A Phase II Randomized Pilot Study of Low Dose Rate Compared to High Dose Rate Prostate Brachytherapy for Favorable Risk and Low Tier Intermediate Risk Prostate Cancer
Juanita Crook, MD, Francois Bachand, MD
This study compares low dose rate permanent seed brachytherapy for prostate cancer to high dose rate (HDR) brachytherapy, looking primarily at Quality of Life and recovery from treatment. The study also involves multiparametric MRI staging of the cancer, and provides the opportunity for Cell Cycle Progression genetic testing of each cancer to look at how aggressive the cancers are and how this correlates with outcome.
Proposed study protocol ; Consent form
Below are summaries of some current research initiatives at BC Cancer – Kelowna. Research interns and clinical staff work together on these projects, in hopes of furthering the goals of controlling cancer and reducing its impact on British Columbians.
Projects described in past years are on these pages:
Biology of Lymphoid Cancer (BioLym)
Samantha Gottfred, B.Sc.
The BioLym project was initiated by the researchers at the Centre for Lymphoid Cancer at BC Cancer – Vancouver centre and expanded into BC Cancer – Kelowna in June 2014. The purpose of BioLym is to support research investigating the biological, genetic and environmental mechanisms that cause lymphoid cancers, the determinants of their clinical behaviour, and how lymphoid cancer treatments work so that more efficient diagnostic tools and therapies can be developed to combat these cancers. An eligible patient provides a blood sample, permission to use leftover biopsy material post-diagnosis, and permission to be contacted to discuss participating in future lymphoma research projects. This resource has enabled the development of novel lymphoma treatments that have been tested and emulated worldwide and study of late complications of successful lymphoma treatment. New lymphoma patients at BC Cancer – Kelowna can discuss participation with their oncologist or contact the BioLym-CSI Research Intern at 250-712-3966 ext 68-6887.
Investigators: Dr. Janine Davies, Dr. Joseph M. Connors
Link for Centre for Lymphoid Cancer homepage, Vancouver site
Personal Response Determinants In Cancer Therapy (PREDICT )
Brittany Boorman, B.Sc.
PREDICT is designed to support studies by giving investigators access to a permission to contact mechanism and a bank of blood samples from newly diagnosed cancer patients. Since its initiation by the BC Cancer Vancouver Island Center in 2006, over 20 research projects have utilized the blood specimens or the permission to contact basis for research on prostate, breast, colorectal, lung, and skin cancers. Since the establishment of PREDICT at BC Cancer – Kelowna in January of 2013, close to 1000 newly diagnosed patients from the interior have consented to participate, helping PREDICT to reach a milestone of 10,000 blood samples this year, half of the target goal.
Investigator (CSI): Dr. Janine Davies
Trends in Mammogram Image Quality, Dose and Screen-Detected Cancer Rates in an Organized Screening Mammography Program
Brent Parker, B. Sc., Ashley Yip B. Sc.
A study was conducted to analyze the trends in the Screening Mammography Program of British Columbia’s quality assurance and outcomes data from 1994 onwards to investigate any correlation between improvements in image quality (IQ), changes in radiation dose delivered per screen and detection of breast cancers. Interestingly, improvements in image quality was related to increased detection of small tumours.
Investigators: Rasika Rajapakshe, PhD, Teresa Wight, RT, Nancy Aldoff, RT, Janette Sam, RT, Dr. Christine Wilson
Figure below: Age adjusted Cancer Detection Rates of invasive cancers ≤ 5mm per 10,000 screens between the years 1994-2005
Modeling Breast Cancer Screening and Care
Chelsea Vandenberg, B. Sc., Stephen Smithbower, B. Sc., Brent Parker, B. Sc., Chelsea Vandenberg, B. Sc., Breanne Cadham, B. Sc., Rebecca Mlikotic, B. Sc.
Breast cancer screening with mammography has been shown to reduce breast cancer mortality. However the frequency and the age range for screening eligibility has been controversial. Therefore a mathematical cancer control model for breast cancer using data from the province of BC is being developed to model different early detection strategies. Once the model is validated, it will be possible to test early detection strategies, and health care costs associated with breast cancer detection, diagnosis, treatment and on-going care.
Investigators: Rasika Rajapakshe, PhD, Cynthia Araujo, PhD, Dr. Chris Baliski, Dr. Susan Ellard, Laurel Kovacic, PharmD, Dr. Melanie Reed, Dr. Scott Tyldesley, Dr. Gillian Fyles, MD
Enhancement of the Breast Cancer Risk Information Collected at the Time of Screening
Chelsea Vandenberg, B.Sc.
In order to provide more personalized screening regimens, it is important to know which women are at an elevated risk of developing breast cancer. Using data from the Breast Cancer Risk Assessment Project, the most significant and prevalent risk factors in the BC population were determined using the Tyrer-Cuzick risk calculation model which is the most accurate model currently available for predicting risk. The results show that the strongest predictive risk factor is having a first degree relative with breast cancer. Other important factors to collect information about include a more extensive family history of breast cancer, length of hormone exposure (endogenous or hormone therapy), and previous biopsies. Using this information, a questionnaire intended for women who participate in the Screening Mammography Program of BC (SMPBC) was drafted which included family history as well as the other important risk factors investigated in this study. Discussion of results with the SMPBC is leading to a more risk-based screening approach.
Investigator (CSI): Rasika Rajapakshe, PhD
Estimating Diagnostic Reference Levels for Mean Glandular Dose within the Screening Mammography Program of British Columbia
Chelsea Vandenberg, B.Sc.
After obtaining radiation data from all of the sites in the Screening Mammography Program (SMP) of BC, the analytic model described by Dance et al. was used to estimate the average and range for mean glandular dose (MGD) and compressed breast thickness at each SMP site. This data was analyzed to compare the difference in MGD and compressed breast thickness for analog (film/screen) units versus digital radiography units. Data was also compared to previously collected data in 2007 to note any changes. The baseline between 2007 and 2011 was the same, but the results showed that the digital units delivered 40% less dose than the analog units.
Investigator: Rasika Rajapakshe, PhD
Comparison of Rigid Registration Between Prostate MRI and US to Deformable Registration for Localization of the Dominant Intraprostatic Lesion for the Purposes of Intraprostatic Dose Escalation Using High Dose Rate Brachytherapy
Annie Collins, Bc. S. student
Brachytherapy is a form of radiation that places radioactive sources directly into the prostate, permitting delivery of a higher radiation dose. If the cancer within the prostate can be imaged, then the dose of radiation can be selectively escalated using brachytherapy, such as to ablate even larger and more aggressive lesions. MRI data can be transferred to ultrasound images in order to enable this escalation. This project compares the dose of radiation received by the dominant intraprostatic lesion when the images are combined using rigid registration (where the images are translated and rotated) versus deformable registration (where the MRI is warped to account for differences in prostate shape).
Investigators (CSI): Dr. Juanita Crook, Deidre Batchelar, PhD
A tool to detect collisions between linear accelerators and patients during external beam radiation therapy
Duncan Szarmes, B. Sc. student
During external beam radiation therapy the linear accelerator rotates around the patient, who is lying on the treatment table, and administers concentrated radiation to the cancer. One problem that may occur during treatment is a collision with the linear accelerator and the patient; this results in the treatment being stopped and re-planned, which is a time consuming process that affects both the radiation therapists and the patient. This study involves developing a tool that simulates the radiation treatment on a computer, before the patient is brought in for the actual treatment. This will allow radiation therapists to check for collisions and adjust the treatment plan prior to treatment delivery. This tool hopes to save time and avoid repetition of treatment planning, and its use will be evaluated over a period of time in order to determine its value and effectiveness.
Investigators (CSI): Rasika Rajapakshe, PhD, Gail Murray, BSc, RTT, ACT, Leigh Bartha, BSc, ACT
Figure below: Sample EBRT treatments reconstructed in a 3D simulation
A tool for the automated computation of dense tissue percentage from screening mammograms, to assist in the development of a comprehensive breast density model
Ethan Owusu, B. Sc. student
To construct a comprehensive model of breast tissue density, as it relates to the development of breast cancer, the percentage of dense tissue must be collected from a large number of screening mammograms and cataloged. This is a problem, because the estimation of dense tissue currently requires a significant amount of time and human resources. Not only is it costly in this regard, but evidence suggests that current methods of estimating percentage of dense tissue in screening mammograms are subject to high levels of inter-observer and intra-observer variation, implying inconsistency in accuracy and precision on the part of the human mammogram analyst.
A possible solution lies in the implementation of a fully automated breast density computation and classification algorithm, that would provide consistently accurate and precise measurements in less time, and with little or no human resources or supervision. When complete, the highly portable BDen2 software package will fulfill this role on whatever system or server it is assigned to, leading to faster results in development of a comprehensive breast density model.
Investigator (CSI): Rasika Rajapakshe, PhD
Figures below: Sample BDen2 processed images
Completeness of Breast Cancer Operative Reports in a Community Care Setting
Jordan Eng, B. Sc. student
Operative reports represent the primary means by which surgical breast cancer data is communicated from the operating surgeon to other care providers. This data is used to inform prognosis and aid management decisions. Despite their importance, these reports have often been shown to be incomplete. We investigated the completeness of breast cancer operative reports in the Interior Health Authority, and examined some factors which may influence the completeness of breast cancer operative reports.
Investigator (CSI): Dr. Chris Baliski
Development of a lung cancer surgical outcomes database for the Southern Interior of British Columbia
Christine Haslock, B. Sc., Ashley Yip, B. Sc., Brent Parker, B. Sc., Christina Weisstock, B. Sc., Stephanie Ruschiensky, B. Sc.
Researchers and physicians in Kelowna are developing a lung cancer surgical outcomes database in order to identify and quantify the challenges related to access to lung cancer care and treatment across the Interior and Northern Health areas of British Columbia. If differences of access to care are apparent, ways to rectify these challenges will be identified.
Investigators: Rasika Rajapakshe, PhD, Dr. Michael Humer, Cynthia Araujo, PhD
Ultrasound-planned high-dose-rate prostate brachytherapy: Dose painting to the dominant intraprostatic lesion
Dr. Ana Ots (fellow), Dr.Miren Gaztanaga (fellow), Brent Parker, B. Sc.
There is evidence from multiple randomized trials that higher radiation doses are required to optimize local control and improve disease-free survival in men with localized prostate cancer and this study investigated the feasibility of using high-dose-rate (HDR) brachytherapy to deliver 125% of the prescription dose to the dominant intraprostatic lesion (DIL) while respecting critical organ dose constraints. The results of this study show that modest dose escalation to the DIL (25–30%) using ultrasound-planned HDR brachytherapy is feasible for selected intermediate- and high-risk patients while respecting critical organ constraints and is achievable within the practice setting of a community cancer center.
Investigators (CSI): Dr. Juanita Crook, Matt Schmid, MSc, Cynthia Araujo, PhD, Michelle Hilts, PhD,Deidre Batchelar, PhD, Dr. Francois Bachand, Marie-Pierre Milette, PhD
Link to the study manuscript
Prostate Volume Downsizing with Degarelix Prior to Brachytherapy
Dr. Jim Rose (fellow), Dr. Ana Ots (fellow), Dr. Miren Gaztanaga, Brent Parker, B. Sc.
This study assesses the effectiveness of the LHRH antagonist Degarelix in downsizing the prostate prior to brachytherapy (BT) and to evaluate testosterone recovery testosterone recovery. The study is ongoing and preliminary results suggest a consistent and rapid pre-BT prostate volume reduction for the majority of patients after 8 weeks of Degarelix administration with volume stability maintained through the implant period and rapid testosterone recovery commencing as early as within a month following BT.
Investigators (CSI): Dr. Juanita Crook, Dr. Francois Bachand, Dr. David Petrik
Use of Clinical and Pathological Factors to Develop a Prognostic Index to Predict High Risk of Recurrence in Patients with Stage II Colon Cancer
Breanne Cadham, B. Sc.
Stage II colon cancers generally have a favorable prognosis. However, various clinical and pathologic factors can be used to identify patients with “high risk” stage II colon cancer. This initiative will work to develop a scoring system for stage II colon cancer patients based on BC Cancer patient data. Once developed, this scoring system could be used by physicians to better estimate the risk of recurrence and the potential for benefit from adjuvant chemotherapy.
Investigators: Dr. Janine Davies, Brent Parker, B. Sc., Dr. Winson Y Cheung
Advance Care Planning
Survey of Engagement with Advance Care Planning; Pilot in Cancer Patient Population
Brent Parker, B. Sc.
Our health care system is facing aging populations and patients are living longer with chronic illness. Advance Care Planning (ACP) may offer some assistance with reducing health care costs while improving quality of care for older Canadians. This study validates measurement tools that will allow for improved ACP research in the future so that health professionals can better use ACP to improve patient, provider, and health care system outcomes.
Investigators: Dr. Michael McKenzie, Dr. Gillian Fyles, Carole Robinson, PhD
A pilot study of a web-based follow-up platform for collecting quality of life outcomes.
Brent Parker B. Sc., Andrew Moldovan, B. Sc.
As technologies improve and as Canadians become more comfortable using computers and other internet devices, there is an increasing potential to use online platforms as a means of communicating with patients to monitor health. These systems can improve healthcare delivery for patients, healthcare providers and healthcare systems. As a proof of principal, this concept was piloted at the Cancer Centre for the Southern Interior to over 1,000 individuals that had been treated for prostate cancer. The pilot demonstrated that the pilot system meets provincial and institutional security, privacy, and ethical regulations. Participation rates from this study indicate that many individuals are interested in engaging in web-based post-treatment follow-up, suggesting that web-based systems are a feasible way to implement treatment related quality of life questionnaires.
Web-Based Follow Up Project homepage
Investigators (CSI): Rasika Rajapakshe, PhD, Cynthia Araujo, PhD, Dr. Juanita Crook
Figure below: Webfollowup pilot study participation rates stratified by age and rural vs. urban status
Data Visualization: A Disease, Treatment and Outcomes Dashboard for a Breast Cancer Registry
Stephen Smithbower, B. Sc., Brent Parker, B. Sc.
Simple to use data visualization tools give clinicians and researchers the ability to examine trends in breast cancer risk factors, disease types, treatment strategies, and cancer outcomes. A computer desktop-based data visualization dashboard was developed to obtain and display this data hosted within a study database. The platform’s user interface continues to be improved upon so that it can accommodate up-to-date and real time data visualization of the breast cancer journey that comparable cohorts of women underwent, from diagnosis to treatment to survivorship and/or palliative care.
Investigators (CSI): Rasika Rajapakshe, PhD
Also see our archive of projects described in past years: