Elena Fidarova

• International Atomic Energy Agency (IAEA)

Following on from the 2015 Lancet Oncology Commission on expanding global access to radiotherapy, Radiotherapy and theranostics: a Lancet Oncology Commission was created to assess the access and availability of radiotherapy to date and to address the important issue of access to the promising field of theranostics at a global level. A marked dispar...

Background The concept of the use of MRI for image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer was introduced 20 years ago. Here, we report on EMBRACE-I, which aimed to evaluate local tumour control and morbidity after chemoradiotherapy and MRI-based IGABT. Methods EMBRACE-I was a prospective, observational, multicent...

Topical Overview and Conclusions of an International Conference

Purpose Patients with stage III non-small-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT) in low- and middle-income countries (LMIC) continue to have a poor prognosis. It is known that FDG PET/CT improves staging, treatment selection and target volume delineation (TVD), and although its use has grown rapidly, it is still not widely av...

Background: The planning of national radiotherapy (RT) services requires a thorough knowledge of the country's cancer epidemiology profile, the radiotherapy utilization (RTU) rates and a future projection of these data. Previous studies have established RTU rates in high-income countries. Methods: Optimal RTU (oRTU) rates were determined for nin...

Background: The quality of radiotherapy services in post-Soviet countries has not yet been studied following a formal methodology. The IAEA conducted a survey using two sets of validated radiation oncology quality indicators (ROIs). Methods: Eleven post-Soviet countries were assessed. A coordinator was designated for each country and acted as th...

Background and purpose: Short-course radiotherapy (25 Gy in five fractions) was recently shown in a randomized phase III trial to be non-inferior to 40 Gy in 15 fractions in elderly and/or frail patients with glioblastoma multiforme. This study compared the cost-effectiveness of the two regimens. Material and methods: The direct unit costs of im...

Purpose To perform a subset analysis of survival outcomes in elderly patients with glioblastoma (GBM) from a randomized phase III trial comparing two short-course radiotherapy (RT) regimens in elderly and/or frail patients. Methods and Materials The original trial population included elderly and/or frail patients diagnosed with GBM. Patients joine...

Over the last 60 years, the International Atomic Energy Agency (IAEA) has been working to introduce, expand and improve radiotherapy services, working with partners such as the World Health Organization (WHO) to improve cancer diagnosis, treatment, care and control through collective action in low- and middle-income countries (LMICs). The Lancet On...

Although not a new concept in itself, competency-based education has set the trend for the globally accepted standard norm for education and training of medical professionals including postgraduate education in radiation oncology. Societal needs demand from radiation oncologists that they be not only competent in the knowledge and skills relevant...

Purpose: Most cervix cancer cases occur in low-income and middle-income countries (LMIC), and outcomes are suboptimal, even for early stage disease. Brachytherapy plays a central role in the treatment paradigm, improving both local control and overall survival. The American Brachytherapy Society (ABS) aims to provide guidelines for brachytherapy d...

Background and purpose: To assess the impact of a standardized delineation protocol and training interventions on PET/CT-based target volume delineation (TVD) in NSCLC in a multicenter setting. Material and methods: Over a one-year period, 11 pairs, comprised each of a radiation oncologist and nuclear medicine physician with limited experience i...

Optimal treatment of recurrent glioblastoma multiforme (rGBM) in elderly and/or frail patients remains virtually unexplored, the best supportive care (BSC) only is routinely administered due to the fatal prognosis. We evaluated the impact of different treatment methods on post-progression survival (PPS) and overall survival (OS) of such patients. D...

Purpose: The optimal radiotherapy regimen for elderly and/or frail patients with newly diagnosed glioblastoma remains to be established. This study compared two radiotherapy regimens on the outcome of these patients. Patients and methods: Between 2010 and 2013, 98 patients (frail = age ≥ 50 years and Karnofsky performance status [KPS] of 50% to...

Upfront quality assurance (QA) is considered essential when starting a multicenter clinical trial in radiotherapy. Despite the long experience gained for external beam radiotherapy (EBRT) trials, there are only limited audit QA methods for brachytherapy (BT) and none include the specific aspects of image guided adaptive brachytherapy (IGABT). EMBRA...

Optimal radiotherapy utilisation rate (RTU) is the proportion of all cancer cases that should receive radiotherapy. Optimal RTU was estimated for 9 Middle Income Countries as part of a larger IAEA project to better understand RTU and stage distribution. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

To optimize palliation in incurable locally advanced non-small cell lung cancer (NSCLC), the International Atomic Energy Agency conducted a prospective randomized study (NCT00864331) comparing protracted palliative radiotherapy (RT) course with chemotherapy (CHT) followed by short-course palliative RT. Treatment-naive patients with histologically c...

To determine the optimal single-dose radiotherapy schedule for pain from bone metastases in a multi-centre, international, randomised trial. 651 patients were randomised to either 8Gy (n=325) or 4Gy (n=326) radiotherapy. Pain at 4, 8, 12, 24 and 52weeks was assessed using a Categorical Scale (CS) and a Visual Analogue Scale (VAS). The primary endpo...

Recent advances in the technology of radiotherapy make it possible to deliver curative doses of radiation to a very well defined volume. These advances are the result of technological innovations in the treatment machines, imaging for tumour localisation, advances in computerised treatment planning and radiobiological research. The Applied Radiatio...

This document describes best practice and evidence based recommendations for the use of FDG-PET/CT for the purposes of radiotherapy target volume delineation (TVD) for curative intent treatment of non-small cell lung cancer (NSCLC). These recommendations have been written by an expert advisory group, convened by the International Atomic Energy Agen...

Survey of available radiotherapy resousrce infrastructures (equipment, staffing, facilities) in 12 countries of the former Soviet Union.

Optimal treatment of recurrent glioblastoma multiforme (rGBM) in elderly and/or frail patients remains virtually unexplored, the best supportive care (BSC) only is routinely administered due to the fatal prognosis. We evaluated the impact of different treatment methods on post-progression survival (PPS) and overall survival (OS) of such patients. D...

To review the various radiation therapy quality assurance (RTQA) procedures used by the Global Clinical Trials RTQA Harmonization Group (GHG) steering committee members and present the harmonized RTQA naming conventions by amalgamating procedures with similar objectives. A survey of the GHG steering committee members' RTQA procedures, their goals,...

About 57% of the total number of cancer cases occur in low and middle income countries. Radiotherapy is one of the main components of cancer treatment and requires substantial initial investment in infrastructure and training. Many departments continue to have basic facilities and to use simple techniques, while modern technologies have only been i...

A unique PDF-form/e-form manager platform to improve data quantity and quality in IAEA randomized trials Objective: Clinical trials need careful monitoring for data quantity and quality to meet regulations and to get a data-set that correctly answers research questions. Data management is being professionalized to more reliably and quickly convert...

Title: A pilot project with multiple IAEA studies exploring a Big Clinical Data strategy for research and to improve quality Objective: Clinical policies are based typically on higher quality studies focussed on narrow questions with limited data. A vague concept of “big data”has emerged for internet informatics and marketing studies, and it has pr...

The need for a global forum on harmonisation of RTQA (Radiation Therapy (RT) Quality Assurance (QA)) within clinical trials thus became apparent. After initial discussions in Göteborg during ESTRO 27 in 2008 the Global Clinical Trials RTQA Harmonisation Group (GHG) was formally established in 2010.

Purpose: To investigate the impact of magnetic resonance imaging (MRI)-morphologic differences in parametrial infiltration on tumour response during primary radiochemotherapy in cervical cancer. Material and methods: Eighty-five consecutive cervical cancer patients with FIGO stages IIB (n = 59) and IIIB (n = 26), treated by external beam radioth...

Background and aim: We aimed to quantify target volume delineation uncertainties in cervix cancer image guided adaptive brachytherapy (IGABT). Materials and methods: Ten radiation oncologists delineated gross tumour volume (GTV), high- and intermediate-risk clinical target volume (HR CTV, IR CTV) in six patients. Their contours were compared wit...

Purpose and background: To study the dosimetric impact of interobserver delineation variability (IODV) in MRI-based cervical cancer brachytherapy. Materials and methods: MR images of six patients were distributed to 10 experienced observers worldwide. They were asked to delineate the target volumes and the organs at risk (OARs) for each patient....

Background: Grey zones, which are defined as tissue with intermediate signal intensity in the area of primary hyperintense tumour extension, can be seen during radiation with or without chemotherapy on the T2-weighted MRI in patients with cervical cancer. The purpose of this study was to systematically measure the tumour volume at the time of diag...

Background and purpose: Treatment-induced chronic vaginal changes after definitive radio(chemo)therapy for locally advanced cervical cancer patients are reported as one of the most distressing consequences of treatment, with major impact on quality of life. Although these vaginal changes are regularly documented during gynecological follow-up exam...

Sectional imaging with computed tomography (CT) or magnetic resonance imaging (MRI) is widely applied in modern gynecological radiotherapy. While external beam radiotherapy (EBRT) relies mainly on CT, image-guided brachytherapy (IGBT) preferably may be based on MRI. Both imaging modalities have advantages and weaknesses. The diagnostic value of sec...

To investigate the clinical feasibility of magnetic resonance image-guided adaptive brachytherapy (IGABT) for patients with locally advanced vaginal cancer and to report treatment outcomes. Thirteen patients with vaginal cancer were treated with external beam radiotherapy (45-50.4 Gy) plus IGABT with or without chemotherapy. Distribution of Interna...

The study aimed to determine whether post-radiation vaginal side effects in cervical cancer patients can be correlated with DVH parameter D(2cc). The result was negative in that no correlation could be demonstrated between D(2cc) and the presence and grade of side effects in this patients' subset treated with high brachytherapy doses.

To test the feasibility of a new inverse planning technology based on the Hybrid Inverse treatment Planning and Optimisation (HIPO) algorithm for image-guided cervical cancer brachytherapy in comparison to conventional manual optimisation as applied in recent clinical practice based on long-term intracavitary cervical cancer brachytherapy experienc...

To analyse dose-response relationships for local control of cervical cancer after MR image-guided brachytherapy (IGBT) based on dose-volume histogram parameters. The analysis includes 141 patients with cervix cancer (stages IB-IVA) treated with 45-50.4 Gy EBRT+/-cisplatin plus 4 x 7 Gy IGBT. Gross tumour volume (GTV), high risk clinical target volu...

Introduction: Image guided adaptive brachytherapy (IGABT) for cervical cancer, using mainly MRI, is an evolving method, increasingly replacing the 2D approach based on conventional radiography. During the complex 4D chain of this procedure image-assistance is provided for disease assessment, provisional treatment planning ("pre-planning"), applica...

To investigate the value of dose-volume histogram (DVH) parameters for predicting local control in magnetic resonance (MR) image-guided brachytherapy (IGBT) for patients with cervical cancer. Our study population consists of 141 patients with cervical cancer (Stages IB-IVA) treated with 45-50 Gy external beam radiotherapy plus four times 7 Gy IGBT...

In the majority of patients with initially inoperable local advanced vulvar cancer, organ-sparing surgery can be achieved after preoperative radiotherapy (RT) or radiochemotherapy (RCHT) has been applied. However, the combination RCHT and surgery is associated with a high morbidity rate. Cisplatin, 5-fluorouracil and mitomycin C are the most freque...

Sectional imaging has played an important role in the management of cervical cancer, in particular for staging, and is now considered for image-guided treatment planning, in particular for brachytherapy. Image-based three-dimensional brachytherapy is a relatively new approach that is increasingly replacing the traditional two-dimensional X-ray-base...

Brachytherapy (BT) represents an essential aspect of radical radiotherapy of cervical cancer. Within the last decade, 3D MRI-based BT was introduced into clinical practice at some institutions and it was shown that this advanced approach could successfully replace the traditional 2D x-ray-based methods of treatment planning. MRI has general advanta...

Most radioimmunotherapy studies on radiolabeled antibody distribution are based on autoradiographic and radioluminographic data, which provide a lack of detailed information due to low resolution. We used fluorescently labeled anti-carcinoembryonic antigen (CEA) antibody (A5B7) to investigate quantitatively the kinetics and microdistribution of ant...