Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Measurement of dose enhancement close to high atomic number media using optical fibre thermoluminescence dosimeters

Present interest concerns development of a system to measure photoelectron-enhanced dose close to a tissue interface using analogue gold-coated doped silica-fibre thermoluminescence detectors and an X-ray set operating at 250. kVp. Study is made of the dose enhancement factor for various thicknesses of gold; measurements at a total gold thickness of 160. nm (accounting for incident and exiting photons) produces a mean measured dose enhancement factor of 1.33±0.01 To verify results, simulations of the experimental setup have been performed. © 2013 Elsevier Ltd

Measurement of dose enhancement close to high atomic number media using optical fibre thermo luminescence dosimeters

Present interest concerns development of a system to measure photoelectron-enhanced dose close to a tissue interface using analogue gold-coated doped silica-fibre thermo luminescence detectors and an X-ray set operating at 250 kVp. Study is made of the dose enhancement factor for various thickness of gold; measurements at a total gold thickness of 160 nm produces a mean dose enhancement factor of 3.19. To verify results, simulations of the experimental setup have been performed. © 2013 Elsevier Ltd. All rights reserved

High sensitivity flat SiO fibres for medical dosimetry

We describe investigation of a novel undoped flat fibre fabricated for medical radiation dosimetry. Using high energy X-ray beams generated at a potential of 6MV, comparison has been made of the TL yield of silica flat fibres, TLD-100 chips and Ge-doped silica fibres. The flat fibres provide competitive TL yield to that of TLD-100 chips, being some 100 times that of the Ge-doped fibres. Pt-coated flat fibres have then been used to increase photoelectron production and hence local dose deposition, obtaining significant increase in dose sensitivity over that of undoped flat fibres. Using 250kVp X-ray beams, the TL yield reveals a progressive linear increase in dose for Pt thicknesses from 20nm up to 80nm. The dose enhancement factor (DEF) of (0.0150±0.0003)nm Pt is comparable to that obtained using gold, agreeing at the 1% level with the value expected on the basis of photoelectron generation. Finally, X-ray photoelectron spectroscopy (XPS) has been employed to characterize the surface oxidation state of the fibre medium. The charge state of Si2p was found to lie on 103.86eV of binding energy and the atomic percentage obtained from the XPS analysis is 22.41%. © 2014 Elsevier Ltd

An investigation of the thermoluminescence of Ge-doped SiO(2) optical fibres for application in interface radiation dosimetry.

We investigate the ability of high spatial resolution (∼120μm) Ge-doped SiO(2) TL dosimeters to measure photoelectron dose enhancement resulting from the use of a moderate to high-Z target (an iodinated contrast media) irradiated by 90kVp X-rays. We imagine its application in a novel radiation synovectomy technique, modelled by a phantom containing a reservoir of I(2) molecules at the interface of which the doped silica dosimeters are located. Measurements outside of the iodine photoelectron range are provided for using a stepped-design that allows insertion of the fibres within the phantom. Monte Carlo simulation (MCNPX) is used for verification. At the phantom medium I(2)-interface additional photoelectron generation is observed, ∼60% above that in the absence of the I(2), simulations providing agreement to within 3%. Percentage depth doses measured away from the iodine contrast medium reservoir are bounded by published PDDs at 80kVp and 100kVp

Preliminary investigations of two types of silica-based dosimeter for small-field radiotherapy

Two thermoluminescent dosimeters (SiO-GeO doped fibres and glass beads (GB)) were used to measure small photon field doses and compared against GAFCHROMIC film, a small ionisation chamber (RK-018) and a p-type silicon diode (SCANDITRONIX, F1356), as well as Monte Carlo simulations with FLUKA and BEAMnrc/DOSXYZnrc. Ge-doped SiO fibres have been shown by this group to offer a viable system for use as dosimeters. The fibres and GB offer good spatial resolution (~120μm and 2mm respectively), large dynamic dose range (with linearity from tens of mGy up to well in excess of many tens of Gy), are non-hygroscopic and are of low cost. Measurements of beam profiles for field sizes of 10mm×10mm, 20mm×20mm, 30mm×30mm, 40mm×40mm, and 100mm×100mm were carried out. Through the use of a customised solid water phantom, doped optical fibres and GBs were placed at defined positions along the x-and y-axes to allow accurate beam profile measurement. The maximum difference between FWHM measurements was 1.8mm. For penumbra measurements (measured between 80% and 20% isodoses), the maximum difference was<1mm. These measurements indicate good agreement, within measurement uncertainty, with Gafchromic film, data obtained from the use of two commonly used detectors and FLUKA and BEAMnrc/ DOSXYZnrc simulations. © 2014 Elsevier Ltd

Development of tailor-made silica fibres for TL dosimetry

The Ge dopant in commercially available silica optical fibres gives rise to appreciable thermoluminscence (TL), weight-for-weight offering sensitivity to MV X-rays several times that of the LiF dosimeter TLD100. The response of these fibres to UV radiation, X-rays, electrons, protons, neutrons and alpha particles, with doses from a fraction of 1Gy up to 10kGy, have stimulated further investigation of the magnitude of the TL signal for intrinsic and doped SiO fibres. We represent a consortium effort between Malaysian partners and the University of Surrey, aimed at production of silica fibres with specific TL dosimetry applications, utilizing modified chemical vapour deposition (MCVD) doped silica-glass production and fibre-pulling facilities. The work is informed by defect and dopant concentration and various production dependences including pulling parameters such as temperature, speed and tension; the fibres also provide for spatial resolutions down to <10μm, confronting many limitations faced in use of conventional (TL) dosimetry. Early results are shown for high spatial resolution (~0.1mm) single-core Ge-doped TL sensors, suited to radiotherapy applications. Preliminary results are also shown for undoped flat optical fibres of mm dimensions and Ge-B doped flat optical fibres of sub-mm dimensions, with potential for measurement of doses in medical diagnostic applications. © 2014 Elsevier Ltd

Development of tailor-made silica fibres for TL dosimetry

The Ge dopant in commercially available silica optical fibres gives rise to appreciable thermoluminscence (TL), weight-for-weight offering sensitivity to MV x-rays several times that of the LiF dosimeter TLD100. The response of these fibres to UV radiation, X-rays, electrons, protons, neutrons and alpha particles, with doses from a fraction of 1 Gy up to 10 kGy, have stimulated further investigation of the magnitude of the TL signal for intrinsic and doped SiO2 fibres. We represent a consortium effort between Malaysian partners and the University of Surrey, aimed at production of silica fibres with specific TL dosimetry applications, utilising modified chemical vapour deposition (MCVD) doped silica-glass production and fibre-pulling facilities. The work is informed by defect and dopant concentration and various production dependencies including pulling parameters such as temperature, speed and tension, the fibres also providing for spatial resolutions down to<10 µm, confronting the many limitations faced in use of conventional (TL) dosimetry. Early results are shown for high spatial resolution (∼ 0.1 mm) single-core Ge-doped TL sensors, suited to radiotherapy applications. Preliminary results are also shown for undoped flat optical fibres of mm dimensions and Ge-B doped flat optical fibres of sub-mm dimensions, with potential for measurement of doses in medical diagnostic applications

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population