Technical Innovations & Patient Support in Radiation Oncology, 2018
The European Society of Radiotherapy and Oncology (ESTRO)/International Atomic Energy Agency (IAE... more The European Society of Radiotherapy and Oncology (ESTRO)/International Atomic Energy Agency (IAEA) Best Practice in Radiation Oncology-a project to train RTT trainers has reached its ten year anniversary and will commence its fifth iteration in 2018. This project commenced as a novel way to address the issue of limited RTT education throughout Europe. In many countries the profession of RTT is not officially recognised and there is no formal education programme. RTT education is frequently a very short component of a broader programme such as diagnostic imaging, nursing or a technical discipline. To date, fifty-nine short courses have been delivered, two RTT-specific National societies have been developed, a South East European cooperation with biannual conferences has evolved and significant progress has been made on improving the radiotherapy-specific content of national educational programmes, which will continue with future iterations of this project.
Technical Innovations & Patient Support in Radiation Oncology, 2017
Background and purpose: Over the last decade, the management of locally advanced head and neck ca... more Background and purpose: Over the last decade, the management of locally advanced head and neck cancers (HNCs) has seen a substantial increase in the use of chemoradiation. These guidelines have been developed to assist Radiation TherapisTs (RTTs) in positioning, immobilisation and position verification for head and neck cancer patients. Materials and methods: A critical review of the literature was undertaken by the writing committee. Materials and methods: Based on the literature review, a survey was developed to ascertain the current positioning, immobilisation and position verification methods for head and neck radiation therapy across Europe. The survey was translated into Italian, German, Greek, Portuguese, Russian, Croatian, French and Spanish. Materials and methods: Guidelines were subsequently developed by the writing committee. Results: Results from the survey indicated that a wide variety of treatment practices and treatment verification protocols are in operation for head and neck cancer patients across Europe currently. Results: The guidelines developed are based on the experience and expertise of the writing committee, remaining cognisant of the variations in imaging and immobilisation techniques used currently in Europe. Conclusions: These guidelines have been developed to provide RTTs with guidance on positioning, immobilisation and position verification of HNC patients. The guidelines will also provide RTTs with the means to critically reflect on their own daily clinical practice with this patient group.
Technical Innovations & Patient Support in Radiation Oncology, 2021
Background and Purpose: The European SocieTy for Radiotherapy and Oncology Radiation Therapist Co... more Background and Purpose: The European SocieTy for Radiotherapy and Oncology Radiation Therapist Committee (ESTRO RTTC) published a guidance document and infographic providing recommendations to minimise risk of COVID-19 transmission in radiotherapy (RT) departments. The purpose of this study was to investigate the changes embedded in RT practice in the COVID-19 era and to recommend proactive measures to protect RT practice in future pandemics. Materials and Methods: The study was initiated by the ESTRO Radiation Oncology Safety and Quality Committee (ROSQC). A survey consisting of multiple choice, open ended and Likert scale questions was created to analyse the extent of changes embedded in RT practice in response to the COVID-19 pandemic under the four domains: patient care, RTT workflow, remote working and RT practice. This online survey was distributed globally in May 2020. Results: 229 respondents across 27 countries completed the survey. 60% of respondents reported continuing/commencing RT in COVID-19 patients. Routine testing of patients and RTTs was not common. Split teams' procedures, hot linacs and separate entrances were implemented by 50% of respondents. Remote working was implemented for RT team members where face to face patient contact was not essential. Lack of staff, connectivity issues and lack of confirmed positive cases in the department were the main reasons cited for not implementing recommended measures. Conclusion: It is suggested that RT departments have responded to the COVID-19 pandemic and implemented certain changes in RT practice. RT departments should act now to implement recommended proactive measures to protect patients and RTTs-frontline healthcare workers.
S144 2 nd ESTRO Forum 2013 survival, local control or toxicity profile. Epidemiological data was ... more S144 2 nd ESTRO Forum 2013 survival, local control or toxicity profile. Epidemiological data was searched to determine the proportion of new cases of cancer with each indication. Patient preference data were included for breast and prostate cancers. Indications and epidemiological data were reviewed by a court of external reviewers. Univariate and Monte Carlo simulations were used in sensitivity analysis. Results: Over 600 papers and guidelines were reviewed for 20 cancer sites. The proportions of cancer types had changed markedly over 10 years. Prostate cancer increased from 12% of all cancers to 18%. The guidelines suggest that 48.6% of new cases of cancer have an indication for radiotherapy (with or without chemotherapy) at least once in the course of their illness. The range was from 0% for liver cancer to 94% for vaginal cancer. 9.1% of cases had an indication for synchronous chemoradiotherapy. Conclusions: The small decrease in optimum radiotherapy utilisation rate was mostly due to changes in the proportions of cancer in the population and the removal of a small numberof indications for radiotherapy.
Technical Innovations & Patient Support in Radiation Oncology
This guideline details the European Higher Education Area Levels 7 and 8 Postgraduate benchmarkin... more This guideline details the European Higher Education Area Levels 7 and 8 Postgraduate benchmarking document for Radiation TherapisTs (RTTs). The purpose of this benchmarking document is to assist higher education institutes in the development of radiation therapy-specific curricula for RTTs engaging in postgraduate education, with a view to working at an advanced level in radiation therapy departments. The document specifies the knowledge, skills and competences that are required to work in specific areas of RTT practice, at levels 7 and 8. These include: advanced delineation and volume determination, advanced treatment planning, advanced imaging, quality and risk management, management and service development, patient care and support, brachytherapy and research.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Feb 5, 2017
The IAEA has developed a methodology for comprehensive quality audits of radiotherapy practices c... more The IAEA has developed a methodology for comprehensive quality audits of radiotherapy practices called Quality Assurance Team for Radiation Oncology (QUATRO). This study explores the factors that impacted quality of care among QUATRO audited centres in the IAEA Europe Region. The 31 QUATRO reports collected over 10years include extensive data describing the quality of radiotherapy at the audited centres. A coding key was developed to aggregate and review these data in terms of recommendations for improvement and positive findings (commendations). Overall 759 recommendations and 600 commendations were given. Eight centres recognized as centres of competence differed from other centres mostly because they operated complete quality management systems and were adequately staffed. Other centres had excessive staff workloads and many gaps in the process of care. Insufficient equipment levels were prevalent. Patient centredness, communication, dosimetry, quality control and radiation prote...
Http Dx Doi Org 10 4161 Cbt 4 4 1646, Feb 21, 2005
Hypoxia is an inevitable feature of solid tumors and a common cause of treatment failure. Hypoxia... more Hypoxia is an inevitable feature of solid tumors and a common cause of treatment failure. Hypoxia acts as a trigger to genetic instability, apoptosis and possibly metastases. The adaptive response to cellular hypoxia involves the modulation of the synthesis of multiple proteins controlling processes such as glucose homeostasis, angiogenesis, vascular permeability and inflammation. The hypoxia responsive element (HRE) sequences isolated from oxygen-responsive genes have been shown to selectively induce gene expression in response to hypoxia when placed upstream of a promoter. The levels of induced gene expression were dependent on the number of HRE copies and the oxygen tension. Hypoxia-mediated cancer gene therapy strategies may represent a promising mean to significantly improve the efficacy of standard radiation therapy and chemotherapy approaches.
The molecular basis for the progression of breast and prostate cancer from hormone dependent to h... more The molecular basis for the progression of breast and prostate cancer from hormone dependent to hormone independent disease remains a critical issue in the management of these two cancers. The DNA mismatch repair system is integral to the maintenance of genomic stability and suppression of tumorigenesis. No firm consensus exists regarding the implications of mismatch repair (MMR) deficiencies in the development of breast or prostate cancer. However, recent studies have reported an association between mismatch repair deficiency and loss of specific hormone receptors, inferring a potential role for mismatch repair deficiency in this transition. An updated review of the experimental data supporting or contradicting the involvement of MMR defects in the development and progression of breast and prostate cancer will be provided with particular emphasis on their implications in the transition to hormone independence.
J.M. Borras). Radiotherapy and Oncology xxx (2015) xxx-xxx Contents lists available at ScienceDir... more J.M. Borras). Radiotherapy and Oncology xxx (2015) xxx-xxx Contents lists available at ScienceDirect Radiotherapy and Oncology j o u r n a l h o m e p a g e : w w w . t h e g r e e n j o u r n a l . c o m Please cite this article in press as: Borras JM et al. The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population based analysis by the ESTRO-HERO project. Radiother Oncol (2015), http://dx.
Background and purpose: The absolute number of new cancer patients that will require at least one... more Background and purpose: The absolute number of new cancer patients that will require at least one course of radiotherapy in each country of Europe was estimated. Material and methods: The incidence and relative frequency of cancer types from the year 2012 European Cancer Observatory estimates were used in combination with the population-based stage at diagnosis from five cancer registries. These data were applied to the decision trees of the evidence-based indications to calculate the Optimal Utilization Proportion (OUP) by tumour site. Results: In the minimum scenario, the OUP ranged from 47.0% in the Russian Federation to 53.2% in Belgium with no clear geographical pattern of the variability among countries. The impact of stage at diagnosis on the OUP by country was rather limited. Within the 24 countries where data on actual use of radiotherapy were available, a gap between optimal and actual use has been observed in most of the countries. Conclusions: The actual utilization of radiotherapy is significantly lower than the optimal use predicted from the evidence based estimates in the literature. This discrepancy poses a major challenge for policy makers when planning the resources at the national level to improve the provision in European countries.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2014
The ESTRO Health Economics in Radiation Oncology (HERO) project has the overall aim to develop a ... more The ESTRO Health Economics in Radiation Oncology (HERO) project has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The first milestone was to assess the availability of radiotherapy resources within Europe. This paper presents the personnel data collected in the ESTRO HERO database. An 84-item questionnaire was sent out to European countries, through their national scientific and professional radiotherapy societies. The current report includes a detailed analysis of radiotherapy staffing (questionnaire items 47-60), analysed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis was conducted between February and July 2014, and is based on validated responses from 24 of the 40 European countries defined by the European Cancer Observatory (ECO). A large variation between countries was found ...
Technical Innovations & Patient Support in Radiation Oncology, 2018
The European Society of Radiotherapy and Oncology (ESTRO)/International Atomic Energy Agency (IAE... more The European Society of Radiotherapy and Oncology (ESTRO)/International Atomic Energy Agency (IAEA) Best Practice in Radiation Oncology-a project to train RTT trainers has reached its ten year anniversary and will commence its fifth iteration in 2018. This project commenced as a novel way to address the issue of limited RTT education throughout Europe. In many countries the profession of RTT is not officially recognised and there is no formal education programme. RTT education is frequently a very short component of a broader programme such as diagnostic imaging, nursing or a technical discipline. To date, fifty-nine short courses have been delivered, two RTT-specific National societies have been developed, a South East European cooperation with biannual conferences has evolved and significant progress has been made on improving the radiotherapy-specific content of national educational programmes, which will continue with future iterations of this project.
Technical Innovations & Patient Support in Radiation Oncology, 2017
Background and purpose: Over the last decade, the management of locally advanced head and neck ca... more Background and purpose: Over the last decade, the management of locally advanced head and neck cancers (HNCs) has seen a substantial increase in the use of chemoradiation. These guidelines have been developed to assist Radiation TherapisTs (RTTs) in positioning, immobilisation and position verification for head and neck cancer patients. Materials and methods: A critical review of the literature was undertaken by the writing committee. Materials and methods: Based on the literature review, a survey was developed to ascertain the current positioning, immobilisation and position verification methods for head and neck radiation therapy across Europe. The survey was translated into Italian, German, Greek, Portuguese, Russian, Croatian, French and Spanish. Materials and methods: Guidelines were subsequently developed by the writing committee. Results: Results from the survey indicated that a wide variety of treatment practices and treatment verification protocols are in operation for head and neck cancer patients across Europe currently. Results: The guidelines developed are based on the experience and expertise of the writing committee, remaining cognisant of the variations in imaging and immobilisation techniques used currently in Europe. Conclusions: These guidelines have been developed to provide RTTs with guidance on positioning, immobilisation and position verification of HNC patients. The guidelines will also provide RTTs with the means to critically reflect on their own daily clinical practice with this patient group.
Technical Innovations & Patient Support in Radiation Oncology, 2021
Background and Purpose: The European SocieTy for Radiotherapy and Oncology Radiation Therapist Co... more Background and Purpose: The European SocieTy for Radiotherapy and Oncology Radiation Therapist Committee (ESTRO RTTC) published a guidance document and infographic providing recommendations to minimise risk of COVID-19 transmission in radiotherapy (RT) departments. The purpose of this study was to investigate the changes embedded in RT practice in the COVID-19 era and to recommend proactive measures to protect RT practice in future pandemics. Materials and Methods: The study was initiated by the ESTRO Radiation Oncology Safety and Quality Committee (ROSQC). A survey consisting of multiple choice, open ended and Likert scale questions was created to analyse the extent of changes embedded in RT practice in response to the COVID-19 pandemic under the four domains: patient care, RTT workflow, remote working and RT practice. This online survey was distributed globally in May 2020. Results: 229 respondents across 27 countries completed the survey. 60% of respondents reported continuing/commencing RT in COVID-19 patients. Routine testing of patients and RTTs was not common. Split teams' procedures, hot linacs and separate entrances were implemented by 50% of respondents. Remote working was implemented for RT team members where face to face patient contact was not essential. Lack of staff, connectivity issues and lack of confirmed positive cases in the department were the main reasons cited for not implementing recommended measures. Conclusion: It is suggested that RT departments have responded to the COVID-19 pandemic and implemented certain changes in RT practice. RT departments should act now to implement recommended proactive measures to protect patients and RTTs-frontline healthcare workers.
S144 2 nd ESTRO Forum 2013 survival, local control or toxicity profile. Epidemiological data was ... more S144 2 nd ESTRO Forum 2013 survival, local control or toxicity profile. Epidemiological data was searched to determine the proportion of new cases of cancer with each indication. Patient preference data were included for breast and prostate cancers. Indications and epidemiological data were reviewed by a court of external reviewers. Univariate and Monte Carlo simulations were used in sensitivity analysis. Results: Over 600 papers and guidelines were reviewed for 20 cancer sites. The proportions of cancer types had changed markedly over 10 years. Prostate cancer increased from 12% of all cancers to 18%. The guidelines suggest that 48.6% of new cases of cancer have an indication for radiotherapy (with or without chemotherapy) at least once in the course of their illness. The range was from 0% for liver cancer to 94% for vaginal cancer. 9.1% of cases had an indication for synchronous chemoradiotherapy. Conclusions: The small decrease in optimum radiotherapy utilisation rate was mostly due to changes in the proportions of cancer in the population and the removal of a small numberof indications for radiotherapy.
Technical Innovations & Patient Support in Radiation Oncology
This guideline details the European Higher Education Area Levels 7 and 8 Postgraduate benchmarkin... more This guideline details the European Higher Education Area Levels 7 and 8 Postgraduate benchmarking document for Radiation TherapisTs (RTTs). The purpose of this benchmarking document is to assist higher education institutes in the development of radiation therapy-specific curricula for RTTs engaging in postgraduate education, with a view to working at an advanced level in radiation therapy departments. The document specifies the knowledge, skills and competences that are required to work in specific areas of RTT practice, at levels 7 and 8. These include: advanced delineation and volume determination, advanced treatment planning, advanced imaging, quality and risk management, management and service development, patient care and support, brachytherapy and research.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, Feb 5, 2017
The IAEA has developed a methodology for comprehensive quality audits of radiotherapy practices c... more The IAEA has developed a methodology for comprehensive quality audits of radiotherapy practices called Quality Assurance Team for Radiation Oncology (QUATRO). This study explores the factors that impacted quality of care among QUATRO audited centres in the IAEA Europe Region. The 31 QUATRO reports collected over 10years include extensive data describing the quality of radiotherapy at the audited centres. A coding key was developed to aggregate and review these data in terms of recommendations for improvement and positive findings (commendations). Overall 759 recommendations and 600 commendations were given. Eight centres recognized as centres of competence differed from other centres mostly because they operated complete quality management systems and were adequately staffed. Other centres had excessive staff workloads and many gaps in the process of care. Insufficient equipment levels were prevalent. Patient centredness, communication, dosimetry, quality control and radiation prote...
Http Dx Doi Org 10 4161 Cbt 4 4 1646, Feb 21, 2005
Hypoxia is an inevitable feature of solid tumors and a common cause of treatment failure. Hypoxia... more Hypoxia is an inevitable feature of solid tumors and a common cause of treatment failure. Hypoxia acts as a trigger to genetic instability, apoptosis and possibly metastases. The adaptive response to cellular hypoxia involves the modulation of the synthesis of multiple proteins controlling processes such as glucose homeostasis, angiogenesis, vascular permeability and inflammation. The hypoxia responsive element (HRE) sequences isolated from oxygen-responsive genes have been shown to selectively induce gene expression in response to hypoxia when placed upstream of a promoter. The levels of induced gene expression were dependent on the number of HRE copies and the oxygen tension. Hypoxia-mediated cancer gene therapy strategies may represent a promising mean to significantly improve the efficacy of standard radiation therapy and chemotherapy approaches.
The molecular basis for the progression of breast and prostate cancer from hormone dependent to h... more The molecular basis for the progression of breast and prostate cancer from hormone dependent to hormone independent disease remains a critical issue in the management of these two cancers. The DNA mismatch repair system is integral to the maintenance of genomic stability and suppression of tumorigenesis. No firm consensus exists regarding the implications of mismatch repair (MMR) deficiencies in the development of breast or prostate cancer. However, recent studies have reported an association between mismatch repair deficiency and loss of specific hormone receptors, inferring a potential role for mismatch repair deficiency in this transition. An updated review of the experimental data supporting or contradicting the involvement of MMR defects in the development and progression of breast and prostate cancer will be provided with particular emphasis on their implications in the transition to hormone independence.
J.M. Borras). Radiotherapy and Oncology xxx (2015) xxx-xxx Contents lists available at ScienceDir... more J.M. Borras). Radiotherapy and Oncology xxx (2015) xxx-xxx Contents lists available at ScienceDirect Radiotherapy and Oncology j o u r n a l h o m e p a g e : w w w . t h e g r e e n j o u r n a l . c o m Please cite this article in press as: Borras JM et al. The impact of cancer incidence and stage on optimal utilization of radiotherapy: Methodology of a population based analysis by the ESTRO-HERO project. Radiother Oncol (2015), http://dx.
Background and purpose: The absolute number of new cancer patients that will require at least one... more Background and purpose: The absolute number of new cancer patients that will require at least one course of radiotherapy in each country of Europe was estimated. Material and methods: The incidence and relative frequency of cancer types from the year 2012 European Cancer Observatory estimates were used in combination with the population-based stage at diagnosis from five cancer registries. These data were applied to the decision trees of the evidence-based indications to calculate the Optimal Utilization Proportion (OUP) by tumour site. Results: In the minimum scenario, the OUP ranged from 47.0% in the Russian Federation to 53.2% in Belgium with no clear geographical pattern of the variability among countries. The impact of stage at diagnosis on the OUP by country was rather limited. Within the 24 countries where data on actual use of radiotherapy were available, a gap between optimal and actual use has been observed in most of the countries. Conclusions: The actual utilization of radiotherapy is significantly lower than the optimal use predicted from the evidence based estimates in the literature. This discrepancy poses a major challenge for policy makers when planning the resources at the national level to improve the provision in European countries.
Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2014
The ESTRO Health Economics in Radiation Oncology (HERO) project has the overall aim to develop a ... more The ESTRO Health Economics in Radiation Oncology (HERO) project has the overall aim to develop a knowledge base of the provision of radiotherapy in Europe and build a model for health economic evaluation of radiation treatments at the European level. The first milestone was to assess the availability of radiotherapy resources within Europe. This paper presents the personnel data collected in the ESTRO HERO database. An 84-item questionnaire was sent out to European countries, through their national scientific and professional radiotherapy societies. The current report includes a detailed analysis of radiotherapy staffing (questionnaire items 47-60), analysed in relation to the annual number of treatment courses and the socio-economic status of the countries. The analysis was conducted between February and July 2014, and is based on validated responses from 24 of the 40 European countries defined by the European Cancer Observatory (ECO). A large variation between countries was found ...
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Papers by Mary Coffey