherapy. Clinical oncology,
Tree, A.C., Ostler, P., Hoskin, P., Dankulchai, P., Nariyangadu, P., Hughes, R.J., Wells, E., Taylor, H., Khoo, V.S. & van As, N.J., et al.
(2014). Prostate Stereotactic Body Radiotherapy — First UK Experience. Clinical oncology,
Tree, A.C., Khoo, V.S., Eeles, R.A., Ahmed, M., Dearnaley, D.P., Hawkins, M.A., Huddart, R.A., Nutting, C.M., Ostler, P.J. & van As, N.J., et al.
(2013). Stereotactic body radiotherapy for oligometastases. Lancet oncol,
The management of metastatic solid tumours has historically focused on systemic treatment given with palliative intent. However, radical surgical treatment of oligometastases is now common practice in some settings. The development of stereotactic body radiotherapy (SBRT), building on improvements in delivery achieved by intensity-modulated and image-guided radiotherapy, now allows delivery of ablative doses of radiation to extracranial sites. Many non-randomised studies have shown that SBRT for oligometastases is safe and effective, with local control rates of about 80%. Importantly, these studies also suggest that the natural history of the disease is changing, with 2-5 year progression-free survival of about 20%. Although complete cure might be possible in a few patients with oligometastases, the aim of SBRT in this setting is to achieve local control and delay progression, and thereby also postpone the need for further treatment. We review published work showing that SBRT offers durable local control and the potential for progression-free survival in non-liver, non-lung oligometastatic disease at a range of sites. However, to test whether SBRT really does improve progression-free survival, randomised trials will be essential..
Tree, A., Wells, E., Khoo, V. & van As, N.
(2013). Hypofractionated Radiotherapy with Cyberknife for Localised Prostate Cancer: Early Experience. Clinical oncology,
Tree, A.C., Alexander, E.J., Van As, N.J., Dearnaley, D.P. & Khoo, V.
(2013). Biological Dose Escalation and Hypofractionation: What is There to be Gained and How Will it Best be Done?. Clinical oncology,
Tree, A., Jones, C., Sohaib, A., Khoo, V. & van As, N.
(2013). Prostate stereotactic body radiotherapy with simultaneous integrated boost: which is the best planning method?. Radiation oncology,
Creak, A.L., Tree, A. & Saran, F.
(2011). Radiotherapy Planning in High-grade Gliomas: a Survey of Current UK Practice. Clinical oncology,
Partridge, M., Tree, A., Brock, J., McNair, H., Fernandez, E., Panakis, N. & Brada, M.
(2009). Improvement in tumour control probability with active breathing control and dose escalation: A modelling study. Radiother oncol,
Introduction: The prognosis from non-small cell lung cancer remains poor, even in those patients suitable for radical radiotherapy. The ability of radiotherapy to achieve local control is hampered by the sensitivity of normal structures to irradiation at the high tumour doses needed. This Study aimed to look at the potential gain in tumour control probability from dose escalation facilitated by moderate deep inspiration breath-hold.Method: The data from 28 patients, recruited into two separate Studies were used. These patients underwent planning with and without the use of moderate deep inspiration breath-hold with an active breathing control (ABC) device. Whilst maintaining the mean lung dose (MLD) at the level of the conventional plan, the ABC plan dose was theoretically escalated to a maximum of 84 Gy, constrained by usual normal tissue tolerances. Calculations were performed using data for both lungs and for the ipsilateral lung only. Resulting local progression-free survival at 30 months Was Calculated using a standard logistic model.Results: The prescription dose could be escalated from 64 Gy to a mean of 73.7 +/- 6.5 Gy without margin reduction, which represents a statistically significant increase in tumour control probability from 0.15 +/- 0.01 to 0.29 +/- 0.11 (p<0.0001). The results were not statistically different whether both lungs or just the ipsilateral lung was used for calculations.Conclusion: A near-doubling of tumour control probability is possible with modest dose escalation, which can be achieved with no extra increase in lung dose if deep inspiration breath-hold techniques are used. (C) 2009 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 91 (2009) 325-329.
Henderson, D., Tree, A., Harrington, K. & van As, N.
Dosimetric Implications of Computerised Tomography-Only versus Magnetic Resonance-Fusion Contouring in Stereotactic Body Radiotherapy for Prostate Cancer. Medicines,
de Muinck Keizer, D.M., Pathmanathan, A.U., Andreychenko, A., Kerkmeijer, L.G., van der Voort van Zyp, J.R., Tree, A.C., van den Berg, C.A. & de Boer, J.C.
Fiducial marker based intra-fraction motion assessment on cine-MR for MR-linac treatment of prostate cancer. Physics in medicine & biology,