On-treatment review for patients with head and neck cancer can be effectively managed by a nurse specialist. Relevance to Practice. Radiotherapy nurse specialists make an important contribution to the supportive care of patients with head and neck cancer. More investment is required to maximize their contribution.
Radiotherapy is a key treatment option for breast cancer, yet the molecular responses of normal human breast epithelial cells to ionizing radiation are unclear. A murine subcutaneous xenograft model was developed in which nonneoplastic human breast tissue was maintained with the preservation of normal tissue architecture, allowing us to study for the first time the radiation response of normal human breast tissue in situ. Ionizing radiation induced dose-dependent p53 stabilization and p53 phosphorylation, together with the induction of p21(CDKN1A) and apoptosis of normal breast epithelium. Although p53 was stabilized in both luminal and basal cells, induction of Ser392-phosphorylated p53 and p21 was higher in basal cells and varied along the length of the ductal system. Basal breast epithelial cells expressed DNp63, which was unchanged on irradiation. Although stromal responses themselves were minimal, the response of normal breast epithelium to ionizing radiation differed according to the stromal setting. We also demonstrated a dose-dependent induction of g-H2AX foci in epithelial cells that was similarly dependent on the stromal environment and differed between basal and luminal epithelial cells. The intrinsic differences between human mammary cell types in response to in vivo irradiation are consistent with clinical observation that therapeutic ionizing radiation is associated with the development of basal-type breast carcinomas. Furthermore, there may be clinically important stromal-epithelial interactions that influence DNA damage responses in the normal breast. These findings demonstrate highly complex responses of normal human breast epithelium following ionizing radiation exposure and emphasize the importance of studying whole-tissue effects rather than single-cell systems. Cancer Res; 70(23); 9808-15. Ó2010 AACR.
Intraoperative radiotherapy (IORT) using a miniature X-ray source has the potential to impart the same clinical benefit as external beam radiotherapy (EBRT), in a single fraction. The patient benefits are significant, since IORT could replace several weeks of fractionated EBRT. We present our initial experiences of IORT using the Zeiss Intrabeam™ system for treating early stage breast cancer and intracranial malignancies. Implementing this treatment modality requires a multidisciplinary approach drawing on the expertise of surgeons, oncologists, medical physicists, anaesthesiologists, nursing staff and pathologists. Team coherence is facilitated by a nurse co-ordinator. We have treated 66 patients in 24 months. For breast tumours, the mean treatment time was 28.54 min and the applicator sizes ranged from 3.0 to 5.0 cm (mode ϭ 4.5 cm). A dose of 5 Gy is prescribed to spherical volume of 1 cm from the applicator surface. For brain tumours, the mean treatment time was 19.70 min and the applicator sizes ranged from 1.5 to 3.5 cm (mode ϭ 2.5 cm). Mean dose was 11.1 Gy prescribed to a spherical volume of 0.5 cm from the applicator surface.A multidisciplinary team is essential for the successful implementation of IORT. This paper describes how, through reliance on an oncology nurse specialist to co-ordinate the programme, we have successfully set-up an IORT service.
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