Correlative imaging and histopathology of a complicated sinonasal teratocarcinosarcoma

Sinonasal teratocarcinosarcoma (SNTCS) is a highly malignant and rare tumour characterised by a complex admixture of teratomatous and carcinosarcomatous components. In the head and neck area, it almost exclusively occurs in the sinonasal cavities; however, rare instances of nasopharyngeal and oral cavity involvement have been reported, with fewer than 100 cases reported in the literature. Contribution: The contributed case involves the correlative CT, MRI and histopathology of a sinonasal teratocarcinosarcoma with intracranial involvemen

Artificial Intelligence-Based Radiotherapy Contouring and Planning to Improve Global Access to Cancer Care.

PURPOSE: Increased automation has been identified as one approach to improving global cancer care. The Radiation Planning Assistant (RPA) is a web-based tool offering automated radiotherapy (RT) contouring and planning to low-resource clinics. In this study, the RPA workflow and clinical acceptability were assessed by physicians around the world. METHODS: The RPA output for 75 cases was reviewed by at least three physicians; 31 radiation oncologists at 16 institutions in six countries on five continents reviewed RPA contours and plans for clinical acceptability using a 5-point Likert scale. RESULTS: For cervical cancer, RPA plans using bony landmarks were scored as usable as-is in 81% (with minor edits 93%); using soft tissue contours, plans were scored as usable as-is in 79% (with minor edits 96%). For postmastectomy breast cancer, RPA plans were scored as usable as-is in 44% (with minor edits 91%). For whole-brain treatment, RPA plans were scored as usable as-is in 67% (with minor edits 99%). For head/neck cancer, the normal tissue autocontours were acceptable as-is in 89% (with minor edits 97%). The clinical target volumes (CTVs) were acceptable as-is in 40% (with minor edits 93%). The volumetric-modulated arc therapy (VMAT) plans were acceptable as-is in 87% (with minor edits 96%). For cervical cancer, the normal tissue autocontours were acceptable as-is in 92% (with minor edits 99%). The CTVs for cervical cancer were scored as acceptable as-is in 83% (with minor edits 92%). The VMAT plans for cervical cancer were acceptable as-is in 99% (with minor edits 100%). CONCLUSION: The RPA, a web-based tool designed to improve access to high-quality RT in low-resource settings, has high rates of clinical acceptability by practicing clinicians around the world. It has significant potential for successful implementation in low-resource clinics

Fully-automated, CT-only GTV contouring for palliative head and neck radiotherapy.

Planning for palliative radiotherapy is performed without the advantage of MR or PET imaging in many clinics. Here, we investigated CT-only GTV delineation for palliative treatment of head and neck cancer. Two multi-institutional datasets of palliative-intent treatment plans were retrospectively acquired: a set of 102 non-contrast-enhanced CTs and a set of 96 contrast-enhanced CTs. The nnU-Net auto-segmentation network was chosen for its strength in medical image segmentation, and five approaches separately trained: (1) heuristic-cropped, non-contrast images with a single GTV channel, (2) cropping around a manually-placed point in the tumor center for non-contrast images with a single GTV channel, (3) contrast-enhanced images with a single GTV channel, (4) contrast-enhanced images with separate primary and nodal GTV channels, and (5) contrast-enhanced images along with synthetic MR images with separate primary and nodal GTV channels. Median Dice similarity coefficient ranged from 0.6 to 0.7, surface Dice from 0.30 to 0.56, and 95th Hausdorff distance from 14.7 to 19.7 mm across the five approaches. Only surface Dice exhibited statistically-significant difference across these five approaches using a two-tailed Wilcoxon Rank-Sum test (p ≤ 0.05). Our CT-only results met or exceeded published values for head and neck GTV autocontouring using multi-modality images. However, significant edits would be necessary before clinical use in palliative radiotherapy

Descriptive epidemiological study of head and neck cancers at a single institution in Southern Africa

Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Radiation Oncology.ENGLISH SUMMARY : Head and Neck Cancers (HNCs) constitute a major public health concern worldwide. The incidence is approximately two times more in less-developed regions as compared to more developed regions. The estimated incidence in sub-Saharan Africa is 27593 per 100000 with a cumulative risk of 0.66. We evaluated patient demographics, risk factors, tumours characteristics, prognostic factors, disease stage, treatment intent and treatment modality in a cohort of patients with HNC in Cape Town, SA. Records of all HNC patients that presented to Tygerberg Hospital oncology department between 1 January 2015 and 31 December 2017 were reviewed. The following variables were described: patient demographics, which include age, sex, HIV status, and socio-economic status as well as tumour characteristics, risk factors, treatment intent and treatment modalities. Data was collected from 854 patients seen between 2015 and 2017. There were 603 (71%) male and 251 (29%) female. The male to female ratio was 2.4:1. The age range was 10-89 years (median age 58 years). Smoking was a risk factor in 737 (86.3%) and alcohol in 634 (74.2%) of patients. Of the 167 patients with oropharyngeal primaries, 16 (9.58%) patients had p16 positive, 78 (46.70%) were p16 negative and the p16 status was unknown in 73 (43.7%). The most common site was the oral cavity (n=320) and the most common sub-site was the anterior tongue (n=137). Eleven patients had two separate primaries at the time of diagnosis. In total, 466 patients (53.87%) presented with locally advanced, stage IVA disease. The median age of diagnosis, the most predominate primary site; histological subtype and stage at presentation were consistent with that reported in the literature. We have demonstrated that the majority of patients present at a late stage, with locally advanced disease. This together with the predominate risk factors of smoking and alcohol consumption is a potential target for health campaigns and awareness programmes. This cohort will be followed up for treatment outcomes and survival rates.AFRIKAANSE OPSOMMING : Kop- en-nek kankers (KNK's) is 'n groot probleem vir die openbare gesondheid sektor. Die voorkoms van KNK’s is ongeveer twee keer meer in minder gegoede areas in vergelyking met meer ontwikkelde streke. Die geraamde voorkoms in sub-Sahara Afrika is 27 593 per 100 000 individue met 'n kummulatiewe risiko van 0,66. Ons het die pasiënt kenmerke , risiko faktore, gewas kenmerke, prognostiese faktore, siekte stadium,en behandelings doelwitte asook die behandelings modaliteit in 'n groep pasiënte wat met KNK’s gediagnostiseer was geëvalueer. Kliniese verslae van alle KNK’s-pasiënte wat vanaf 1 Januarie 2015 tot 31 Desember 2017 by Tygerberg-hospitaal se onkologie-afdeling gepresenteer het, is nagegaan. Die volgende veranderlikes is beskryf: pasiënt kenmerke, ouderdom, geslag, MIV- en sosio-ekonomiese status, sowel as die kanker gewas-karaktertrekke, risiko faktore, behandelings-doelwitte en modaliteit is geëvalueer. Kliniese inligting van 854 pasiënte, is nagegaan. Daar was 71% manlike en 29% vroulike pasiënte. Die verhouding tussen mans en vroue was 2.4:1. Die groep se ouderdom verspreiding was 10-89 jaar, met ‘n gemiddelde ouderdom van 58 jaar. Rook was 'n risiko faktor in 86,3% en alkohol in 74,2% van die pasiënte. In 167 pasiënte met primêre orofaryngeale kanker, was 9,58% pasiënte p16 positief, 46,70% was p16 negatief en in 43,7% van die pasiënte was die p16-status onbekend. Die oorwegende aangetasde area was die mondholte (n = 320) met die algemeenste sub-lokasie die anterior gedeelte van die tong (n = 137). Elf pasiënte het by hul aanvanklike presentasie, gepresenteer met twee afsonderlike primêre kankers. In totaal het 53,87% pasiënte gepresenteer met lokaal gevorderde stadium IVA-siekte. Die gemidelde ouderdom by diagnose, die oorheersende primêre area; histologiese subtipe en stadium tydens aanvanklike presentasie was in ooreenstemming met wat in die Internationale literatuur gemeld word. Ons het ook getoon dat die meerderheid van pasiënte presenteer met lokaal gevorderde siekte en met die risiko faktore van rook en alkohol misbruik is dit 'n potensiële teiken vir gesondheids veldtogte en bewusmakings programme. Hierdie groep word ook nog tans opgevolg vir behandelings uitkomste en oorlewing syfers.Master

Addressing the Global Expertise Gap in Radiation Oncology: The Radiation Planning Assistant

PURPOSEAutomation, including the use of artificial intelligence, has been identified as a possible opportunity to help reduce the gap in access and quality for radiotherapy and other aspects of cancer care. The Radiation Planning Assistant (RPA) project was conceived in 2015 (and funded in 2016) to use automated contouring and treatment planning algorithms to support the efforts of oncologists in low- and middle-income countries, allowing them to scale their efforts and treat more patients safely and efficiently (to increase access).DESIGNIn this review, we discuss the development of the RPA, with a particular focus on clinical acceptability and safety/risk across jurisdictions as these are important indicators for the successful future deployment of the RPA to increase radiotherapy availability and ameliorate global disparities in access to radiation oncology.RESULTSRPA tools will be offered through a webpage, where users can upload computed tomography data sets and download automatically generated contours and treatment plans. All interfaces have been designed to maximize ease of use and minimize risk. The current version of the RPA includes automated contouring and planning for head and neck cancer, cervical cancer, breast cancer, and metastases to the brain.CONCLUSIONThe RPA has been designed to bring high-quality treatment planning to more patients across the world, and it may encourage greater investment in treatment devices and other aspects of cancer treatment