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Radiotherapy is the treatment of cancer and other diseases with high energy (ionising) radiation. Ionising radiation damages or destroys cells in the area being treated making it impossible for the cancer cells to continue to grow and multiply. Most radiotherapy is delivered from the outside of the body (external beam radiotherapy) usually in the form of high energy X-rays or sometimes as Gamma rays. For certain cancers a radioactive implant can be placed next to the tumour inside the body (internal radiotherapy). As radiotherapy can damage normal cells as well as cancer cells there can be potential side effects, these may depend on the radiotherapy dose, site(s) of treatment, age and other factors.
Recent Research
Radiation Oncology (medical specialty)
Specialist Journals
Overviews - What is Radiotherapy? (8 links)
National Cancer Institute
Online book available in a variety of formats. Covers external beam and internal radiation, your feelings during radiation therapy, side effects and ways to manage them, questions to ask, foods and liquids and more.
Cancer treatment: what happens during radiotherapy?
NHS Choices
A video explaining what happens during radiotherapy treatment. An expert describes what happens and advises what questions to ask if you're referred for radiotherapy
Cancer Research UK
CancerHelp information is examined by both expert and lay reviewers. Content is reviewed every 12 to 18 months. Further info.
Macmillan Cancer Support
Content is developed by a team of information development nurses and content editors, and reviewed by health professionals. Further info.
Cancer Research UK
Before you begin your radiotherapy treatment, the radiotherapy team carefully plan your treatment. Learn about why you need it and what happens during planning... (video Aug 2013)
Understanding Radiation Therapy
Content is peer reviewed and Cancer.Net has an Editorial Board of experts and advocates. Content is reviewed annually or as needed. Further info.
Cancer Australia
Radiation Oncologist David Ball talks about radiotherapy and patients tell of their experiences with radiotherapy. Part of a series of video clips produced by Peter MacCallum Cancer Centre with the support of The Australian Lung Foundation. (2011)
Recent Research
Melatonin for Prevention of Breast Radiation Dermatitis: A Phase II, Prospective, Double-Blind Randomized Trial.
Isr Med Assoc J. 2016 Mar-Apr; 18(3-4):188-92 [PubMed] Related Publications
OBJECTIVES: To evaluate the efficacy of melatonin-containing cream in minimizing acute radiation dermatitis.
METHODS: In this phase II, prospective, randomized, placebo-controlled double-blind study, patients who underwent breast-conserving surgery for stage 0-2 breast cancer were randomly allocated to melatonin emulsion (26 women) or placebo (21 women) for twice daily use during radiation treatment and 2 weeks following the end of radiotherapy. All women received 50 Gy whole breast radiation therapy with 2 Gy/fx using computed tomography-based 3D planning. Patients were examined and completed a detailed questionnaire weekly and 2 weeks following the end of treatment.
RESULTS: The occurrence of grade 1/2 acute radiation dermatitis was significantly lower (59% vs. 90%, P = 0.038) in the melatonin group. Women older than 50 had significantly less dermatitis than younger patients (56% vs. 100%, P = 0.021). The maximal radiation dermatitis in the study group was grade 2 in 15% of the treated patients.
CONCLUSIONS: Patients treated with melatonin-containing emulsion experienced significantly reduced radiation dermatitis compared to patients receiving placebo.
Efficacy and safety of Yunxiangjing derived from Chinese herbal medicine administered as an enema in the management of acute radiation-induced proctitis in patients with pelvic malignancy.
J Tradit Chin Med. 2016; 36(1):45-50 [PubMed] Related Publications
METHODS: Forty-eight patients with grade 2 ARIP were administered YXJ as an enema (1 : 30 dilution) for 2 weeks and followed up for 2 years. All were assessed for response and ARIP grade. Quality of life (QOL) was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30.
RESULTS: Of the 48 patients, six (12.5%) achieved complete remission of ARIP and 28 (58.3%) showed a decrease from grade 2 to grade 1 ARIP. No patient experienced a grade ≥3 toxicity. At the end of radiotherapy, patients showed significant improvements in QOL (P < 0.05). Two years after treatment, 46 patients showed no late toxicity, with only two experiencing grade 1 late toxicity.
CONCLUSION: YXJ can be used as an enema to manage acute radiation-induced proctitis in cancer patients undergoing radiotherapy. These findings suggest that YXJ enema may be an alternative treatment of ARIP.
Radiotherapy With 4 Gy × 5 Versus 3 Gy × 10 for Metastatic Epidural Spinal Cord Compression: Final Results of the SCORE-2 Trial (ARO 2009/01).
J Clin Oncol. 2016; 34(6):597-602 [PubMed] Related Publications
PATIENTS AND METHODS: Two-hundred three patients with MESCC and poor to intermediate expected survival were randomly assigned to 4 Gy × 5 in 1 week (n = 101) or 3 Gy × 10 in 2 weeks (n = 102). Patients were stratified according to ambulatory status, time developing motor deficits, and primary tumor type. Seventy-eight and 77 patients, respectively, were evaluable for the primary end point, 1-month overall response regarding motor function defined as improvement or no further progression of motor deficits. Other study end points included ambulatory status, local progression-free survival, and overall survival. End points were evaluated immediately after RT and at 1, 3, and 6 months thereafter.
RESULTS: At 1 month, overall response rates regarding motor function were 87.2% after 4 Gy × 5 and 89.6% after 3 Gy × 10 (P = .73). Improvement rates were 38.5% and 44.2%, respectively, no further progression rates 48.7% and 45.5%, respectively, and deterioration rates 12.8% and 10.4%, respectively (P = .44). Ambulatory rates at 1 month were 71.8% and 74.0%, respectively (P = .86). At other times after RT, the results were also not significantly different. Six-month local progression-free survival was 75.2% after 4 Gy × 5 and 81.8% after 3 Gy × 10 (P = .51); 6-month overall survival was 42.3% and 37.8% (P = .68).
CONCLUSION: Short-course RT with 4 Gy × 5 was not significantly inferior to 3 Gy × 10 in patients with MESCC and poor to intermediate expected survival.
Short-Course Hypofractionated Radiation Therapy With Boost in Women With Stages 0 to IIIa Breast Cancer: A Phase 2 Trial.
Int J Radiat Oncol Biol Phys. 2016; 94(1):118-25 [PubMed] Related Publications
METHODS AND MATERIALS: We delivered a whole-breast dose of 36.63 Gy in 11 fractions of 3.33 Gy over 11 days, followed by a lumpectomy bed boost in 4 fractions of 3.33 Gy delivered once daily for a total of 15 treatment days. Acute toxicities were scored using Common Terminology Criteria for Adverse Events version 4. Late toxicities were scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. Cosmesis was scored using the Harvard Cosmesis Scale. Our primary endpoint was freedom from locoregional failure; we incorporated early stopping criteria based on predefined toxicity thresholds. Cosmesis was examined as a secondary endpoint.
RESULTS: We enrolled 83 women with stages 0 to IIIa breast cancer. After a median follow-up of 40 months, 2 cases of isolated ipsilateral breast tumor recurrence occurred (2 of 83; crude rate, 2.4%). Three-year estimated local recurrence-free survival was 95.9% (95% confidence interval [CI]: 87.8%-98.7%). The 3-year estimated distant recurrence-free survival was 97.3% (95% CI: 89.8%-99.3%). Three-year secondary malignancy-free survival was 94.3% (95% CI: 85.3%-97.8%). Twenty-nine patients (34%) had grade 2 acute toxicity, and 1 patient had a late grade 2 toxicity (fibrosis). One patient had acute grade 3 dermatitis, whereas 2 patients experienced grade 3 late skin toxicity. Ninety-four percent of evaluable patients had good or excellent cosmesis.
CONCLUSIONS: Our phase 2 institutional study offers one of the shortest courses of HF therapy, delivered in 15 fractions inclusive of a sequential boost. We demonstrated expected low toxicity and high local control rates with good to excellent cosmetic outcomes. This fractionation scheme is feasible and well tolerated and offers women WBI in a highly convenient schedule.
Multi-Institutional Phase II Study of High-Dose Hypofractionated Proton Beam Therapy in Patients With Localized, Unresectable Hepatocellular Carcinoma and Intrahepatic Cholangiocarcinoma.
J Clin Oncol. 2016; 34(5):460-8 [PubMed] Article available free on PMC after 10/10/2016 Related Publications
MATERIALS AND METHODS: In this single-arm, phase II, multi-institutional study, 92 patients with biopsy-confirmed HCC or ICC, determined to be unresectable by multidisciplinary review, with a Child-Turcotte-Pugh score (CTP) of A or B, ECOG performance status of 0 to 2, no extrahepatic disease, and no prior radiation received 15 fractions of proton therapy to a maximum total dose of 67.5 Gy equivalent. Sample size was calculated to demonstrate > 80% local control (LC) defined by Response Evaluation Criteria in Solid Tumors (RECIST) 1.0 criteria at 2 years for HCC patients, with the parallel goal of obtaining acceptable precision for estimating outcomes for ICC.
RESULTS: Eighty-three patients were evaluable: 44 with HCC, 37 with ICC, and two with mixed HCC/ICC. The CTP score was A for 79.5% of patients and B for 15.7%; 4.8% of patients had no cirrhosis. Prior treatment had been given to 31.8% of HCC patients and 61.5% of ICC patients. The median maximum dimension was 5.0 cm (range, 1.9 to 12.0 cm) for HCC patients and 6.0 cm (range, 2.2 to 10.9 cm) for ICC patients. Multiple tumors were present in 27.3% of HCC patients and in 12.8% of ICC patients. Tumor vascular thrombosis was present in 29.5% of HCC patients and in 28.2% of ICC patients. The median dose delivered to both HCC and ICC patients was 58.0 Gy. With a median follow-up among survivors of 19.5 months, the LC rate at 2 years was 94.8% for HCC and 94.1% for ICC. The overall survival rate at 2 years was 63.2% for HCC and 46.5% ICC.
CONCLUSION: High-dose hypofractionated proton therapy demonstrated high LC rates for HCC and ICC safely, supporting ongoing phase III trials of radiation in HCC and ICC.
Phase I study of topical epigallocatechin-3-gallate (EGCG) in patients with breast cancer receiving adjuvant radiotherapy.
Br J Radiol. 2016; 89(1058):20150665 [PubMed] Related Publications
METHODS: Patients with breast cancer who received radiotherapy to the chest wall after mastectomy were enrolled. EGCG solution was sprayed to the radiation field from the initiation of Grade 1 radiation dermatitis until 2 weeks after completion of radiotherapy. EGCG concentration escalated from 40 to 660 μmol l(-1) in 7 levels with 3-6 patients in each level. EGCG toxicity was graded using the NCI (National Cancer Institute Common Terminology Criteria for Adverse Events) v. 3.0. Any adverse event >Grade 1 attributed to EGCG was considered dose-limiting toxicity. The maximum tolerated dose was defined as the dose level that induced dose-limiting toxicity in more than one-third of patients at a given cohort. Radiation dermatitis was recorded weekly by the Radiation Therapy Oncology Group scoring and patient-reported symptoms.
RESULTS: From March 2012 to August 2013, 24 patients were enrolled. Acute skin redness was observed in 1 patient and considered to be associated with the EGCG treatment at 140 μmol l(-1) level. Three more patients were enrolled at this level and did not experience toxicity to EGCG. The dose escalation stopped at 660 μmol l(-1). No other reported acute toxicity was associated with EGCG. Grade 2 radiation dermatitis was observed in eight patients during or after radiotherapy, but all decreased to Grade 1 after EGCG treatments. Patient-reported symptom scores were significantly decreased at 2 weeks after the end of radiotherapy in pain, burning, itching and tenderness, p < 0.05.
CONCLUSION: The topical administration of EGCG was well tolerated and the maximum tolerated dose was not found. EGCG may be effective in treating radiation dermatitis with preliminary investigation.
ADVANCES IN KNOWLEDGE: EGCG solution seemed to be feasible for treating radiation dermatitis in patients with breast cancer after mastectomy. It should be tested as a way to reduce radiation-induced normal tissue toxicity and complications in future years.
Phase 1 Dose Escalation Study of Accelerated Radiation Therapy With Concurrent Chemotherapy for Locally Advanced Lung Cancer.
Int J Radiat Oncol Biol Phys. 2015; 93(5):997-1004 [PubMed] Related Publications
METHODS AND MATERIALS: Patients with locally advanced lung cancer (non-small cell and small cell) with good performance status and minimal weight loss received concurrent cisplatin and etoposide with RT. Intensity modulated RT with daily image guidance was used to facilitate esophageal avoidance and delivered using 6 fractions per week (twice daily on Fridays with a 6-hour interval). The dose was escalated from 58 Gy to a planned maximum dose of 74 Gy in 4 Gy increments in a standard 3 + 3 trial design. Dose-limiting toxicity (DLT) was defined as acute grade 3-5 nonhematologic toxicity attributed to RT.
RESULTS: A total of 24 patients were enrolled, filling all dose cohorts, all completing RT and chemotherapy as prescribed. Dose-limiting toxicity occurred in 1 patient at 58 Gy (grade 3 esophagitis) and 1 patient at 70 Gy (grade 3 esophageal fistula). Both patients with DLTs had large tumors (12 cm and 10 cm, respectively) adjacent to the esophagus. Three additional patients were enrolled at both dose cohorts without further DLT. In the final 74-Gy cohort, no DLTs were observed (0 of 6).
CONCLUSIONS: Dose escalation and acceleration to 74 Gy with intensity modulated RT and concurrent chemotherapy was tolerable, with a low rate of grade ≥3 acute esophageal reactions.
Outcome According to Elective Pelvic Radiation Therapy in Patients With High-Risk Localized Prostate Cancer: A Secondary Analysis of the GETUG 12 Phase 3 Randomized Trial.
Int J Radiat Oncol Biol Phys. 2016; 94(1):85-92 [PubMed] Related Publications
METHODS AND MATERIALS: Patients with a nonpretreated high-risk localized prostate cancer and a staging lymphadenectomy were randomly assigned to receive either goserelin every 3 months for 3 years and 4 cycles of docetaxel plus estramustine or goserelin alone. Local therapy was administered 3 months after the start of systemic treatment. Performance of pelvic ENI was left to the treating physician. Only patients treated with primary RT were included in this analysis. The primary endpoint was biochemical progression-free survival (bPFS).
RESULTS: A total of 413 patients treated from 2002 to 2006 were included, of whom 358 were treated using primary RT. A total of 208 patients received pelvic RT and 150 prostate-only RT. Prostate-specific antigen (PSA) concentration, Gleason score, or T stage did not differ according to performance of pelvic RT; pN+ patients more frequently received pelvic RT than pN0 patients (P<.0001). Median follow-up was 8.8 years. In multivariate analysis, bPFS was negatively impacted by pN stage (hazard ratio [HR]: 2.52 [95% confidence interval [CI]: 1.78-3.54], P<.0001), Gleason score 8 or higher (HR: 1.41 [95% CI: 1.03-1.93], P=.033) and PSA higher than 20 ng/mL (HR: 1.41 [95% CI: 1.02-1.96], P=.038), and positively impacted by the use of chemotherapy (HR: 0.66 [95% CI: 0.48-0.9], P=.009). There was no association between bPFS and use of pelvic ENI in multivariate analysis (HR: 1.10 [95% CI: 0.78-1.55], P=.60), even when analysis was restricted to pN0 patients (HR: 0.88 [95% CI: 0.59-1.31], P=.53). Pelvic ENI was not associated with increased acute or late patient reported toxicity.
CONCLUSIONS: This unplanned analysis of a randomized trial failed to demonstrate a benefit of pelvic ENI on bPFS in high-risk localized prostate cancer patients.
Stereotactic intracavitary brachytherapy with P-32 for cystic craniopharyngiomas in children.
Strahlenther Onkol. 2016; 192(3):157-65 [PubMed] Related Publications
PATIENTS AND METHODS: Between 1992 and 2009, 17 children (median age 15.4 years; range 7-18 years) with cystic CP underwent intracavitary brachytherapy using P-32. Eleven patients were treated for recurrent tumor cysts; 6 patients were treated primarily. MR imaging revealed solitary cysts in 7 patients; 10 patients had mixed solid-cystic lesions (median tumor volume 11.1 ml; range 0.5-78.9 ml). The median follow-up time was 61.9 months (range 16.9-196.6 months).
RESULTS: Local cyst control could be achieved in 14 patients (82 %). Three patients showed progression of the treated cystic formation (in-field progression) after a median time of 8.3 months (range 5.3-10.3 months), which led to subsequent interventions. The development of new, defined cysts and progression of solid tumor parts (out-of-field progression) occurred in 5 patients and led to additional interventions in 4 cases. There was neither surgery-related permanent morbidity nor mortality in this study. The overall progression-free survival was 75, 63, and 52 % after 1, 3, and 5 years, respectively.
CONCLUSION: Intracavitary brachytherapy using P-32 represents a safe and effective treatment option for children harboring cystic CP, even as primary treatment. However, P-32 does not clearly affect growth of solid tumor parts or the development of new cystic formations.
Acute Toxicity and Quality of Life After Dose-Intensified Salvage Radiation Therapy for Biochemically Recurrent Prostate Cancer After Prostatectomy: First Results of the Randomized Trial SAKK 09/10.
J Clin Oncol. 2015; 33(35):4158-66 [PubMed] Related Publications
PATIENTS AND METHODS: Patients with BF but without evidence of macroscopic disease were randomly assigned to either 64 or 70 Gy. Three-dimensional conformal radiation therapy or intensity-modulated radiation therapy/rotational techniques were used. The primary end point was freedom from BF. Secondary end points were acute toxicity according to the National Cancer Institute Common Terminology Criteria for Adverse Events (version 4.0) and quality of life (QoL) according to the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaires C30 and PR25.
RESULTS: Three hundred fifty patients were enrolled between February 2011 and April 2014. Three patients withdrew informed consent, and three patients were not eligible, resulting in 344 patients age 48 to 75 years in the safety population. Thirty patients (8.7%) had grade 2 and two patients (0.6%) had grade 3 genitourinary (GU) baseline symptoms. Acute grade 2 and 3 GU toxicity was observed in 22 patients (13.0%) and one patient (0.6%), respectively, with 64 Gy and in 29 patients (16.6%) and three patients (1.7%), respectively, with 70 Gy (P = .2). Baseline grade 2 GI toxicity was observed in one patient (0.6%). Acute grade 2 and 3 GI toxicity was observed in 27 patients (16.0%) and one patient (0.6%), respectively, with 64 Gy, and in 27 patients (15.4%) and four patients (2.3%), respectively, with 70 Gy (P = .8). Changes in early QoL were minor. Patients receiving 70 Gy reported a more pronounced and clinically relevant worsening in urinary symptoms (mean difference in change score between arms, 3.6; P = .02).
CONCLUSION: Dose-intensified SRT was associated with low rates of acute grade 2 and 3 GU and GI toxicity. The impact of dose-intensified SRT on QoL was minor, except for a significantly greater worsening in urinary symptoms.
Hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate-risk localised prostate cancer: 2-year patient-reported outcomes of the randomised, non-inferiority, phase 3 CHHiP trial.
Lancet Oncol. 2015; 16(16):1605-16 [PubMed] Article available free on PMC after 10/10/2016 Related Publications
METHODS: The CHHiP trial is a randomised, non-inferiority phase 3 trial done in 71 centres, of which 57 UK hospitals took part in the QoL substudy. Men with localised prostate cancer who were undergoing radiotherapy were eligible for trial entry if they had histologically confirmed T1b-T3aN0M0 prostate cancer, an estimated risk of seminal vesicle involvement less than 30%, prostate-specific antigen concentration less than 30 ng/mL, and a WHO performance status of 0 or 1. Participants were randomly assigned (1:1:1) to receive a standard fractionation schedule of 74 Gy in 37 fractions or one of two hypofractionated schedules: 60 Gy in 20 fractions or 57 Gy in 19 fractions. Randomisation was done with computer-generated permuted block sizes of six and nine, stratified by centre and National Comprehensive Cancer Network (NCCN) risk group. Treatment allocation was not masked. UCLA Prostate Cancer Index (UCLA-PCI), including Short Form (SF)-36 and Functional Assessment of Cancer Therapy-Prostate (FACT-P), or Expanded Prostate Cancer Index Composite (EPIC) and SF-12 quality-of-life questionnaires were completed at baseline, pre-radiotherapy, 10 weeks post-radiotherapy, and 6, 12, 18, and 24 months post-radiotherapy. The CHHiP trial completed accrual on June 16, 2011, and the QoL substudy was closed to further recruitment on Nov 1, 2009. Analysis was on an intention-to-treat basis. The primary endpoint of the QoL substudy was overall bowel bother and comparisons between fractionation groups were done at 24 months post-radiotherapy. The CHHiP trial is registered with ISRCTN registry, number ISRCTN97182923.
FINDINGS: 2100 participants in the CHHiP trial consented to be included in the QoL substudy: 696 assigned to the 74 Gy schedule, 698 assigned to the 60 Gy schedule, and 706 assigned to the 57 Gy schedule. Of these individuals, 1659 (79%) provided data pre-radiotherapy and 1444 (69%) provided data at 24 months after radiotherapy. Median follow-up was 50·0 months (IQR 38·4-64·2) on April 9, 2014, which was the most recent follow-up measurement of all data collected before the QoL data were analysed in September, 2014. Comparison of 74 Gy in 37 fractions, 60 Gy in 20 fractions, and 57 Gy in 19 fractions groups at 2 years showed no overall bowel bother in 269 (66%), 266 (65%), and 282 (65%) men; very small bother in 92 (22%), 91 (22%), and 93 (21%) men; small bother in 26 (6%), 28 (7%), and 38 (9%) men; moderate bother in 19 (5%), 23 (6%), and 21 (5%) men, and severe bother in four (<1%), three (<1%) and three (<1%) men respectively (74 Gy vs 60 Gy, ptrend=0.64, 74 Gy vs 57 Gy, ptrend=0·59). We saw no differences between treatment groups in change of bowel bother score from baseline or pre-radiotherapy to 24 months.
INTERPRETATION: The incidence of patient-reported bowel symptoms was low and similar between patients in the 74 Gy control group and the hypofractionated groups up to 24 months after radiotherapy. If efficacy outcomes from CHHiP show non-inferiority for hypofractionated treatments, these findings will add to the growing evidence for moderately hypofractionated radiotherapy schedules becoming the standard treatment for localised prostate cancer.
FUNDING: Cancer Research UK, Department of Health, and the National Institute for Health Research Cancer Research Network.
Intensive Multiagent Therapy, Including Dose-Compressed Cycles of Ifosfamide/Etoposide and Vincristine/Doxorubicin/Cyclophosphamide, Irinotecan, and Radiation, in Patients With High-Risk Rhabdomyosarcoma: A Report From the Children's Oncology Group.
J Clin Oncol. 2016; 34(2):117-22 [PubMed] Related Publications
PATIENTS AND METHODS: Patients with metastatic RMS received 54 weeks of therapy: blocks of therapy with vincristine/irinotecan (weeks 1 to 6, 20 to 25, and 47 to 52), interval compression with vincristine/doxorubicin/cyclophosphamide alternating with etoposide/ifosfamide (weeks 7 to 19 and 26 to 34), and vincristine/dactinomycin/cyclophosphamide (weeks 38 to 46). Radiation therapy occurred at weeks 20 to 25 (primary) but was also permitted at weeks 1 to 6 (for intracranial or paraspinal extension) and weeks 47 to 52 (for extensive metastatic sites).
RESULTS: One hundred nine eligible patients were enrolled, with a median follow-up of surviving patients of 3.8 years (3-year EFS for all patients, 38% [95% CI, 29% to 48%]; survival, 56% [95% CI, 46% to 66%]). Patients with one or no Oberlin risk factor (age > 10 years or < 1 year, unfavorable primary site of disease, ≥ three metastatic sites, and bone or bone marrow involvement) had a 3-year EFS of 69% (95% CI, 52% to 82%); high-risk patients with two or more risk factors had a 3-year EFS of 20% (95% CI, 11% to 30%). Toxicity was similar to that on prior RMS studies.
CONCLUSION: Patients with metastatic RMS with one or no Oberlin risk factor had an improved 3-year EFS of 69% on ARST0431 compared with an historical cohort from pooled European and US studies; those with two or more risk factors have a dismal prognosis, and new approaches are needed for this very-high-risk group.
5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial.
Lancet. 2016; 387(10015):229-38 [PubMed] Related Publications
METHODS: We did a phase 3, randomised, non-inferiority trial at 16 hospitals and medical centres in seven European countries. 1184 patients with low-risk invasive and ductal carcinoma in situ treated with breast-conserving surgery were centrally randomised to either whole-breast irradiation or APBI using multicatheter brachytherapy. The primary endpoint was local recurrence. Analysis was done according to treatment received. This trial is registered with ClinicalTrials.gov, number NCT00402519.
FINDINGS: Between April 20, 2004, and July 30, 2009, 551 patients had whole-breast irradiation with tumour-bed boost and 633 patients received APBI using interstitial multicatheter brachytherapy. At 5-year follow-up, nine patients treated with APBI and five patients receiving whole-breast irradiation had a local recurrence; the cumulative incidence of local recurrence was 1.44% (95% CI 0.51-2.38) with APBI and 0.92% (0.12-1.73) with whole-breast irradiation (difference 0.52%, 95% CI -0.72 to 1.75; p=0.42). No grade 4 late side-effects were reported. The 5-year risk of grade 2-3 late side-effects to the skin was 3.2% with APBI versus 5.7% with whole-breast irradiation (p=0.08), and 5-year risk of grade 2-3 subcutaneous tissue late side-effects was 7.6% versus 6.3% (p=0.53). The risk of severe (grade 3) fibrosis at 5 years was 0.2% with whole-breast irradiation and 0% with APBI (p=0.46).
INTERPRETATION: The difference between treatments was below the relevance margin of 3 percentage points. Therefore, adjuvant APBI using multicatheter brachytherapy after breast-conserving surgery in patients with early breast cancer is not inferior to adjuvant whole-breast irradiation with respect to 5-year local control, disease-free survival, and overall survival.
FUNDING: German Cancer Aid.
Clinical impact of IMPORT HIGH trial (CRUK/06/003) on breast radiotherapy practices in the United Kingdom.
Br J Radiol. 2015; 88(1056):20150453 [PubMed] Related Publications
METHODS: A questionnaire was sent to all 26 IMPORT HIGH recruiting RT centres to determine whether the trial has influenced non-trial breast RT techniques in terms of volume delineation, dosimetry, treatment delivery and verification. In order to compare the clinical practice of breast RT between IMPORT HIGH and non-IMPORT HIGH centres, parts of the Royal College of Radiologists (RCR) breast RT audit result were used in this study.
RESULTS: 26/26 participating centres completed the questionnaire. After joining the trial, the number of centres routinely using tumour bed clips to guide whole-breast RT rose from 5 (19%) to 21 (81%). 20/26 (77%) centres now contour target volumes and organs at risk (OARs) in some or all patients compared with 14 (54%) before the trial. 14/26 (54%) centres offer inverse-planned IMRT for selected non-trial patients with breast cancer, and 10/14 (71%) have adopted the IMPORT HIGH trial protocol for target volume and OARs dose constraints. Only 2/26 (8%) centres used clip information routinely for breast treatment verification prior to IMPORT HIGH, a minority that has since risen to 7/26 (27%). Data on 1386 patients was included from the RCR audit. This suggested that more cases from IMPORT HIGH centres had surgical clips implanted (83 vs 67%), were treated using CT guided planning with full three-dimensional dose compensation (100 vs 75%), and were treated with photon boost RT (30 vs 8%).
CONCLUSION: The study suggests that participation in the IMPORT HIGH trial has played an important part in providing the guidance and support networks needed for the safe integration of advanced RT techniques, where appropriate, as a standard of care for breast cancer patients treated at participating cancer centres.
ADVANCES IN KNOWLEDGE: We investigated the impact of the IMPORT HIGH trial on the adoption of advanced breast RT techniques in the UK and the trial has influenced non-trial breast RT techniques in terms of volume delineation, dosimetry, treatment delivery and verification.
Randomized, prospective assessment of moisturizer efficacy for the treatment of radiation dermatitis following radiotherapy after breast-conserving surgery.
Jpn J Clin Oncol. 2015; 45(12):1146-53 [PubMed] Article available free on PMC after 10/10/2016 Related Publications
METHODS: A total of 30 patients were randomly assigned to receive heparinoid moisturizer (Group M), and 32 patients comprised the control group (Group C). Patients in Group M were instructed to apply heparinoid moisturizer from 2 weeks following whole-breast radiotherapy, and to continue to use the moisturizer until 3 months after completion of whole-breast radiotherapy. Group C patients were instructed to not apply any topical moisturizer during the study period. The relative ratio of skin water content ratio (RWCR(t) = (It /Nt)/(I0/N0)) between irradiated and non-irradiated field was calculated. Signs and symptoms were also assessed. The primary endpoint was the difference in relative ratio of skin water content ratio between 2 and 4 weeks following whole-breast radiotherapy.
RESULTS: In Group C, relative ratio of skin water content ratio dropped to 0.80 ± 0.15 at 2 weeks and maintained the low level at 4 weeks following whole-breast radiotherapy. Similarly, in Group M, relative ratio of skin water content ratio dropped to 0.81 ± 0.19 at 2 weeks (prior to application), however, it returned to baseline level (1.05 ± 0.23) at 4 weeks (2 weeks after application). The arithmetic difference of relative ratio of skin water content ratio in Group M was 0.24 ± 0.23 and was significantly larger than in Group C (0.06 ± 0.15; P < 0.01). Skin dryness and desquamation were less severe in Group M.
CONCLUSIONS: The application of heparinoid moisturizer for 2 weeks following whole-breast radiotherapy significantly increased water content and helped improve skin dryness and desquamation compared with no use of moisturizer.
Optimizing Radiation Therapy Quality Assurance in Clinical Trials: A TROG 08.03 RAVES Substudy.
Int J Radiat Oncol Biol Phys. 2015; 93(5):1045-51 [PubMed] Related Publications
METHODS AND MATERIALS: RAVES (Radiation Therapy-Adjuvant vs Early Salvage) (Trans-Tasman Radiation Oncology Group 08.03) is a randomized trial comparing adjuvant with early salvage radiation therapy in men with positive surgical margins or pT3 disease after prostatectomy. Quality assurance in RAVES required each clinician and site to submit a credentialing dummy run (DR) and for each patient's radiation therapy plan to undergo external RTR before treatment. Prospectively defined major violations from trial protocol required remedy and resubmission. Site and clinician factors associated with RTR resubmission were examined using hierarchical modeling.
RESULTS: Data were collected from 171 consecutive patients, treated by 46 clinicians at 32 hospitals. There were 47 RTR resubmissions (27%) due to 65 major violations. The relative rate of resubmission decreased by 29% per year as the study progressed (odds ratio OR. 0.71, P=.02). The majority of resubmissions were due to contouring violations (39 of 65) and dosimetric violations (22 of 65). For each additional patient accrued, significant decreases in RTR resubmission were seen at both clinician level (OR 0.75, P=.02) and site level (OR 0.72, P=.01). The rate of resubmission due to dosimetric violations was only 1.6% after the first 5 patients. Use of IMRT was associated with lower rates of resubmission compared with 3-dimensional conformal radiation therapy (OR 0.38, P=.05).
CONCLUSION: Several low- and high-risk factors that may assist with tailoring future clinical trial QA were identified. Because the real-time resubmission rate was largely independent of the credentialing exercise, some form of RTR QA is recommended. The greatest benefit from QA was derived early in trial activation and clinician experience.
Report on the Clinical Outcomes of Permanent Breast Seed Implant for Early-Stage Breast Cancers.
Int J Radiat Oncol Biol Phys. 2015; 93(3):614-21 [PubMed] Related Publications
METHODS AND MATERIALS: The trials accrued postmenopausal patients with infiltrating ductal carcinoma or ductal carcinoma in situ ≤3 cm and clear surgical margins, who were node negative, and had a planning target volume <120 cm(3). The outcomes included overall and disease-free survival and local and contralateral recurrence at 5 years. The true local recurrence rate was compared using 2-tailed paired t tests for estimates calculated using the Tufts University ipsilateral breast tumor recurrence and Memorial Sloan Kettering ductal carcinoma in situ nomograms.
RESULTS: The cohort included 134 patients, and the observed local recurrence rate at a median follow-up period of 63 months was 1.2% ± 1.2%, similar to the estimate for whole breast irradiation (P=.23), significantly better than for surgery alone (relative risk 0.27; P<.001), and significantly lower than contralateral recurrence (relative risk 0.33; P<.001). The 5-year overall survival rate was 97.4% ± 1.9%, and the disease-free survival rate was 96.4% ± 2.1%. At 2 months, 42% of the patients had erythema, 20% induration, and 16% moist desquamation. The rate of mainly grade 1 telangiectasia was 22.4% at 2 years and 24% at 5 years. The rate of asymptomatic induration was 23% at 2 years and 40% at 5 years.
CONCLUSIONS: The 5-year data suggest that permanent breast seed implantation is a safe accelerated partial breast irradiation option after lumpectomy for early-stage breast cancer with a tolerance profile similar to that of whole breast irradiation.
Nutritional Supplement Based on Zinc, Prebiotics, Probiotics and Vitamins to Prevent Radiation-related Gastrointestinal Disorders.
Anticancer Res. 2015; 35(10):5687-92 [PubMed] Related Publications
PATIENTS AND METHODS: Forty consecutive patients who were candidates for pelvic radiotherapy received Dixentil before starting and during radiotherapy. The primary end-point was to evaluate the safety and tolerance of Dixentil. Secondary end-points were incidence and severity of radiation-induced diarrhea and number of patients who discontinued radiotherapy because of diarrhea.
RESULTS: Radiation-induced enteritis occurred in 17 patients, grade I and grade II diarrhea was documented in 14 and 3 patients respectively; no grade III or IV diarrhea was observed. Radiotherapy was discontinued due to treatment-induced enteritis only in two patients for 6 days.
CONCLUSION: Use of Dixentil is an easy, safe, and feasible approach to protect patients against the risk of radiation-induced diarrhea.
Carbon-ion Radiotherapy for Prostate Cancer: Analysis of Morbidities and Change in Health-related Quality of Life.
Anticancer Res. 2015; 35(10):5559-66 [PubMed] Related Publications
PATIENTS AND METHODS: Seventy-six patients underwent C-ion RT at our center using a recommended dose fractionation of 57.6 GyE in 16 fractions established at the National Institute of Radiological Sciences. Health-related Quality of Life (HRQOL) assessment was also performed using the Medical Outcome Study 8-items Short Form Health Survey (SF-8) questionnaire.
RESULTS: The median follow-up time was 51 months (range=8-58 months). Grade 2 gastrointestinal and genitourinary complications developed in 1 (1.3%) and 5 (6.6%) patients, respectively. Recurrences occurred in 4 patients, and the 4-year biochemical relapse-free rate was 94.6%. The HRQOL scores after C-ion RT were objectively well-maintained.
CONCLUSION: Irrespective of the small number of patients of the study, C-ion RT for prostate cancer using the first commercial-based accelerator reproduced the toxicity outcomes at the NIRS.
OLIGOPELVIS - GETUG P07: a multicentre phase II trial of combined salvage radiotherapy and hormone therapy in oligometastatic pelvic node relapses of prostate cancer.
BMC Cancer. 2015; 15:646 [PubMed] Article available free on PMC after 10/10/2016 Related Publications
METHODS/DESIGN: We plan to assess the two year outcome in oligometastatic prostate cancer patients (1-5 pelvic oligometastases) treated concomitantly with high-dose IMRT (54 Gy, 30 fractions to the pelvis and 66 Gy, 30 fractions to the lymph nodes) and ADT for six months.
DISCUSSION: This multicenter prospective phase II study will yield new data regarding the safety and efficacy of high-dose radiotherapy combined with ADT and will provide a basis for a larger phase III study to examine the role of radiotherapy in this population currently treated only with hormone therapy.
TRIAL REGISTRATION: NCT02274779 , date of registration: 23/10/14.
Determining appropriate timing of adaptive radiation therapy for nasopharyngeal carcinoma during intensity-modulated radiation therapy.
Radiat Oncol. 2015; 10:192 [PubMed] Article available free on PMC after 10/10/2016 Related Publications
METHODS: Nineteen NPC patients were recruited. Each patient had repeat computed tomography (CT) scans after each five fractions and at treatment completion. Automatic re-contouring the targets and OARs by using deformable registration algorithm was conducted through CT-CT fusion. Anatomic changes were assessed by comparing the initial CT and repeated CT. Hybrid plans with re-contouring were generated and the dose-volume histograms (DVH) of the hybrid plan and the original plan were compared.
RESULTS: Progressive volume reductions in gross target volume for primary disease (GTVnx), gross target volume for involved lymph nodes (GTVnd), and parotids were observed over time. Comparing with the original plan, each hybrid plan had no significant difference in homogeneity index (HI) for all the targets. Some parameters for planning target volumes for primary disease and high-risk clinical target volume (PTVnx and PTV1, respectively) improved significantly, notably starting from the 10th fraction. These parameters included mean dose (Dmean), dose to 95% of the volume (D95), percentage of the volume receiving 95% of the prescription dose (V95), and conformity index (CI) for PTVnx, and Dmean, D95, and CI for PTV1. The dosimetric parameters for PTVnd remained the same in general except for D95 and V95 which had significant improvement at specific time points; whereas for PTV2, similar trend of dosimetric changes was also observed. Dose to some OARs increased significantly at some time points.
CONCLUSIONS: There were significant anatomic and dosimetric changes in the targets and OARs. The target dose coverage in the hybrid plans did not get worse, but overdose occurred in some critical structures. Significant dosimetric changes should be considered as a trigger point at which ART replanning is indicated. D95/V95/CI for PTV2, Dmax for the brain stem, spinal cord, right eyeball and left lens, and Dmean/V30 for the parotids and glottis were taken into account for predicting the need for ART. Two replans at the 5th and 15th fractions were suggested.
Feasibility of Preoperative Chemotherapy With or Without Radiation Therapy in Localized Soft Tissue Sarcomas of Limbs and Superficial Trunk in the Italian Sarcoma Group/Grupo Español de Investigación en Sarcomas Randomized Clinical Trial: Three Versus Five Cycles of Full-Dose Epirubicin Plus Ifosfamide.
J Clin Oncol. 2015; 33(31):3628-34 [PubMed] Related Publications
PATIENTS AND METHODS: Of 321 eligible patients, 161 were randomly assigned to three preoperative cycles of epirubicin 120 mg/m(2) plus ifosfamide 9 g/m(2), and 160 were randomly assigned to three preoperative plus two postoperative cycles. Among them, 303 patients were included in this analysis; 169 were male and 134 were female, with a median age of 48 years (range, 15 to 79 years). One hundred fifty-two patients received concurrent RT preoperatively at a total dose of 44 to 50 Gy. Preoperative chemotherapy-related hematologic toxicity and early postoperative complications were reported. The influence of RT, age, and sex on hematologic grade 3 or 4 toxicities and wound complications was analyzed. Chemotherapeutic dose intensity (DI) was analyzed.
RESULTS: Among the patients, 61.4%, 22.4%, and 23.8% experienced, grade 4 leucopenia, grade 3 or 4 anemia, and grade 3 or 4 thrombocytopenia, respectively. Respective rates were 66.4%, 24.3%, and 31.6% when RT was added preoperatively, and 56.3%, 20.5%, and 15.9% when preoperative chemotherapy was administered alone. Patient age affected grade 3 or 4 thrombocytopenia. Grade 4 leucopenia and grade 3 or 4 anemia presented 2.5 times more frequently in female patients than in male patients. Wound complications were observed in 13.5% of patients: 17% with preoperative RT and 10% without. Chemotherapeutic DI was greater than 90%, even in patients receiving preoperative RT and in patients age 65 years or older.
CONCLUSION: This preoperative chemotherapy is feasible and can also be proposed for selected elderly patients. Grade 3 or 4 hematologic toxicity was common, but DI was excellent. Concurrent preoperative RT is safe, although an increased rate of grade 4 thrombocytopenia and limited increase in wound complications may be observed.
Atlas-guided prostate intensity modulated radiation therapy (IMRT) planning.
Phys Med Biol. 2015; 60(18):7277-91 [PubMed] Article available free on PMC after 21/09/2016 Related Publications
The impact of adjuvant radiotherapy on radically resected T3 esophageal squamous cell carcinoma.
J Cancer Res Clin Oncol. 2016; 142(1):277-86 [PubMed] Related Publications
METHODS: Data of a single-center cohort of 692 patients with T3 stage ESCC who underwent radical resection, with or without adjuvant radiotherapy, were reviewed. Univariate and multivariate analyses were performed to compare overall survival (OS) and locoregional recurrence-free survival (LRFS).
RESULTS: Two hundred and forty-six patients received adjuvant radiotherapy (S + R group), and 446 patients underwent surgery alone (S group). The median survival time and 5-year OS rate were 40.0 months and 40.9 % for the entire population, 50.0 months and 45.6 % for the S + R group and 38.0 months and 38.3 % for the S group (P = 0.114 for S + R group vs. S group). The 5-year LRFS rate for the S + R group was significantly higher than that for S group (50.8 vs. 35.9 %, P < 0.001). In subgroup analyses, adjuvant radiotherapy was found to improve the 5-year OS in the subgroups of tumor length >5 cm, pN0 and pN1 categories, pTNM stage IIa, IIb and IIIa (P < 0.005).
CONCLUSIONS: Adjuvant radiotherapy is effective in local control of radically resected T3 stage ESCC and may improve the overall survival in certain subgroups, such as the patients with tumor length >5 cm, pN0 and pN1 categories, pTNM stage IIa, IIb and IIIa. Further studies are required to confirm our results.
Intra-fractional bladder motion and margins in adaptive radiotherapy for urinary bladder cancer.
Acta Oncol. 2015; 54(9):1461-6 [PubMed] Related Publications
MATERIAL AND METHODS: Nine patients treated in a clinical phase II ART trial of daily plan selection for bladder cancer were included. In the library plans, 5 mm isotropic margins were added to account for intra-fractional changes. Pre-treatment and weekly repeat magnetic resonance imaging (MRI) series were acquired in which a full three-dimensional (3D) volume was scanned every second min for 10 min (a total of 366 scans in 61 series). Initially, the bladder clinical target volume (CTV) was delineated in all scans. The t = 0 min scan was then rigidly registered to the planning computed tomography (CT) and plan selections were simulated using the CTV_0 (at t = 0 min). To assess intra-fractional motion, coverage of the CTV_10 (at t = 10 min) was quantified using the applied PTV. Population-based margins were calculated using the van Herk margin recipe while patient-specific margins were calculated using a linear model.
RESULTS: For 49% of the cases, the CTV_10 extended more than 5 mm outside the CTV_0. However, in 58 of the 61 cases (97%) CTV_10 was covered by the selected PTV. Population-based margins of 14 mm Sup/Ant, 9 mm Post and 5 mm Inf/Lat were sufficient to cover the bladder. Using patient-specific margins, the overlap between PTV and bowel-cavity was reduced from 137 cm(3) with the plan selection strategy to 24 cm(3).
CONCLUSION: In this phase II ART trial, 5 mm isotropic margin for intra-fractional motion was sufficient even though considerable intra-fractional motion was observed. In online re-optimised ART, population-based margin can be applied although patient-specific margins are preferable.
Imaging Predictors of Elevated Lung Shunt Fraction in Patients Being Considered for Yttrium-90 Radioembolization.
J Vasc Interv Radiol. 2015; 26(10):1472-8 [PubMed] Related Publications
MATERIALS AND METHODS: During the period 2009-2014, 152 consecutive patients underwent planning hepatic arteriography with technetium-99m ((99m)Tc) macroaggregated albumin (MAA) injection. Computed tomography (CT) or magnetic resonance imaging performed before the procedure for each patient was assessed for hepatic vein (HV) tumor thrombus or occlusion from external compression by tumor. When imaging was a multiphase CT scan (117 patients), the arterial phase was evaluated for evidence of early HV opacification (relative to unaffected HVs), indicating hepatic venous shunting. These factors were correlated with LSF determined by (99m)Tc-MAA imaging.
RESULTS: Median LSF was 6.7% (range, < 0.1%-71%), significantly higher for HCC (8.0% vs 6.3% for other tumors, P = .048). Larger tumor size was associated with higher LSF in univariate analysis (P = .001). There was high interobserver agreement for determining hepatic venous shunting (97%, κ = 0.847), which was associated with higher LSF (P < .001; 78% sensitivity, 93% specificity). Of 5 cases of HV tumor thrombus, all had high (> 20%) LSF (P < .001). HV occlusion was also associated with higher LSF (P = .039). Multivariate analysis confirmed that early HV opacification and either HV tumor thrombus or occlusion were associated with higher LSF.
CONCLUSIONS: Early HV opacification and HV tumor thrombus or occlusion on cross-sectional imaging performed before radioembolization are associated with elevated LSF, which may contraindicate or limit the dose delivered in (90)Y radioembolization. This information could be helpful during patient counseling for anticipating the most appropriate mode of liver-directed therapy.
Precision Hypofractionated Radiation Therapy in Poor Performing Patients With Non-Small Cell Lung Cancer: Phase 1 Dose Escalation Trial.
Int J Radiat Oncol Biol Phys. 2015; 93(1):72-81 [PubMed] Related Publications
METHODS AND MATERIALS: Patients with stage II to IV or recurrent NSCLC and Eastern Cooperative Oncology Group performance status of 2 or greater and not candidates for surgical resection, stereotactic radiation, or concurrent chemoradiation were eligible. Highly conformal radiation therapy was given to treat intrathoracic disease in 15 fractions to a total of 50, 55, or 60 Gy.
RESULTS: Fifty-five patients were enrolled: 15 at the 50-Gy, 21 at the 55-Gy, and 19 at the 60-Gy dose levels. A 90-day follow-up was completed in each group without exceeding the MTD. With a median follow-up of 12.5 months, there were 93 grade ≥ 3 adverse events (AEs), including 39 deaths, although most AEs were considered related to factors other than radiation therapy. One patient from the 55- and 60-Gy dose groups developed grade ≥ 3 esophagitis, and 5, 4, and 4 patients in the respective dose groups experienced grade ≥ 3 dyspnea, but only 2 of these AEs were considered likely related to therapy. There was no association between fraction size and toxicity (P = .24). The median overall survival was 6 months with no significant differences between dose levels (P = .59).
CONCLUSIONS: Precision hypofractionated radiation therapy consisting of 60 Gy in 15 fractions for locally advanced NSCLC is generally well tolerated. This treatment regimen could provide patients with poor performance status a potent alternative to chemoradiation. This study has implications for the cost effectiveness of lung cancer therapy. Additional studies of long-term safety and efficacy of this therapy are warranted.
COSMIC: A Regimen of Intensity Modulated Radiation Therapy Plus Dose-Escalated, Raster-Scanned Carbon Ion Boost for Malignant Salivary Gland Tumors: Results of the Prospective Phase 2 Trial.
Int J Radiat Oncol Biol Phys. 2015; 93(1):37-46 [PubMed] Related Publications
PATIENTS AND METHODS: COSMIC (combined treatment of malignant salivary gland tumors with intensity modulated radiation therapy and carbon ions) is a prospective phase 2 trial of 24 Gy(RBE) C12 followed by 50 Gy IMRT in patients with pathologically confirmed MSGT. The primary endpoint is mucositis Common Terminology Criteria grade 3; the secondary endpoints are locoregional control (LC), progression-free survival (PFS), overall survival (OS), and toxicity. Toxicity was scored according to the Common Terminology Criteria for Adverse Events version 3; treatment response was scored according to Response Evaluation Criteria in Solid Tumors 1.1.
RESULTS: Between July 2010 and August 2011, 54 patients were accrued, and 53 were available for evaluation. The median follow-up time was 42 months; patients with microscopically incomplete resections (R1, n = 20), gross residual disease (R2, n = 17), and inoperable disease (n = 16) were included. Eighty-nine percent of patients had ACC, and 57% had T4 tumors. The most common primary sites were paranasal sinus (34%), submandibular gland, and palate. At the completion of radiation therapy, 26% of patients experienced grade 3 mucositis, and 20 patients reported adverse events of the ear (38%). The most common observed late effects were grade 1 xerostomia (49%), hearing impairment (25%, 2% ipsilateral hearing loss), and adverse events of the eye (20%), but no visual impairment or loss of vision. Grade 1 central nervous system necrosis occurred in 6%, and 1 grade 4 ICA hemorrhage without neurologic sequelae. The best response was 54% (complete response/partial remission). At 3 years, the LC, PFS, and OS were 81.9%, 57.9%, and 78.4%, respectively. No difference was found regarding resection status. The most common site of failure was distant (55%). Local relapse was predominantly in field (79%).
CONCLUSION: Treatment was tolerated, with moderate acute and late toxicity. The LC at 3 years was promising. No significant difference could be shown regarding resection status; hence, extensive and mutilating surgical procedures should be rediscussed. Further dose escalation may be limited in view of potential vascular adverse events.
A randomized phase II/III study of adverse events between sequential (SEQ) versus simultaneous integrated boost (SIB) intensity modulated radiation therapy (IMRT) in nasopharyngeal carcinoma; preliminary result on acute adverse events.
Radiat Oncol. 2015; 10:166 [PubMed] Article available free on PMC after 21/09/2016 Related Publications
METHODS: Newly diagnosed stage I-IVB NPC patients were randomized to receive SEQ-IMRT or SIB-IMRT, with or without chemotherapy. SEQ-IMRT consisted of two sequential radiation treatment plans: 2 Gy x 25 fractions to low-risk planning target volume (PTV-LR) followed by 2 Gy x 10 fractions to high-risk planning target volume (PTV-HR). In contrast, SIB-IMRT consisted of only one treatment plan: 2.12 Gy and 1.7 Gy x 33 fractions to PTV-HR and PTV-LR, respectively. Toxicities were evaluated according to CTCAE version 4.0.
RESULTS: Between October 2010 and November 2013, 122 eligible patients were randomized between SEQ-IMRT (54 patients) and SIB-IMRT (68 patients). With median follow-up time of 16.8 months, there was no significant difference in toxicities between the two IMRT techniques. During chemoradiation, the most common grade 3-5 acute toxicities were mucositis (15.4% vs 13.6%, SEQ vs SIB, p = 0.788) followed by dysphagia (9.6% vs 9.1%, p = 1.000) and xerostomia (9.6% vs 7.6%, p = 0.748). During the adjuvant chemotherapy period, 25.6% and 32.7% experienced grade 3 weight loss in SEQ-IMRT and SIB-IMRT (p = 0.459). One-year overall survival (OS) and progression-free survival (PFS) were 95.8% and 95.5% in SEQ-IMRT and 98% and 90.2% in SIB-IMRT, respectively (p = 0.472 for OS and 0.069 for PFS).
CONCLUSION: This randomized, phase II/III trial comparing SIB-IMRT versus SEQ-IMRT in NPC showed no statistically significant difference between both IMRT techniques in terms of acute adverse events. Short-term tumor control and survival outcome were promising.
Acute and Short-term Toxic Effects of Conventionally Fractionated vs Hypofractionated Whole-Breast Irradiation: A Randomized Clinical Trial.
JAMA Oncol. 2015; 1(7):931-41 [PubMed] Article available free on PMC after 21/09/2016 Related Publications
OBJECTIVE: To assess acute and 6-month toxic effects and quality of life (QOL) with conventionally fractionated WBI (CF-WBI) vs hypofractionated WBI (HF-WBI).
DESIGN, SETTING, AND PARTICIPANTS: Unblinded randomized trial of CF-WBI (n = 149; 50.00 Gy/25 fractions + boost [10.00-14.00 Gy/5-7 fractions]) vs HF-WBI (n = 138; 42.56 Gy/16 fractions + boost [10.00-12.50 Gy/4-5 fractions]) following breast-conserving surgery administered in community-based and academic cancer centers to 287 women 40 years or older with stage 0 to II breast cancer for whom WBI without addition of a third field was recommended; 76% of study participants (n = 217) were overweight or obese. Patients were enrolled from February 2011 through February 2014 and observed for a minimum of 6 months.
INTERVENTIONS: Administration of CF-WBI or HF-WBI.
MAIN OUTCOMES AND MEASURES: Physician-reported acute and 6-month toxic effects using National Cancer Institute Common Toxicity Criteria, and patient-reported QOL using the Functional Assessment of Cancer Therapy for Patients with Breast Cancer (FACT-B). All analyses were intention to treat, with outcomes compared using the χ2 test, Cochran-Armitage test, and ordinal logistic regression.
RESULTS: Of 287 participants, 149 were randomized to CF-WBI and 138 to HF-WBI. Treatment arms were well matched for baseline characteristics, including FACT-B total score (HF-WBI, 120.1 vs CF-WBI, 118.8; P = .46) and individual QOL items such as somewhat or more lack of energy (HF-WBI, 38% vs CF-WBI, 39%; P = .86) and somewhat or more trouble meeting family needs (HF-WBI, 10% vs CF-WBI, 14%; P = .54). Maximum physician-reported acute dermatitis (36% vs 69%; P < .001), pruritus (54% vs 81%; P < .001), breast pain (55% vs 74%; P = .001), hyperpigmentation (9% vs 20%; P = .002), and fatigue (9% vs 17%; P = .02) during irradiation were lower in patients randomized to HF-WBI. The rate of overall grade 2 or higher acute toxic effects was less with HF-WBI than with CF-WBI (47% vs 78%; P < .001). Six months after irradiation, physicians reported less fatigue in patients randomized to HF-WBI (0% vs 6%; P = .01), and patients randomized to HF-WBI reported less lack of energy (23% vs 39%; P < .001) and less trouble meeting family needs (3% vs 9%; P = .01). Multivariable regression confirmed the superiority of HF-WBI in terms of patient-reported lack of energy (odds ratio [OR], 0.39; 95% CI, 0.24-0.63) and trouble meeting family needs (OR, 0.34; 95% CI, 0.16-0.75).
CONCLUSIONS AND RELEVANCE: Treatment with HF-WBI appears to yield lower rates of acute toxic effects than CF-WBI as well as less fatigue and less trouble meeting family needs 6 months after completing radiation therapy. These findings should be communicated to patients as part of shared decision making.
TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01266642.


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This is a page about postal code of Väylänpää, with more professional information like latitude, longitude and online map etc.
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Sina (NASDAQ:SINA) declined about 4.5% to 78.35 late in Tuesday's after-hours trade after posting results and guidance, but despite the negative trade, longs should give this one a hard look, as the stock has a strong tendency to reverse direction in next-day trade.
SINA has recorded an earnings-driven after-hours decline in five of the last 11 quarters tracked by our MT Pro database. 80.0% of the time (four out of five times) the stock reversed in the opposite direction by the close of the next day's regular session, compared to the extended hours "effective close." When it reversed, the price closed in the opposite direction on average by 9.0% (in four events) from the "effective close."
The solid reversal trend in place -- and some decent upside liquidity that flowed into SINA shares off the Tuesday night after-hours low -- may open the door for more risk-tolerant longs to eye the stock off any revisit down to the 78 to 77 area ... levels that saw decent upside liquidity as the stock rose off its bottom Tuesday night.
SINA dropped in evening trade after topping Q4 estimates, guiding in-line for Q1 and announcing a deal to buy shares of Mecox Lane (NASDAQ:MCOX), a Chinese online platform for apparel and accessories.
SINA slumped through the 81 mark to an after-hours low of 77 before spiking back up to 81 after the mid-session. It spent much of the second-half of after-hours trade drifting south from 80 to 78.
A pre-market open Wednesday may have potential in the 80 to 78 area.
Disclosure: I have no positions in any stocks mentioned, and no plans to initiate any positions within the next 72 hours.


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Calendar & Events
Garden Plan
Eucalyptus Arboretum
Photo Gallery
Contact Us
About Us
Support Us
Corporate Members
FMBG Patron
Jane Edmanson OAM
Inc#: A00450772
Mission: We are working to foster, promote and support the development of a botanic garden in Melton - Join us!
"Botanic gardens are institutions holding documented collections of living plants for the purposes of scientific research, conservation, display and education." - International Agenda for Botanic Gardens in Conservation
Melton Botanic Garden - Public Car Park is at 40 Lakewood Boulevard.
Plant Nursery and Depot - 21 Wlliams St (near corner of Tullidge St and Williams St).
see Google
Map or Melways Map 337 Ref: C10 and D10.
Getting there by public transport.
Monthly Meetings:
Second Wednesday of the Month @ 7.30pm (except
January no meeting, February & Dec meetings at the MBG)
Venue: Botanica Springs Community Centre -
249 Clarkes Rd, Brookfield VIC 3338 - parking
available - Contact
Next Meeting - Wednesday 8th February 2017 6.30pm
Celebrate the new FMBG year with a sausage sizzle at the depot and take a walk around the garden
Sausages provided - BYO and drinks. A salad or dessert to share would be appreciated. There will be a raffle at $1 ticket.
Please let Jill know on 9743 3819 if you are coming.
For information on FMBG meetings contact Janet Dyke: 9743 2733
Plant Nursery
The nursery is open for sales Tuesdays, Thursdays, 2nd and 4th Sundays 10am-1pm. Address: 21 Williams St, Melton, 3338.
Short break of about 4 weeks over Christmas/New Year re-opening mid-January.
Library Resources - list of books etc.
Public Guided Tours of the Melton Botanic Garden
Sustainable Living Festival Guided Tour - Sunday 12th February 2017 10am-noon
During the Sustainable Living Festival take a guided walking tour through the Melton Botanic Garden to see the ever developing garden areas and incorporation of sustainability principles. The walk is just over one and half hours followed by morning tea. See flyer.
Book your group for a guided walk: see plants that tolerate a dry climate and low water conditions. The usual guided walk is about an hour to an hour and a half. Highlights are the natural features, the dryland eucalyptus arboretum, the indigenous plantings, the Koori Student Garden designed by Koori students from Melton primary and secondary schools, the lake, Sensory Garden, Victorian Volcanic Plains Garden and the garden beds in development (West Australian and South Australian and Southern African).
Information: JohnBentley 03 9743 3819 / 0412 762 531 <email@example.com>
and a category Winner 2016
Melton Business Excellence Awards
"Best Access and Inclusion" 2016
"Best Community Enterprise" 2015
"Best Community & Not for Profit Organisation" -2014
"Best Community or Not for Profit Organisation " -2012
"Leaders in Sustainability" -2011
Prominent Friends
Well everybody is!
Julia Gillard (past Prime Minister of Australia) was member during her parlimentary term and Don Nardella (Legislative Assembly Member for Melton - Parliament of Victoria) is an
FMBG member
News and Events
MBG Plant Species
We starting
to list the garden's plant species with links to information sources about the species - Click on Plant Species to see the test list
Version 1 of the booklet
Eucalypts of MBG Eucalyptus Arborteum has been released (3MB download - higher quality version available on request 15MB)
Melton Botanic Garden on ABC Gardening Australia -
The Melton Botanic Garden was featured in
Series 25 Episode 10 shown on 24 May 2014 with Jane and Costa.
See the Factsheet and the show with just the MBG segments here.
Southern African Garden
The Southern African Garden has commenced and extensive bed preparation and planting is being done.
Volunteer and Help Build the Garden - Everyone is welcome to join in with any group (Volunteer Information)
Grow the Garden Days on the 4th Sunday every month 10am to noon - planting, watering and weeding
Generally work in various areas of the Melton Botanic Garden.
Enter the Melton Botanic Garden at the north end at the corner of Williams and Tullidge Street behind Melton Home Timber and Hardware store.
Gumnuts and Sandgropers
Gumnuts work in the Eucalyptus Arborteum or teh Western Australian/South Australian Garden 1st to 4th Wednesday every month 9.30am-noon - Contact David Pye (5428 9369)
This group meets every Thursday 9.30am-noon and work on Ryans Creek rehabilitation - Contact Margaret Peters (5367 3328)
Lakers work around the Lake 2nd, 3rd and 4thd Tuesdays every month 10am-noon - Contact Jill Bentley (9743 3819)
Work in the Southern African Garden on Tuesdays and Thursdays 9.30am-noon.
Odd Jobbers
Odd Jobbers undertake various handyperson jobs at the Depot and in the garden - Usually every Tuesday and Thursday 10am-noon or when required - Contact John Bentley (9743 3819)
Nursery Team
Meet at the Plant Nursery
inside the Depot to sell, tend and propagate plants - Tuesday 10am-1pm Contact email@example.com
FMBG Depot - 21 Williams Street, Melton (near corner of Williams and Tullidge Streets)
Clean Up Days
2nd Sunday of every 2nd month 10am to noon (Feb, April, June, August, October)
Also Clean Up Australia Day is on the first Sunday in March at 10am.
Melton Botanic Garden - Meet at the Depot - Cnr Williams and Tullidge Streets
MBG Working Party
The Working Party meets about every 2 months at 3pm - Venue: MBG Depot, 21 Williams St, Melton
To develop the Melton Botanic Garden much planning and preparation is required. The Working Party is a meeting of project managers, coordinators and external representatives.
Reminder - Membership
fees due 30th June annually
City of Melton Budget 2015/2016 and 2016/2017
July 2016 - $50,000 allocated in the Melton City Council budget 2016/2017 for development of the Melton Botanic Garden
July 2015 - $35,000 allocated in the Melton City Council budget 2015/2016 for development of the Melton Botanic Garden
"Resource Recovery and Waste Management" - Sustainable Cities Keep Victoria Beautiful Award 2016 with Melton City Council
"Best Access and Inclusion" - City of Melton Business Excellence Awards 2016
"Best Community Enterprise Business"- City of Melton Business Excellence Awards 2015
"Victorian Compost User Demonstrating Innovation and Advocacy in Amenity Markets" - Australian Organics Recycling Association 2015
"Best Community or Not for Profit Organisation"- City of Melton Business Excellence Awards 2014
"Community Action and Leadership" - Keep Australia Beautiful Victoria Sustainable Cities Award 2013
"Best Community or Not for Profit Organisation"- Melton Business Excellence Awards 2012
"Leaders in Sustainability"- Melton Business Excellence Awards 2011
Search FMBG Website:
Copyright © Friends of the Melton Botanic Garden 2004
Last updated:
For comments or suggestions e-mail: webmaster


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Jacalyn Dailey
MAPLE GROVE, MINN. Jacalyn Belle (Parizek) Dailey, 78, of Plymouth, Minn., passed away peacefully Sunday, Aug. 4, 2013, surrounded by the love of her family.
She is preceded in death by her husband, Allan "Jack" Dailey; and daughter, Becky (Dailey) Carroll. She is survived by daughters Connie (Mike) Neveaux, Julie (Mike) Buck, and Toni (Cory) Tamm; son-in-law, James Carroll; grandchildren, Dustin Carroll, Andrea, Daniel and Rachel Neveaux, Jon and Kathryn Buck, Jack Tamm; great-grandson Benjamin Brock; and many family and friends.
A celebration of Jackie's life will be held at 11 a.m Friday, Aug. 9, at Lord of Life Lutheran Church, 7401 County Rd. 101, Maple Grove, Minn., with a visitation one hour prior.


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November 26th, 2006, 12:23 AM
So here I am with 2,500 bucks in my pocket wanting to make a gaming rig for the upcoming year. But my question is what should I make it based off of. I mean the pentium d's have up to a 3.73 gig processor while the duel cores top out aroud 2.4 gigs max. But what is better? When it comes to processors I love AMD's but the new games all seem to want 3.0 gigs min so what should I look at processor wise that won't break me to bad?


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Stanford senior opposite Eric Mochalski has been named the Sports Imports/AVCA Men's Division I-II National Player of the Week, the organization announced today.
Against UCSD, Mochalski registered six kills and hit .300 in the two sets he played. The team held the Tritons to a .100 attack percentage, the lowest by a Cardinal opponent this season. The following day against the defending champion Anteaters, the Manhattan Beach native tallied 12 kills on a .526 hitting percentage to accompany his seven digs and three blocks.
This marks the 13th time in program history a Stanford player has garnered Sports Imports/Player of the Week honors, with the most recent coming from Brad Lawson on April 17, 2012.
Nationally No. 7 Stanford travels to Stockton on Wednesday to take on Pacific at 7 p.m. Stanford then returns home to play host to No. 4 BYU on Saturday at 7 p.m. on the Pac-12 Networks.
This story contains 210 words.
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83 posts tagged with sql and database.
Displaying 1 through 50 of 83. Subscribe:
MS Access SQL question
I think this should be simple, but I don't use Access very often and my brain isn't working tonight. [more inside]
You speak like a green girl / unsifted in such perilous circumstances.
I would like to create a database, using MS SQL, MySQL or SQLite. I would also really like to create some sort of user interface on top of the database so people can enter information in forms and be able to view reports where the information is sorted and filtered in various ways to make the important stuff a little more easily readable. [more inside]
Securing custom MySQL tables in Wordpress
I have personal tables I'm using within the Wordpress database for my own data storage and manipulation purposes. How can I protect these *most easily* from sql injections and/or whatever other evil lurks? [more inside]
Help me become good at relational databases
I'm a fairly seasoned developer but not much of a relational database expert, though I know the fundamentals. I'm looking for resources to get to the next stage. [more inside]
Starting a SQL Career at 32?
I am interested in a career in SQL databases. Is this worth it and how would I get started on it? [more inside]
Best resources for learning SQL for database newbies
I am making a transition from an Excel-based reporting analyst to a database-oriented role in which SQL will be the primary necessary skill. I have next to zero database experience. I'm looking for resources that would be effective at teaching me what I need to learn. More within… [more inside]
Help me get a Microsoft DB certification
I want to get a Microsoft Database certification so I can become a database developer (I know some basic SQL using Postgres but I'd like to know more and get a certification). What's the best way to do this using a book instead of taking a class? [more inside]
SQL Trace: How to aggregate data by stored procedure without ClearTrace
I'm trying to put together an automated SQL server monitoring and diagnostics solution, including SQL Trace data. I want to be able to group RPC:Completed event data by stored procedure. Unfortunately, the formatting and parameter values in each specific call make this kind of aggregation impossible. For instance "Select * From qryLinksByNewsletterID Where NewsletterID=19" and "Select * From qryLinksByNewsletterID Where NewsletterID=234" would be considered different remote procedure calls. ClearTrace does that for you. But, ClearTrace can't run as an automated SQL job. Some kind of script would be ideal, and someone by the name of Andrew Zanevsky made a post describing one back in 2004, but the link to the actual script is dead. I could create my own with Regexes and such, but it seems like someone out there must have done it already. [more inside]
Document-Oriented Database for Non-Programmers?
Is there such a thing as a Document-Oriented Database for Non-Programmers? I've been searching the web for several days and I'm quite confused so I thought to post here. [more inside]
SQL Teaching Game
I remember coming across a game that represented rows in a database as stars in a galaxy, and gave the player visual feedback for the queries they entered. What was that called?
MS Access Combo Box Fields behaving strangely.
I'm putting together an Access database (woe is me), which includes some "multiple choice" fields, that contain a defined list of options. I've got some code that puts together a query, and generates a report. The way these fields are displayed in this report is inconsistent, and I'm trying to figure out why. [more inside]
Data Driven Clinical Care - Dynamic Graphing Website
I would like advice on creating a dynamic graphing website to display clinical data on a intranet website to better aide clinicians. What my superiors are seeking is a "Data Mall." My programming/server-admin. experience is minimal, but my Linux-hobbyist mentality hates the MS Access solution that is being built. [more inside]
How do I go from MAMP to champ?
How do I transfer my locally-created Wordpress site (using MAMP) to my live Dreamhost site? [more inside]
SQL: How do I increment an alphanumeric field by + 1?
I'm a bit of a SQL novice but learning at a decent clip. I'm using SQL (Aqua Data Studio, if that matters to you) to update a couple of fields in an Oracle database table. I'd like to do this across a range of one of the fields. One field is a numeric field (trans_id - a transaction id) that I need to increase by 1 -- I think have that part licked. The next field is alphanumeric (calendar_name - represents the name of a week) and also needs to be incremented by one. The doozy (for me) is the alphanumeric field. Who's the guru? [more inside]
Is there a way to visually organize database tables (and saved queries and views)?
I have a wonderful (Oracle) SQL database and I use Navicat Lite to crunch around in it. My problem is that I'm staring at lists of 50+ tables, 60+ saved queries, 10+ views, etc. Is there anything I can do to somehow organise things in a visually pleasing and/or functional way? [more inside]
How do I move this database online?
What's the easiest, most secure way to move this SQL database and its browser-based front end online? [more inside]
Learning Oracle and SQL
Hey all. I need to learn the basic principles of SQL and Oracle databases. I'm looking for web resources and books. Got any favorites? What's out there? Thanks in advance.
SELECT careerhelp FROM much better informer mefites.
It is time to refine my career. Help me become an excellent database administrator. [more inside]
i need a database!
[Python/database filter] I wrote a script in python for a class and I want to challenge myself now to make it attached to a database... [more inside]
Looking for a good book to help me brush up on my database skills
I've been working with SQL and RDBMSes for a number of years, but my most recent job involved no DB work at all. Understandably, I'm a bit rusty. So I'd like to get a good book to help me brush up, and also to learn a bit more about RDBMS technology. What would you recommend? [more inside]
[hɛlp mi si junikod ɪn maɪ deɪtəbeɪs, ɔr maɪ dætəbeɪs ivɛn]
I'm using Navicat Lite to connect to my Oracle research database (Mac OSX). Much of my data is in IPA (International Phonetic Alphabet). These are unicode symbols. Is there a way to display the IPA/Unicode in Navicat? Or some other GUI? Or is there some addon/code/plugin/whatever that will show me the symbols? [more inside]
SQL Query help in Access 2000
I have a MS Access 2000 table with approx 300,000 records. I need help with constructing a query. [more inside]
How do I collect dictionary definitions for ~350 words to put into a database?
I have a list of about 350 words that I'm putting into a database that I'm building from scratch. For each word in the list, I'd like to include its American English dictionary definition (preferably American Heritage Dictionary), UrbanDictionary entry, and Wikipedia page link (I realize that entries may not exist for some columns for many of these words). Is there some way to streamline or data-mine this process, so I don't have to look up each word individually in 3 separate sources x350+, not to mention all the copying and pasting? [more inside]
I haven't needed SQL this ugly before
What SQL magic do I need to turn one column into several? [more inside]
How can I select this in SQL?
SQLfilter: Help me solve a problem that's driving me crazy. I'm working with someone else's data, and I've got a seemingly insurmountable select problem that no amount of googling has helped me with so far. [more inside]
Best front ends for SQL databases?
What are the current best options for providing a front end for users to search and enter data to a SQL database? [more inside]
How to export data from a SQL database into a CSV file and add some new data?
How can I export data from a SQL database into a CSV file and add a new column at the same time? [more inside]
Effing Access combo boxes, how do they work?
I'm trying to make a combo box populate properly in an MS Access form (oh, the pain), and I need some help. [more inside]
SQL on demand?
Is there somewhere you can go to upload some tables (or import CSV files) and run SQL commands on it? [more inside]
SQL - Accurately show how many rows an UPDATE statement is going to affect before execution.
SQL - How to get an accurate count of the rows potentially affected by an UPDATE statement, or best practices for performing updates? [more inside]
Need recs for IT training in Seattle.
In the Seattle/Snohomish area. Which schools provide good training in beginning SQL, or database design, or IT project management? [more inside]
How to keep track of many computers?
I need an inventory management system to keep track of computer hardware and its users. [more inside]
SQL Query Question
SQL query help. Given the (fictional but equivalent) table disk_status = computer_id:int, disk_id:int, datetime:datetime, temperature:float, rpm:int, I need to provide a table of disk status for a given computer_id, without knowing in advance how many disks there are. So if there were two disks for a particular computer, the result would have the header: datetime, disk_1_temperature, disk_1_rpm, disk_2_temperature, disk_2_rpm, disk_2_rpm [more inside]
Upsize Access database?
I have been asked to make a proposal to upsize an Access database to allow for a few more concurrent users (currently 10) and ideally improve the overall performance of the system. Am I getting in over my head? [more inside]
Comparing two similar but non-matching tables in Access?
Microsoft Access query problem - Comparing two similar tables that don't match up well. It's lists of classes in a collection of locations from two consecutive years, and what I need is to show the class fees side by side for any class that happened in the same location both years. [more inside]
How does flickr do it?
My developer and I want to create a database schema that allows us to search through hundreds of tags applied to thousands of records. So far our benchmarks suck. Are we expecting too much? [more inside]
How do I convert checkbox results to numbers?
Can anyone give me advice on dealing with checkboxes in PHP, to hand off to SQL. [more inside]
Database suggestions
Database Olympics: File Maker Pro vs. MySQL! Help us pick a database system (Anko or Firebrand). Which do you think is superior to run a print publication database? [more inside]
Reconstituting a wiki database from html?
I'd like to reconstitute a years-defunct wiki I used to collaborate on. I've contacted the principals, & our searches for the database backup have come up empty so far. Without having the original database, the simplest path appears to be taking the html & transforming it into, say, an sql dump. So - how do I do that? Are there any MediaWiki, database, or Perl trails to follow?
How can I import a 46GB database into MSSQL without ending up with a 46GB transaction log?
I need to import a database into MS SQL but I do not want to end up with a transaction log as large as the database. What's the best way to do the import? [more inside]
PerHaPs SeQuentiaLly?
Which version of PHP should I start to learn, and how? I know HTML and CSS, and intend to build with Drupal (or similar) and its many extensions. [more inside]
SQL sorting when sort field is null
MySQL sorting issue. When I have "first name" and "last name" columns, and I'm sorting primarily by "last name." Some entries have only a "first name," and rather than have those end up at either the start or end of the sort, I'd like it to pretend the "first name" IS the "last name" and sort accordingly. Is there a way to do this with the SQL SELECT statement or should I just edit the data? [more inside]
How much database normalization is too much?
How much SQL normalization is too much? [more inside]
How to count the number of times a string appears in a database field.
SQL Filter: What query can I use to count the number of times a word appears in a text field? [more inside]
SQL/DBMS ninjas please help! How can I replicate my current abilities at a new company from scratch?
Some colleagues and I will soon be leaving our current employer and starting a new company. How can I best replicate our current relational database/SQL abilities from scratch? [more inside]
Best DBA certification?
What DBA certification should I pursue? MS, Oracle, something else? [more inside]
SQL help
Please help me with a giant SQL-ish mess. I need a better solution than MS Access for dealing with millions of records and building queries. [more inside]
All months, now.
Sum of data for all months, including months with no rows, in MySQL? [more inside]
ColdFusion SQL Injection Attack Terror
ColdFusion MX 7 and Microsoft SQL Server 2005. There's a lot of unvalidated parameters in our CFQUERYs. But, I'm told that putting the parameters in single-quotes will prevent injection attacks, because of the way ColdFusion escapes single-quotes. Is this foolproof, or do I have to go in and validate everything with CFQUERYPARAM tags?
Could I design databases for a living?
Can I, should I, make a career change into database design? [more inside]
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