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Daly M, McDaid L, Nelder C, Chuter R, Choudhury A, McWilliam A, Radhakrishna G, Eccles C. Feasibility of abdominal fat quantification on MRI and impact on effectiveness of abdominal compression for radiotherapy motion management. Tech Innov Patient Support Radiat Oncol 2024; 29:100232. [PMID: 38269244 PMCID: PMC10805931 DOI: 10.1016/j.tipsro.2023.100232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 01/26/2024] Open
Abstract
The impact of fat on abdominal compression effectiveness in abdominal cancers was determined using magnetic resonance imaging (MRI). Visceral and subcutaneous fat were delineated on T2W 3D MRI, and motion change with compression was measured on 2D cine MRI. Results from 16 participants showed no correlation between fat percentage, body mass index (BMI), and motion change. Median BMI was 28.7 (SD, 4.9). Mean motion reduction was 7.8 mm (IQR, 5.0; p = 0.001) with compression. While no direct link was found between fat, BMI, and compression effectiveness, abdominal compression remains crucial for motion management in radiotherapy planning, providing dosimetric benefits.
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Affiliation(s)
- M. Daly
- Division of Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Northern Ireland, United Kingdom
| | - L. McDaid
- Department of Radiotherapy, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - C. Nelder
- Department of Radiotherapy, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - R. Chuter
- Division of Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Northern Ireland, United Kingdom
- Department of Medical Physics and Engineering, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - A. Choudhury
- Division of Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Northern Ireland, United Kingdom
- Department of Clinical Oncology, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - A. McWilliam
- Division of Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Northern Ireland, United Kingdom
- Department of Medical Physics and Engineering, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - G. Radhakrishna
- Department of Medical Physics and Engineering, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
| | - C.L. Eccles
- Division of Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Northern Ireland, United Kingdom
- Department of Radiotherapy, The Christie NHSFT, Wilmslow Road, Manchester M20 4BX, Northern Ireland, United Kingdom
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Greathouse KL, Stone JK, Vargas AJ, Choudhury A, Padgett RN, White JR, Jung A, Harris CC. Co-enrichment of cancer-associated bacterial taxa is correlated with immune cell infiltrates in esophageal tumor tissue. Sci Rep 2024; 14:2574. [PMID: 38296990 PMCID: PMC10831118 DOI: 10.1038/s41598-023-48862-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/30/2023] [Indexed: 02/02/2024] Open
Abstract
Esophageal carcinoma (ESCA) is a leading cause of cancer-related death worldwide, and certain oral and intestinal pathogens have been associated with cancer development and progression. We asked if esophageal microbiomes had shared alterations that could provide novel biomarkers for ESCA risk. We extracted DNA from tumor and non-tumor tissue of 212 patients in the NCI-MD case control study and sequenced the 16S rRNA gene (V3-4), with TCGA ESCA RNA-seq (n = 172) and WGS (n = 123) non-human reads used as validation. We identified four taxa, Campylobacter, Prevotella, Streptococcus, and Fusobacterium as highly enriched in esophageal cancer across all cohorts. Using SparCC, we discovered that Fusobacterium and Prevotella were also co-enriched across all cohorts. We then analyzed immune cell infiltration to determine if these dysbiotic taxa were associated with immune signatures. Using xCell to obtain predicted immune infiltrates, we identified a depletion of megakaryocyte-erythroid progenitor (MEP) cells in tumors with presence of any of the four taxa, along with enrichment of platelets in tumors with Campylobactor or Fusobacterium. Taken together, our results suggest that intratumoral presence of these co-occurring bacterial genera may confer tumor promoting immune alterations that allow disease progression in esophageal cancer.
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Affiliation(s)
- K L Greathouse
- Department of Biology, Baylor University, Waco, TX, USA.
- Nutrition Division, Human Sciences and Design, Baylor University, Waco, TX, USA.
| | - J K Stone
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - A J Vargas
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - A Choudhury
- Department of Biology, Baylor University, Waco, TX, USA
| | - R N Padgett
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - J R White
- Resphera Biosciences, LLC, Baltimore, MD, USA
| | - A Jung
- Department of Biology, Baylor University, Waco, TX, USA
| | - C C Harris
- Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
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Maitre P, Haris M, Portner R, Hoskin P, Hudson A, Wylie J, Logue J, Conroy R, Tran A, Serra M, Croxford W, Song Y, Oates J, Ramani V, Clarke N, Choudhury A. Outcomes in Locally Advanced Non-Metastatic Prostate Cancer Presenting with Low PSA at Diagnosis. Int J Radiat Oncol Biol Phys 2023; 117:e413-e414. [PMID: 37785368 DOI: 10.1016/j.ijrobp.2023.06.1561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Men with low serum prostate-specific antigen (PSA) and high Gleason grade group (GGG) are thought to have poor outcomes compared to high PSA secretors. However, there is limited outcome data to support this. We report clinical outcomes from a single-institutional cohort of men presenting with locally advanced prostate cancer but low serum PSA. MATERIALS/METHODS Data from electronic database of a UK tertiary cancer center was acquired for men with histological diagnosis of prostate adenocarcinoma, GGG 4 or 5, stage ≥cT3a, and PSA <10ug/L at diagnosis. Men with metastatic disease, or prior androgen deprivation therapy (ADT) were excluded. Biochemical progression was defined as per Phoenix criteria (PSA > nadir+2) for primary radiotherapy, or PSA >0.2 ug/L after primary prostatectomy (and post-operative radiotherapy, if received). Overall survival (OS, from date of diagnosis to death), metastasis-free survival (MFS, from diagnosis to first recorded metastasis or death), and biochemical progression free survival (bPFS, from diagnosis to biochemical progression or death) were estimated by Kaplan Meier method, and multivariable analysis performed using Cox proportional hazards method. RESULTS Medical records of 7,200 men presenting with non-metastatic prostate cancer from 2013 to 2021 were screened, of which 270 men satisfying the eligibility criteria were included for this study. Initial analysis of 123 men shows median PSA at presentation 7.1 ug/L (IQR 5.6-8.5), and median age 70 years (IQR 65-75). Histology was GGG 4 in 47.6% and 5 in 52.4%. Tumor stage was cT3a in 56.6%, cT3b in 36.9%, and T4 in 6.6%. Pelvic nodes were involved in 5% patients. Majority (83.7%) were treated with radical radiotherapy (external beam alone 64.2%, brachytherapy boost 19.5%), with 24 months ADT; 11.4% underwent radical prostatectomy, and 4.9% received ADT alone. Three men (2.4%) received docetaxel, and one received abiraterone. At a median follow up of 66 months (IQR 27-77), 36 (29.3%) patients had biochemical failure. Total 23 (18.6%) patients had metastases at recurrence, which were visceral in 4%, bone-only in 10%, and nodal-only in 4%. Total 38 (30.6%) patients had died, 23% with prostate cancer and 11% due to other causes. Five-year bPFS was 65.9%, MFS 69.0%, and OS was 77.4%. GGG 5 (versus 4) was associated with significantly worse 5-year bPFS (59.4% vs 73.9%, HR 1.8, 95% CI 1.0-3.2, p = 0.05) and MFS (59.2% vs 81.6%, HR 2.2, 1.2-4.2, p = 0.02). On multivariable analysis including age and PSA at diagnosis, only GGG 5 was associated with worse bPFS (HR 1.8, 1.0-3.3, p = 0.05) and MFS (HR 2.42, 1.25-4.67, p = 0.009). CONCLUSION Men with low secreting but high Gleason grade group prostate cancer are a relatively rare group with poor clinical outcomes despite being non-metastatic. Ongoing work (expected completion June 2023) will analyze remaining cases, and compare outcomes within an expanded multicentric cohort with matched controls having elevated PSA at presentation.
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Affiliation(s)
- P Maitre
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M Haris
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R Portner
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - P Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - A Hudson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - J Wylie
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - J Logue
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R Conroy
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A Tran
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M Serra
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - W Croxford
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Y Song
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - J Oates
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - V Ramani
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - N Clarke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
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Ponce SEB, Daamen LA, Van der Voort vanZyp J, Westerhoff JM, Pos FJ, Christodouleas JP, Choudhury A, van der Heide U, Lawton CAF, Straza MW, Bedi M, Paulson ES, Nasief HG, Li A, Verkooijen H, Tree A, Hall WA. Quality of Life in Prostate Cancer Patients Undergoing Daily Adaptive Versus Non-Adaptive Radiation Therapy Utilizing A 1.5 Tesla MR-Linac. Int J Radiat Oncol Biol Phys 2023; 117:S114-S115. [PMID: 37784299 DOI: 10.1016/j.ijrobp.2023.06.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Using adaptive radiation therapy (ART) physicians can re-contour normal organs (such as bladder and rectum) before each fraction. While ART may result in more reliable dosimetry to regional organs at risk, the process is time consuming and more expensive than non-ART. We evaluated differences in patient reported quality of life (PR-QOL) between daily ART and non- ART. MATERIALS/METHODS Patients with prostate cancer from 3 centers in the Netherlands and United States were treated using a 1.5 Tesla MR Linear accelerator. Patients consented to the Multiple Outcome Evaluation of Radiation Therapy Using the MR-Linac Study (MOMENTUM, NCT04075305) between 2019 and 2022. PR-QOL was prospectively collected using the EORTC QLQ-C30 and PR-25 at baseline (before RT), and at 3 and 6 months after RT. Patients without complete QOL data were excluded. QOL differences were compared between patients undergoing daily ART vs. non-ART. A linear mixed effect model was performed to account for repeated measurements. Analyses were performed using R Studio. RESULTS One hundred thirty-six patients underwent RT with QOL were analyzed. Median follow up was 13 months (6-26 months). Patients were treated without daily ART (n = 94) or with daily ART (n = 42). The median age was 70 (range 53-83) years and 65.4% had intermediate risk disease, 35% of patients received hormonal therapy. Fractionation schedules included 36 Gy/6 (n = 16), 36.25 Gy/5 (n = 103), 60 Gy/20 (n = 6), 62 Gy/20 (n = 8), and 70 Gy/28 (n = 3). Compared to baseline scores, EORTC QLQ C30 diarrhea scores at 6 months post-treatment were significantly worse for patients treated without daily ART compared to those treated with daily ART (p < 0.05). Other QLQ PR25 bowel scores were not significantly different at 3 or 6 months. Both PR25 urinary and treatment-related symptoms were improved with daily ART compared to non-ART at the 3 (p < 0.001 and p < 0.01, respectively) and 6 (p < 0.01 and p < 0.001, respectively) month time points. Magnitude of improvements can be found in Table 1. CONCLUSION Among prostate cancer patients treated using 1.5 Tesla MRI-guided RT, daily ART was associated with improved PR-QOL in urinary and bowel domains compared to non-ART. These hypotheses generating preliminary results provide the first indications (to our knowledge) that adapting contours to daily anatomy may improve short-term urinary and bowel PR-QOL. Updated results will be presented at ASTRO 2023.
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Affiliation(s)
- S E Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - L A Daamen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - F J Pos
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - A Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
| | - U van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C A F Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M W Straza
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Bedi
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - H G Nasief
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - A Li
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - H Verkooijen
- University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Tree
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
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Swinton M, Dubec M, McHugh D, Biglin E, Sanchez DF, Oliveira P, Price G, McWilliam A, van Herk M, Hoskin P, Buckley DL, Hudson A, Bristow RG, Choudhury A. Validation of Hypoxia Detection Sequences on the MR Linac. Int J Radiat Oncol Biol Phys 2023; 117:e723-e724. [PMID: 37786109 DOI: 10.1016/j.ijrobp.2023.06.2234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Magnetic resonance linear accelerator (MRL) systems permit acquisition of novel imaging at the time of radiotherapy. A validated MR hypoxia imaging biomarker could select patients for adaptive radiotherapy with hypoxia modification or dose escalation. The aims of this study were (1) to develop a protocol for quantitative hypoxia sensitive MRI (2) to validate these in prostate cancer (PCa) against pimonidazole-stained prostatectomy sections. MATERIALS/METHODS Blood oxygen level dependent (BOLD), intravoxel incoherent motion (IVIM), oxygen-enhanced (OE) and dynamic contrast enhanced (DCE) MRI were used. Sequences were developed on a diagnostic 1.5 T MR (MRD) and MRL with healthy volunteers and PCa patients. The Hyprogen trial includes men with localized PCa scheduled for prostatectomy. Imaging is acquired twice prior to surgery and oral pimonidazole is taken 8-16 hours before surgery. Whole prostate (WP) and dominant prostatic lesion (DIL) were outlined on T2-weighted (T2W) images and a 'normal prostate' (NP) volume created by subtracting DIL from WP. Contours were applied to parametric maps from the quantitative MRI, with median and IQR extracted. Patient-specific 3D-printed prostate molds were created from WP volumes and used to guide prostate whole organ dissection. RESULTS Three of 20 patients recruited to date. MRI data were acquired successfully. A personalized prostate mold was produced for each patient and facilitated dissection of the prostatectomy specimen in a matching plane to MRI to validate hypoxia detection of the MR protocol. Correlation with pimonidazole staining is underway. Imaging parameter median values for NP and DIL acquired on MRD and MRL for the first patient are shown (Table 1). The expected differences between NP and DIL for T1 and D are seen and median values for T2* are consistent with reported values in the literature. CONCLUSION The MR hypoxia protocol can be acquired safely and is well-tolerated on the MRL. Once validated against pimonidazole staining adaptive radiotherapy protocols will be developed to use this information.
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Affiliation(s)
- M Swinton
- Christie Hospital, Manchester, United Kingdom
| | - M Dubec
- University of Manchester, Manchester, United Kingdom
| | - D McHugh
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - E Biglin
- University of Manchester, Manchester, United Kingdom
| | - D F Sanchez
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - P Oliveira
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - G Price
- The University of Manchester, Manchester, United Kingdom
| | - A McWilliam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - M van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - P Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - D L Buckley
- Biomedical Imaging, University of Leeds, Leeds, United Kingdom
| | - A Hudson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R G Bristow
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - A Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
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Lodhi T, Song YP, Elumalai T, Walshaw L, Tralau-Stewart L, Nikapota AD, Tagaldeen R, Kapur G, Hoskin P, Choudhury A. Real World Multi-Institutional Outcomes of Bladder Carbogen and Nicotinamide (BCON) in Muscle-Invasive Bladder Cancer (MIBC). Int J Radiat Oncol Biol Phys 2023; 117:e410-e411. [PMID: 37785361 DOI: 10.1016/j.ijrobp.2023.06.1554] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Bladder carbogen and nicotinamide (BCON), combined with radiotherapy, is a standard of care in the bladder-preserving treatment of muscle-invasive bladder cancer (MIBC). UK national guidelines recommend neoadjuvant chemotherapy (NAC) before bladder preservation. However, patients did not receive NAC in the definitive phase III BCON trial. This study assessed tolerability and real-world outcomes of BCON alone or with NAC (NAC-BCON). MATERIALS/METHODS With institutional approval, demographics and clinical information were obtained for a retrospective cohort study of BCON patients (2017-2021) across 3 UK centers. Clinician-reported toxicity was assessed using RTOG grading during radiotherapy, 6 weeks and 12 months after. Cross-sectional imaging and cystoscopy determined local control, metastasis-free survival (MFS), and cancer-specific survival (CSS). Subgroup differences were compared using T and χ2 tests. Survival was analyzed by Kaplan-Meier, log-rank, and multivariate Cox proportional hazard regression. Statistical analysis was conducted using R version 4.2.1 (R Core Team (2022)). RESULTS A total of 317 patients were treated with BCON; 75 (24%) received NAC-BCON. Median follow-up was 29 months (4-63m). Patient characteristics are shown in Table 1. NAC-BCON patients were younger (median 72 vs 78 years, p<0.05), with better PS (p<0.05) and ACE-27 (p<0.05), with no statistical difference in T-staging and histopathology. 298 (94%) completed BCON, whilst 59/75 (79%) completed ≥3 cycles of NAC. There was no significant increased grade 3 acute or late bowel or bladder toxicity with NAC. 3-month cystoscopy post radiotherapy demonstrated complete response in 282/317 (89%). 121 (38%) developed metastases, and 112 (35%) died of MIBC. 5-year BCON MFS was 62% and 49% for NAC-BCON (HR 0.69, 95% CI 0.98- 2.51, p = 0.064); 5-year BCON CSS was 55% and 52% for NAC-BCON (HR 0.83, 95% CI 0.79-1.83, p = 0.39). This remained after adjusting for clinical factors in a multivariate Cox model for both MFS (p = 0.22) and CSS (p = 0.37). CONCLUSION Our real-world data compares favorably to published BCON 5-year relapse-free survival (41%) and OS (49%). NAC-BCON has no increased toxicity with comparable treatment completion rates to BCON alone. No significant improvement in survival outcomes was seen with NAC, possibly due to small numbers and patient selection in a non-randomized cohort. Further analysis is planned with additional center input.
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Affiliation(s)
- T Lodhi
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Y P Song
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
| | - T Elumalai
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - L Walshaw
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - L Tralau-Stewart
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - A D Nikapota
- University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom
| | - R Tagaldeen
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - G Kapur
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - P Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - A Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
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Daamen LA, Westerhoff JM, Christodouleas JP, Orrling K, Eggert D, Choudhury A, Fuller CD, van der Heide U, Sahgal A, Schultz CJ, Schytte T, Tersteeg R, Tree A, Hall WA, Verkooijen H. Evolution of the MOMENTUM Study for Evidence-Based Implementation of MR-Guided Radiotherapy Using the 1.5 Tesla MR-Linac. Int J Radiat Oncol Biol Phys 2023; 117:e576-e577. [PMID: 37785753 DOI: 10.1016/j.ijrobp.2023.06.1912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The international prospective 'Multiple Outcome Evaluation of Radiation Therapy Using the MR-Linac' (MOMENTUM) study (NCT04075305) was initiated in 2019 by seven hospitals and industry partner precision radiation medicine company, with the aim to facilitate evidence-based implementation of magnetic resonance (MR) guided radiotherapy using the 1.5 Tesla (T) MR-linear accelerator (Linac). Over the last four years, MOMENTUM has expanded to other institutions and the design and organization of MOMENTUM have evolved. Herein, we give an overview of the current status of MOMENTUM and study innovations that have been implemented to accelerate development and assessment of the 1.5T MR-Linac. MATERIALS/METHODS We summarized operational outputs of MOMENTUM, including site participation, data aggregation, academic output, and study design elements that have been introduced since 2019. RESULTS As of January 2023, 17 sites have joined and 10 sites are actively enrolling patients in MOMENTUM. The MOMENTUM infrastructure, which consists of prospectively collected clinical and technical patient data and patient reported outcomes, is increasingly being used for predicate studies, technical development studies, safety and early clinical evaluation, and hypothesis testing studies according to R-IDEAL. Over 3500 patients who received treatment for 33 different tumor sites have provided informed consent for using their data for scientific research and product development. The technical database currently includes over 190.000 items, including approximately 98,000 MRI scans and 33,800 dose plans. A total of 38 data requests have been accepted (2019: n = 1; 2020: n = 5; 2021: n = 10; 2022: n = 22), including technical studies focused on algorithmic development. The MOMENTUM infrastructure is also hosting prospective clinical studies, including the randomized HERMES trial (NCT04595019) and prospective UNITED study (NCT04726397). Recently, the 'Trials within Cohorts' (TwiCs) design has been implemented, which is well suited to perform pragmatic randomized trials. MOMENTUM has partnered with Kaiku Health, an electronic patient-reported outcomes application, to facilitate collection of patient reported toxicity. CONCLUSION Over the past four years, the MOMENTUM study has evolved into a unique platform, whose infrastructure is increasingly being used by clinicians, researchers, physicists and industry. Continuous efforts are being made to encourage the participation of new sites and the development of innovative tools to facilitate the conduct of well-designed trials that are expected to transform daily clinical practice.
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Affiliation(s)
- L A Daamen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | | | - D Eggert
- Elekta Inc., Atlanta, GA, United States
| | - A Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
| | - C D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - U van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A Sahgal
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | | | - T Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - R Tersteeg
- University Medical Center Utrecht, Utrecht 3584CX, The Netherlands
| | - A Tree
- Radiotherapy and Imaging Division, Institute of Cancer Research, London, United Kingdom
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - H Verkooijen
- University Medical Center Utrecht, Utrecht, The Netherlands
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Eccles CL, Dubec M, Cobben D, van Herk M, McDaid L, Nelder C, Whiteside L, Davies LSC, McHugh L, Bridge J, Fendallamaro P, Chuter R, Hoskin P, Huddart RA, Choudhury A. Single Institution Preliminary Evaluation of a National Study for the Development of Daily Online Magnetic Resonance Image Guided Radiotherapy. Int J Radiat Oncol Biol Phys 2023; 117:e663. [PMID: 37785963 DOI: 10.1016/j.ijrobp.2023.06.2101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A 4-stage non-comparative prospective feasibility study to assess and develop imaging protocols for MRIgRT was opened at the first two centers using MR Linac technology in the UK. The primary aims of this study were to determine a) the acceptability of MR images for target and organ at risk delineation and registration; b) inter/intra observer registration and delineation variation. This work reports on the initial results from a single center. MATERIALS/METHODS In June 2019, following ethical and regulatory approvals the 2nd UK centre began study recruitment as follows: Stage A: non-patient volunteer imaging to determine sequence suitability for normal tissue in 6 anatomical sites (head & neck (H&N), chest wall/breast, lung/esophagus, abdomen, male and female pelvis). Volunteers were recruited in cohorts of 3 participants per region, and image quality was assessed by 3 independent observers using a visual guidance assessment tool (VGA). Stage B: the most suitable sequences defined in stage A used to assess the visibility of targets/normal tissues in patient volunteers using the same methods as in stage A. Stage C: patient volunteers were imaged using sequences selected from stage B to determine inter and intra observer segmentation and registration variation. Stage D recruitment of patient and non-patient volunteers for further image develop and refinement of MRIgRT workflows. All participants completed experience questionnaires to optimize workflows. Participants were asked to undergo 1-12 imaging sessions, lasting no more than 60. RESULTS To date 151 participants (61 non-patients; 90 patients) have undergone 231 imaging sessions. From stage B, vendor provided, in-workflow sequences have been agreed from 47 completed VGAs by prioritizing high scores in either the tumor (e.g., lung) or organs at risk (e.g., cervix). T2w 3D sequences scored best in cervix, pancreas, prostate, bladder, liver, soft-tissue metastases and rectal cancers; T1w 3D sequences for H&N, and patient a specific approach for lung. No suitable sequences have been selected for partial breast. Research sequences (e.g., diffusion weighted or motion corrected imaging) have been agreed or are in development in stages C & D for H&N, cervix, bladder and prostate cancers. The mean interobserver (n = 8) vector variation in 5 H&N patients was largest (3.6mm) using T1-CT boney registrations and smallest (2.1mm) using T1-T1 soft-tissue registrations (mean observer match confidence 3.7/5). Analyses using MR to CT, MR to MR and CT to CT registrations in lung, pancreas, cervix, bladder, and prostate have also been completed. Interobserver delineation studies are on-going. CONCLUSION Using a 4-stage non-comparative prospective feasibility study has facilitated clinical implementation MRIgRT of multiple treatment sites at our institution.
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Affiliation(s)
- C L Eccles
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - M Dubec
- University of Manchester, Manchester, United Kingdom
| | - D Cobben
- The Clatterbridge Cancer Centre NHS, Liverpool, United Kingdom
| | - M van Herk
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - L McDaid
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - C Nelder
- The Christie NHS, Manchester, United Kingdom
| | - L Whiteside
- The Christie NHS FT, Manchester, United Kingdom
| | | | - L McHugh
- The Christie NHS FT, Manchester, United Kingdom
| | - J Bridge
- The Christie NHS FT, Manchester, United Kingdom
| | | | - R Chuter
- The Christie NHS Foundation, Manchester, United Kingdom
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - R A Huddart
- The Institute of Cancer Research, Division of Radiotherapy and Imaging, London, United Kingdom
| | - A Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK, Manchester, United Kingdom
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Huddart R, Hafeez S, Omar A, Alonzi R, Birtle A, Cheung KC, Choudhury A, Foroudi F, Gribble H, Henry A, Hilman S, Hindson B, Lewis R, Muthukumar D, McLaren DB, McNair H, Nikapota A, Olorunfemi A, Parikh O, Philipps L, Rimmer Y, Syndikus I, Tolentino A, Varughese M, Vassallo-Bonner C, Webster A, Griffin C, Hall E. Acute Toxicity of Hypofractionated and Conventionally Fractionated (Chemo)Radiotherapy Regimens for Bladder Cancer: An Exploratory Analysis from the RAIDER Trial. Clin Oncol (R Coll Radiol) 2023; 35:586-597. [PMID: 37225552 DOI: 10.1016/j.clon.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
AIMS Adding concurrent (chemo)therapy to radiotherapy improves outcomes for muscle-invasive bladder cancer patients. A recent meta-analysis showed superior invasive locoregional disease control for a hypofractionated 55 Gy in 20 fractions schedule compared with 64 Gy in 32 fractions. In the RAIDER clinical trial, patients undergoing 20 or 32 fractions of radical radiotherapy were randomised (1:1:2) to standard radiotherapy or to standard-dose or escalated-dose adaptive radiotherapy. Neoadjuvant chemotherapy and concomitant therapy were permitted. We report exploratory analyses of acute toxicity by concomitant therapy-fractionation schedule combination. MATERIALS AND METHODS Participants had unifocal bladder urothelial carcinoma staged T2-T4a N0 M0. Acute toxicity was assessed (Common Terminology Criteria for Adverse Events) weekly during radiotherapy and at 10 weeks after the start of treatment. Within each fractionation cohort, non-randomised comparisons of the proportion of patients reporting treatment emergent grade 2 or worse genitourinary, gastrointestinal or other adverse events at any point in the acute period were carried out using Fisher's exact tests. RESULTS Between September 2015 and April 2020, 345 (163 receiving 20 fractions; 182 receiving 32 fractions) patients were recruited from 46 centres. The median age was 73 years; 49% received neoadjuvant chemotherapy; 71% received concomitant therapy, with 5-fluorouracil/mitomycin C most commonly used: 44/114 (39%) receiving 20 fractions; 94/130 (72%) receiving 32 fractions. The acute grade 2+ gastrointestinal toxicity rate was higher in those receiving concomitant therapy compared with radiotherapy alone in the 20-fraction cohort [54/111 (49%) versus 7/49 (14%), P < 0.001] but not in the 32-fraction cohort (P = 0.355). Grade 2+ gastrointestinal toxicity was highest for gemcitabine, with evidence of significant differences across therapies in the 32-fraction cohort (P = 0.006), with a similar pattern but no significant differences in the 20-fraction cohort (P = 0.099). There was no evidence of differences in grade 2+ genitourinary toxicity between concomitant therapies in either the 20- or 32-fraction cohorts. CONCLUSION Grade 2+ acute adverse events are common. The toxicity profile varied by type of concomitant therapy; the gastrointestinal toxicity rate seemed to be higher in patients receiving gemcitabine.
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Affiliation(s)
- R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Radiotherapy Department, The Royal Marsden NHS Foundation Trust, London, UK.
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Radiotherapy Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Omar
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - R Alonzi
- Clinical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Middlesex, UK
| | - A Birtle
- Cancer Oncology, Lancashire Teaching Hospitals NHS Trust, Lancashire, UK
| | - K C Cheung
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - A Choudhury
- Translational Radiobiology, The Christie NHS Foundation Trust, Manchester, UK
| | - F Foroudi
- Radiation Oncology, Austin Health, Heidelberg, Australia
| | - H Gribble
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - A Henry
- University of Leeds and the Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - S Hilman
- Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - B Hindson
- Canterbury Regional Cancer and Haematology Service, Te Whatu Ora, Waitaha Canterbury, Christchurch, New Zealand
| | - R Lewis
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - D Muthukumar
- Oncology, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - D B McLaren
- Department of Clinical Oncology, Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK
| | - H McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Radiotherapy Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Nikapota
- Clinical Oncology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Olorunfemi
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - O Parikh
- Lancashire Teaching Hospitals NHS Trust, Burnley, UK
| | - L Philipps
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - Y Rimmer
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - I Syndikus
- Department of Radiotherapy, The Clatterbridge Cancer Centre, Liverpool, UK
| | - A Tolentino
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - M Varughese
- Department of Oncology, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - C Vassallo-Bonner
- Patient Representative, The Institute of Cancer Research, London, UK
| | - A Webster
- National Radiotherapy Trials Quality Assurance Group (RTTQA), University College Hospital, London, UK
| | - C Griffin
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - E Hall
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
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10
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Portner R, Ticknell G, Song Y, Hudson A, Choudhury A. The Use of Frailty Scores to Predict Tolerance to Chemotherapy in Patients with Metastatic Prostate Cancer. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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11
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Ali A, Baker S, Oliveira P, Choudhury A, Bristow R, Baena E. The Role of Prostate Zones in Cancer Progression. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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12
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Mukund A, Rana S, Choudhury A, Sasturkar SV, Patidar Y, Sarin SK. Outcome of percutaneous transhepatic biliary interventions in the management of biliary enteric anastomotic strictures with hepatolithiasis. Clin Radiol 2023; 78:e6-e12. [PMID: 36116970 DOI: 10.1016/j.crad.2022.08.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/01/2022] [Accepted: 08/01/2022] [Indexed: 01/07/2023]
Abstract
AIM To evaluate percutaneous transhepatic biliary interventions (PTBI) using the ADDFREE (Access-Drain-Dilate-Flush-REpeat periodically-Evaluate and remove) technique and its outcomes in patients with biliary enteric anastomotic strictures (BEAS) and hepatolithiasis. MATERIAL AND METHODS A retrospective review was undertaken of patients having hepatolithiasis with BEAS who underwent PTBI with a therapeutic intent (from January 2010 to January 2021) was performed. The technical and clinical successes of PTBI were analysed. Technical success was divided into duct access, crossing of BEAS, stricture resolution, and calculi clearance. Improvement of liver function tests, resolution of leucocytosis and presenting complaints were considered as clinical success. The patients were followed-up for a minimum duration of 6-months. RESULTS Eighteen patients received PTBI in form of the ADDFREE technique. Hepatolithiasis was bilobar (44.4%), unilobar in multiple ducts (unilobar-m; 27.8%) and unilobar in a single duct (unilobar-s; 27.8%) along with anastomotic stricture. The average number of sessions of stone clearance for bilobar, unilobar-m, and unilobar-s was 4.4 (±1.6), 3.6 (±2.4), and 1.5 (±0.5), respectively. Clinical success was observed in 14 (77.8%), while one patient had recurrence of calculi and received repeat treatment. Bile culture was positive for bacterial organisms in 17 (94.4%) patients. No major complication were seen while minor complication were seen in five patients consisting of self-limiting haemobilia (n=1), per-catheter bile leak (n=2) and aggravation of cholangitis (n=2). CONCLUSION PTBI, consisting of bile duct access, cholangioplasty, and calculi clearance, is a safe and effective technique for the treatment of patients having hepatolithiasis secondary to BEAS.
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Affiliation(s)
- A Mukund
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India.
| | - S Rana
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
| | - A Choudhury
- Department of Hepatology, Institute of Liver & Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
| | - S Vasantrao Sasturkar
- Department of Liver Transplant Surgery, Institute of Liver & Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
| | - Y Patidar
- Department of Interventional Radiology, Institute of Liver & Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
| | - Shiv K Sarin
- Department of Hepatology, Institute of Liver & Biliary Sciences, D-1, Vasant Kunj, New Delhi 110070, India
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13
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McWilliam A, Kerns S, Marshall D, Azria D, Farcy-Jacquet M, Chang-Claude J, Choudhury A, Dunning A, Lambrecht M, Avuzzi B, de Ruysscher D, Seibold P, Sperk E, Talbot C, Vega A, Veldeman L, Webb A, Rancati T, Rosenstein B, West C. Prostate Cancer Patients with a High Polygenic Risk of Rheumatoid Arthritis have Increased Radiotherapy Toxicity. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Schottstaedt A, Daamen L, Van der Voort vanZyp J, Choi S, Choudhury A, Teunissen F, Tree A, van der Heide U, Lawton C, Christodouleas J, Verkooijen H, Hall W. EQ5D-5L Scores in Men Undergoing Radiation Therapy for Prostate Cancer Using a 1.5 MR Linac Included in the MOMENTUM (NCT04075305) Prospective Multi Institutional Trial. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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15
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Swinton M, Mariam N, Tan J, Murphy K, Elumalai T, Soni M, Ferrera A, Richardson C, Walshaw R, Mistry H, Ramani V, Song Y, Birtle A, Henry A, Chan J, Hoskin P, Choudhury A. Clinical Outcomes in cN+M0 Bladder Cancer Patients: Can Bladder be Spared? Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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16
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Raja W, Testa L, Popolo Rubbio A, Cortese B, Wassef N, Raju P, Sharma V, Choudhury A, Hailan A, Lelasi A, Mastrangelo A, Bartorelli A, Basavarajaiah S. Shockwave intravascular lithotripsy (IVL) for calcified coronary lesions; a real world multicentre European study with long term follow up. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The presence of calcium in atherosclerotic plaques is a challenge for successful angioplasty and is an independent risk factor for restenosis and stent thrombosis. Despite conventional tools (non-compliant, scoring and cutting balloons and rotational atherectomy), cracking calcium can still be challenging and incomplete. Intra-vascular lithotripsy (IVL) has shown promising results, although long-term data on safety and efficacy from real-world is lacking.
Purpose
This study was undertaken to report long-term outcomes following use of IVL from a European multi-centre experience.
Methods
This was a multicentre, retrospective observational study in which we enrolled all patients treated with shockwave lithotripsy from November 2018 to June 2021. Procedural success, complications and in hospital events were evaluated. The clinical outcomes during follow-up included cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularisation (TLR), and major adverse cardiac event (MACE) (composite of cardiac death, TVMI, and TVR).
Result
A total of 272 patients were treated with IVL, with a mean age of 72 9.1 years and 78.5% (n=216) were male. Forty percent (n=110) were diabetic while 16% (n=45) had chronic kidney disease. Acute coronary syndrome was the presentation in 36% (n=99) while 51% (n=141) had stable angina. De novo lesions accounted for 78% (n=215) of the cases and the remainder were in-stent restenosis (21%; n=58). The LAD was the commonest artery treated 50% (n=139) followed by RCA 24% (n=68). Intracoronary imaging was performed in 33% of cases. Upfront IVL strategy was adopted in 37% (n=101) while 63% (n=171) were bail out procedures due to inadequate pre dilatation. Adjuvant rotational atherectomy was used on 31 (11.4%) cases. Procedural success was achieved in 96% (260) cases with major complications in 8 cases (perforation requiring covered stent in 3 patients) but there was no in-hospital mortality. Clinical outcomes over the median follow up of 641 days are shown in the table.
Conclusion
This is the largest multicentre registry with long term follow up. It has demonstrated that IVL appears to be safe with high success rates, low rates of complication and no in-hospital mortality. The long-term follow-up show promising results with low rates of hard-endpoints and revascularization rates.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- W Raja
- Birmingham Heartlands Hospital , Birmingham , United Kingdom
| | - L Testa
- IRCCS Clinical Scientific Institute Maugeri , Milano , Italy
| | - A Popolo Rubbio
- IRCCS Clinical Scientific Institute Maugeri , Milano , Italy
| | - B Cortese
- San Carlo Borromeo Hospital , Milan , Italy
| | - N Wassef
- Kettering General Hospital , Kettering , United Kingdom
| | - P Raju
- Kettering General Hospital , Kettering , United Kingdom
| | - V Sharma
- Birmingham City Hospital , Birmingham , United Kingdom
| | - A Choudhury
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - A Hailan
- Regional Cardiac Centre Morriston Hospital , Swansea , United Kingdom
| | - A Lelasi
- Clinical Institute Saint Ambrogio , Milan , Italy
| | | | | | - S Basavarajaiah
- Birmingham Heartlands Hospital , Birmingham , United Kingdom
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Chattopadhyay S, Soman B, Taylor G, Choudhury A, Desilva R. Determinants of neointimal strut coverage in bio-degradable polymer coated ultrathin strut stent. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Incomplete strut coverage (ISC) is the most important morphometric determinant of stent thrombosis. Determinants of ISC have been studied in thick and thin strut stents.
Purpose
To identify morphometric factors causing ISC in the biodegradable polymer-coated ultra-thin strut drug eluting stent (BP-UTS-DES) that are designed to encourage better strut coverage.
Methods
Patients undergoing implantation of a 65μm BP-UTS-DES had opportunistic OCT during staged PCI to assess strut coverage at 90 days. Images were analysed offline by experienced operators blinded to patient and procedural data. Neointimal thickness (NIT, μm) was measured as the minimum endoluminal distant between the strut and lumen border. All malapposed struts were considered uncovered. ISC was defined as <100% covered struts in a frame. Stepwise logistic regression using multiple morphometric variables was used to identify independent determinants of ISC including markers of circumferential distribution of neointimal growth (CVS,NUS,RUS), symmetry of stent expansion (SEI, AVS, MAS) in each cross section and the geographical location of the frame along the axis of the stent.
Results
We analysed 11652 frames of 65 stents (1976 mm) in 46 arteries of 40 patients. All stents were post dilated. 95.6% arteries had >20mm stents, 39.1% were overlapped and 15.2% were chronic total occlusions. Malapposition was seen in 2.6% of all struts and 39.2% of uncovered struts. The proportion of covered struts decreased as indices of circumferential uniformity of distribution of neointimal hyperplasia increased (CVS: r=0.37, p<0.001; RUS: r=0.36, p<0.001; NUS: r=0.52, p<0.001). As uniformity of stent expansion improved (SEI increased) strut coverage and circumferential uniformity of neointimal hyperplasia increased (CVS, NUS and RUS decreased) suggesting that distribution of neointimal growth becomes homogeneous as uniformity of stent expansion improves (Fig. 1). Determinants ISC is shown in Table 1.
Conclusion
SEI but not AVS or MAS determines ISC. Compared to the distal third of the stent frames in the middle third had lower and the proximal third had high risk of ISC.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Chattopadhyay
- Bedfordshire Hospitals NHS Foundation Trust, Cardiology , Bedford , United Kingdom
| | - B Soman
- Milton Keynes University Hospital NHS Trust, Cardiology , Milton Keynes , United Kingdom
| | - G Taylor
- Bedfordshire Hospitals NHS Foundation Trust, Cardiology , Bedford , United Kingdom
| | - A Choudhury
- Regional Cardiac Centre Morriston Hospital, Cardiology , Swansea , United Kingdom
| | - R Desilva
- Bedfordshire Hospitals NHS Foundation Trust, Cardiology , Bedford , United Kingdom
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Abdelkarem OAI, Choudhury A, Burnet NG, Summersgill HR, West CML. Effect of Race and Ethnicity on Risk of Radiotherapy Toxicity and Implications for Radiogenomics. Clin Oncol (R Coll Radiol) 2022; 34:653-669. [PMID: 35431121 DOI: 10.1016/j.clon.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/21/2022] [Accepted: 03/16/2022] [Indexed: 11/03/2022]
Abstract
AIMS Patient factors affect the risk of radiotherapy toxicity, but many are poorly defined. Studies have shown that race affects cancer incidence, survival, drug response, molecular pathways and epigenetics. Effects on radiosensitivity and radiotherapy toxicity are not well studied. The aim of the present study was to identify the effects of race and ethnicity on the risk of radiotherapy toxicity. MATERIALS AND METHODS A systematic review was carried out of PubMed, Ovid Medline and Ovid Embase with no year limit. PRISMA 2020 guidelines were followed. Two independent assessors reviewed papers. RESULTS Of 607 papers screened, 46 fulfilled the inclusion criteria. Papers were published between 1996 and 2021 and involved 30-28,354 individuals (median 433). Most involved patients with prostate (33%), breast (26%) and lung (9%) cancer. Both early and late toxicities were studied. Some studies reported a higher risk of toxicity in White men with prostate cancer compared with other races and ethnicities. For breast cancer patients, some reported an increased risk of toxicity in White women compared with other race and ethnic groups. In general, it was difficult to draw conclusions due to insufficient reporting and analysis of race and ethnicity in published literature. CONCLUSIONS Reporting of race and ethnicity in radiotherapy studies must be harmonised and improved and frameworks are needed to improve the quality of reporting. Further research is needed to understand how ancestral heritage might affect radiosensitivity and risk of radiotherapy toxicity.
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Affiliation(s)
- O A I Abdelkarem
- Chemical Pathology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt; Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - A Choudhury
- Proton Beam Therapy Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - N G Burnet
- Proton Beam Therapy Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - H R Summersgill
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK
| | - C M L West
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, The University of Manchester, Christie Hospital NHS Foundation Trust, Manchester, UK.
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19
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Tsinaslanidis P, Choudhury A, Smith T, Hing C. 495 Virtual Reality Simulation Training in Hip Surgery Versus Traditional Surgical Education Method: A Systematic Review of Randomised Controlled Trials. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
The purpose of this study was to perform a systematic review of the effects of orthopaedic virtual reality simulators on surgical skills across randomised controlled trials.
Method
The authors searched PubMed, CINAHL, MEDLINE, AMED, Eric, Embase, Cochrane Central Register of Controlled Trials, TRIP database and grey literature from 1946 to November 2020. Inclusion criteria were all level one studies, specifically randomised controlled trials with orthopaedic training simulators in hip surgery and clear evaluation of skills attained after virtual reality simulation (VR) training. The primary outcome was the reported quantitative assessment of operative skills acquisition. The Jadad scale was used as a tool in order to appraise the methodological quality of the included trials. The data collected were not amenable for meta-analysis as they were too heterogenous and were analysed and presented using a narrative analysis and the Synthesis Without Meta-analysis (SWiM) reporting guideline.
Results
A total of 1095 articles were identified. Four level I studies, all randomised controlled trials, including 86 participants were eligible for the final analysis. There were significant differences in the types of simulators, training structure, validity types, performance scores and outcome measures described in each study. In three out of four studies (75%) the use of VR training simulators led to improved surgical skills acquisition compared to other traditional teaching methods.
Conclusions
Overall, this review showed that the use of VR simulation training is a potential tool that can enhance surgical skills acquisition in hip surgery procedures compared to traditional education methods.
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Affiliation(s)
- P Tsinaslanidis
- St George's University Hospitals NHS Foundation Trust , London , United Kingdom
| | | | - T Smith
- c. University of East Anglia , Norwich , United Kingdom
| | - C Hing
- St George's University Hospitals NHS Foundation Trust , London , United Kingdom
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Gilbert DC, Henry AM, Choudhury A. Marginal Gains and Clinical Trials - Improving and Influencing Practice. Clin Oncol (R Coll Radiol) 2022; 34:419-420. [PMID: 35491365 PMCID: PMC9047616 DOI: 10.1016/j.clon.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/07/2022] [Indexed: 12/15/2022]
Affiliation(s)
- D C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK.
| | - A M Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - A Choudhury
- The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
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21
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Elumalai T, Barker C, Elliott T, Malik J, Tran A, Hudson A, Song YP, Patel K, Lyons J, Hoskin P, Choudhury A, Mistry H. Translation of Prognostic and Pharmacodynamic Biomarkers from Trial to Non-trial Patients with Metastatic Castration-resistant Prostate Cancer Treated with Docetaxel. Clin Oncol (R Coll Radiol) 2022; 34:e291-e297. [PMID: 35314092 DOI: 10.1016/j.clon.2022.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 01/17/2022] [Accepted: 01/26/2022] [Indexed: 11/03/2022]
Abstract
AIMS We conducted a pooled analysis of four randomised controlled trials and a non-trial retrospective dataset to study the changes in serum prostate-specific antigen (PSA) concentrations during treatment and its impact on survival in men treated with docetaxel for metastatic castration-resistant prostate cancer. We also compared the outcomes and pre-treatment prognostic factors between trial and non-trial patients. MATERIALS AND METHODS Data were obtained from four randomised controlled trials and a non-trial cohort from a tertiary cancer centre. The PSA kinetics covariates chosen were absolute value (PSAT), best percentage change (BPCH) and tumour growth rate (K). The association between the covariates collected and overall survival was assessed within a Cox proportional hazards model. How well a covariate captured the difference between trial and non-trial patients was assessed by reporting on models with or without trial status as a covariate. RESULTS We reviewed individual datasets of 2282 patients. The median overall survival for trial patients was 20.4 (95% confidence interval 19.6-22.2) months and for the non-trial cohort was 12.4 (10.7-14.7) months (P < 0.001). Of the pre-treatment factors, we found that only lactate dehydrogenase fully captured the difference in prognosis between the trial and non-trial cohorts. All PSA kinetic metrics appeared to be prognostic in both the trial and non-trial patients. However, the effect size was reduced in non-trial versus trial patients (interaction P < 0.001). Of the time-dependent covariates, we found that BPCH best captured the difference between trial and non-trial patient prognosis. CONCLUSIONS The analysis presented here highlights how data from open-source trial databases can be combined with emerging clinical practice databases to assess differences between trial versus non-trial patients for particular treatments. These results highlight the importance of developing prognostic models using both pre-treatment and time-dependent biomarkers of new treatments.
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Affiliation(s)
- T Elumalai
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Barker
- The Christie NHS Foundation Trust, Manchester, UK
| | - T Elliott
- Western General Hospital, Edinburgh Cancer Centre, Edinburgh, UK
| | - J Malik
- Western General Hospital, Edinburgh Cancer Centre, Edinburgh, UK
| | - A Tran
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Hudson
- The Christie NHS Foundation Trust, Manchester, UK
| | - Y P Song
- The Christie NHS Foundation Trust, Manchester, UK
| | - K Patel
- The Christie NHS Foundation Trust, Manchester, UK
| | - J Lyons
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Hoskin
- The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK; Mount Vernon Cancer Centre, Northwood, UK; Division of Pharmacy, University of Manchester, Manchester, UK
| | - A Choudhury
- The Christie NHS Foundation Trust, Manchester, UK; University of Manchester, Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK; Division of Pharmacy, University of Manchester, Manchester, UK
| | - H Mistry
- Division of Cancer Sciences, University of Manchester, UK; Division of Pharmacy, University of Manchester, Manchester, UK.
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Sritharan K, Akhiat H, Cahill D, Choi S, Choudhury A, Chung P, Diaz J, Dysager L, Hall W, Kerkmeijer L, Lawton C, Murray J, Nyborg C, Pos F, Rigo M, Schytte T, Sidhom M, Sohaib A, Tan A, van der Voort van Zyp J, Vesprini D, Zelefsky M, Tree A. PD-0571 Determining interobserver variability in prostate bed CTV target delineation using MRI. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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Benson R, Sideris A, McDaid L, Chuter R, Portner R, Freear L, Clough A, Nelder C, Pitt E, Daly M, Vassiliou M, Rembielak A, Hoskin P, Choudhury A, Eccles C. PD-0087 Developing rapid response MRI-guided palliative radiotherapy for metastatic spinal cord compression. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02757-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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24
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Westerhoff J, Daamen L, Christodouleas J, Blezer E, Choudhury A, Westley R, Erickson B, Fuller C, Hafeez S, van der Heide U, Intven M, Kirby A, Lalondrelle S, Minsky B, Mook S, Nowee M, Marijnen C, Orrling K, Sahgal A, Schultz C, Tersteeg R, Tree A, Tseng C, van der Voort van Zyp J, Verkooijen H, Hall W. OC-0419 Patterns of Care and Safety in 1800 patients treated on a high-field MR-Linac platform registry. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02555-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dubec M, Datta A, Clough A, Buckley D, Little R, Berks M, Cheung S, Eccles C, Higgins D, Naish J, Matthews J, van Herk M, Bristow R, Parker G, Hoskin P, McPartlin A, Choudhury A, O'Connor J. OC-0623 First-in-human clinical translation of oxygen-enhanced MRI onto an MR Linac. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Kombathula S, Cree A, Joshi P, Akturk N, Barraclough L, Haslett K, Choudhury A, Hoskin P. PO-1348 Prognostic factors in patients receiving palliative radiotherapy for female genital tract cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03312-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Moore C, Jackson S, Stickley J, Clough A, Nelder C, Chuter R, Choudhury A, McHugh D, Dubec M. PO-1752 Daily prostate ADC in patients having SABR and conventional prostate cancer treatment on an MR-Linac. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03716-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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28
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Rancati T, Gioscio E, Cicchetti A, Rosenstein B, Seibold P, Avuzzi B, Azria D, Choudhury A, De Ruysscher D, Dunning A, Elliott R, Kerns S, Lambrecht M, Sperk E, Symonds P, Talbot C, Vega A, Veldeman L, Valdagni R, Webb A, Chang-Claude J, West C. MO-0557 Estimates of α/β ratios for individual late urinary toxicity endpoints: analysis of a cohort trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02391-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Elumalai T, Portner R, Mariam N, Young T, Hughes S, Wickramasinghe K, Bhana R, Jayaprakash K, Sabar M, Hudson A, Hoskin P, Mistry H, Choudhury A. MO-0555 Radiotherapy for node-positive prostate cancer correlates with improved survival. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02389-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Swinton M, Mariam N, Tan J, Afferi L, Lonati C, Moshini M, Lau M, Ramani V, Sangar V, Clarke N, Mistry H, Elumalai T, Hoskin P, Choudhury A. PD-0418 Resect or Preserve? Comparing treatment strategies in clinically node positive bladder cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02853-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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31
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Zhang C, Choudhury A, Bermejo I, Dekker A. PO-1116 Towards Privacy-Preserving Federated Deep Learning infrastructure : proof-of-concept. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03080-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Teles Amaro P, McDaid L, Davies L, Whiteside L, Clough A, Faivre-Finn C, Parker J, Bailey R, Benson R, Nelder C, Pitt E, Eccles C, Crockett C, Salem A, Choudhury A. PO-1877 Initial experience delivering stereotactic radiotherapy to a gluteal metastasis on a 1.5T MR Linac. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03840-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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33
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Choudhury A. SP-0340 Fractionation and biology in bladder cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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34
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Daly M, Benson R, Chuter R, Clough A, McDaid L, Mcwilliam A, Nelder C, Pitt E, Radhakrishna G, Choudhury A, Eccles C. PO-1832 Quantification of fat on MRI and impact on effectiveness of abdominal compression for radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gouthamchand V, K G, Subramanian R, Choudhury A, Wee L, Dekker A, Sinha S, Ghosh Laskar S, Reddy L. PO-1062 Privacy-preserving dashboard for clinical data using open-source federated learning infrastructure. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Loudet JC, Choudhury A, Qiu M, Feng JJ. Particle trapped at the isotropic-nematic liquid crystal interface: Elastocapillary phenomena and drag forces. Phys Rev E 2022; 105:044607. [PMID: 35590681 DOI: 10.1103/physreve.105.044607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
We present numerical simulations of a particle trapped at the isotropic-nematic liquid crystal (Iso-N) interface. We use our recent model, based on a phase-field approach [see Qiu et al., Phys. Rev. E 103, 022706 (2021)10.1103/PhysRevE.103.022706], to couple the capillary forces acting on the interface with the elastic stresses in the nematic phase along with topological defects. A range of floating configurations are first investigated as a function of the contact angle and various anchoring conditions at the fluid interface. The results show that the response of the system is driven by the existence of an anchoring conflict at the contact line. Substantial particle displacements and/or interfacial deformations may occur in this case even for moderate anchoring strengths. These findings highlight the coupling between elastic and capillary forces. In a second part, we compute drag forces exerted on a particle that moves along the Iso-N interface for several contact angles and a moderate Ericksen number. Because of the coupling between the velocity and order parameter fields, topological defects are swept downstream of the particle by the flow and sometimes escape from the particle or merge with the interface. We also find linear force-velocity laws, with drag forces at the Iso-N interface being slightly greater than their isotropic counterparts due to director distortions. We discuss these results in light of past studies on the behavior of particles being dragged in the bulk of a liquid crystal matrix.
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Affiliation(s)
- J-C Loudet
- Université de Bordeaux, CNRS, Centre de Recherche Paul Pascal (UMR 5031), 33600 Pessac, France
| | - A Choudhury
- Department of Mechanical and Aerospace Engineering, Indian Institute of Technology Hyderabad, 502284 Telangana, India
- University of British Columbia, Department of Mathematics, Vancouver, BC, Canada V6T 1Z2
| | - M Qiu
- Laboratoire de Physique, École Normale Supérieure, 75005 Paris, France
| | - J J Feng
- University of British Columbia, Department of Mathematics, Vancouver, BC, Canada V6T 1Z2
- University of British Columbia, Department of Chemical and Biological Engineering, Vancouver, BC, Canada V6T 1Z3
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Iype R, Mistry H, Choudhury A, Song Y. Is Clinical Frailty Score Associated with Toxicity during Radical Radiotherapy for Bladder Cancer? Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2021.11.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Elumalai T, Croxford W, Buijtenhuijs B, Conroy R, Sanderson B, Enting D, Aversa C, Doss G, Das A, Vasudev N, Kitetere E, Tolan S, Law A, Hoskin P, Mistry H, Choudhury A. Using Real-world Data to Define a Validated Nomogram for Advanced Bladder Cancer Patients Who Respond to Immunotherapy. Clin Oncol (R Coll Radiol) 2022; 34:642-652. [DOI: 10.1016/j.clon.2022.02.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 02/09/2022] [Accepted: 02/24/2022] [Indexed: 11/03/2022]
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39
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Billy Graham Mariam N, Swinton M, Tan J, Elumalai T, Mistry H, Choudhury A. Outcomes in Clinically Node Positive Bladder Cancer Patients at a Tertiary Cancer Centre in the UK. Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2021.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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40
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Tharmalingam H, Tsang Y, Alonzi R, Beasley W, Taylor N, McWilliam A, Padhani A, Choudhury A, Hoskin P. Changes in Magnetic Resonance Imaging Radiomic Features in Response to Androgen Deprivation Therapy in Patients with Intermediate- and High-risk Prostate Cancer. Clin Oncol (R Coll Radiol) 2022; 34:e246-e253. [DOI: 10.1016/j.clon.2021.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/26/2021] [Accepted: 12/22/2021] [Indexed: 11/03/2022]
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41
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Mukund A, V Srinivasan S, Rana S, Vijayaraghavan R, Patidar Y, Arora V, Jindal A, Choudhury A, Shasthry SM, Sarin SK. Response evaluation of locoregional therapies in combined hepatocellular-cholangiocarcinoma and intrahepatic cholangiocarcinoma versus hepatocellular carcinoma: a propensity score matched study. Clin Radiol 2021; 77:121-129. [PMID: 34789395 DOI: 10.1016/j.crad.2021.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/14/2021] [Indexed: 11/16/2022]
Abstract
AIM To evaluate the response of locoregional therapy (LRT) on combined hepatocellular-cholangiocarcinoma (cHCC-CC) and intrahepatic cholangiocarcinoma (IHC) and compare their outcomes with propensity matched hepatocellular carcinoma (HCC) patients. MATERIALS AND METHODS From January 2011 to July 2020, 13 patients with cHCC-CC (11 men, two women, median age 56 years) and 15 IHC patients (10 men, five women, median age 60 years) were compared with 101 HCC patients (79 men, 22 women, median age 60 years) after LRT. All tumours were proven histologically. Among the 13 cHCC-CC patients, 11 received transarterial chemoembolisation (TACE), one received microwave ablation (MWA) and one received TACE with radiofrequency ablation (RFA). Of 15 IHC patients, eight received TACE, five received RFA, and one received MWA, and one received TACE with RFA. Propensity score matching (PSM) was done with conditional logistic regression adjusted for age, type of LRT, tumour specific features and Child-Pugh score. RESULTS After LRT, on univariate analysis an objective response was seen in 30% of cHCC-CC and 53% of IHC patients. PSM analysis demonstrated shorter progression-free survival (PFS; cHCC-CC versus HCC: 1.5 versus 7.5 months; IHC versus HCC: 6 versus 14 months, p<0.05), overall survival (OS; cHCC-CC versus HCC: 12 versus 28 months; IHC versus HCC: 18 versus 34 months, p<0.005), and poor objective response (cHCC-CC versus HCC: 25% versus 91%; IHC versus HCC: 58% versus 88%, p<0.05) in cHCC-CC and IHC patients versus HCC patients. Hypovascular tumour, macrovascular invasion, and infiltrative appearance were independent prognostic factors for OS in IHC patients. CONCLUSION cHCC-CC and IHC are aggressive tumours with a poor objective response, greater distant progression of the disease and shorter PFS and OS post LRT as compared to HCC.
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Affiliation(s)
- A Mukund
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India.
| | - S V Srinivasan
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S Rana
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - R Vijayaraghavan
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Y Patidar
- Department of Interventional Radiology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - V Arora
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - A Jindal
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - A Choudhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S M Shasthry
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S K Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
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Singh S, Brandenburg JT, Choudhury A, Gómez-Olivé FX, Ramsay M. Systematic Review of Genomic Associations with Blood Pressure and Hypertension in Populations with African-Ancestry. Front Genet 2021; 12:699445. [PMID: 34745203 PMCID: PMC8564494 DOI: 10.3389/fgene.2021.699445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/10/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Despite hypertension being highly prevalent in individuals with African-ancestry, they are under-represented in large genome-wide association studies. Inclusion of African participants is essential to better understand genetic associations with blood pressure-related traits in Africans. This systematic review critically evaluates existing studies with African-ancestry participants and identifies knowledge gaps. Methods: We followed the PRISMA protocol, HuGE Review handbook to identify literature on original research, in English, on genetic association studies for blood pressure-related traits (systolic and diastolic blood pressure, pulse and mean-arterial pressure, and hypertension) in populations with African-ancestry (January 2007 to April 2020). A narrative synthesis of the evidence was conducted. Results: Twelve studies with African-ancestry participants met the eligibility criteria, within which 10 studies met the additional genetic association data criteria (i.e., reporting only on African-ancestry participants). Across the five blood pressure-related traits, 26 genome-wide significantly associated SNPs were identified, with six SNPs linked to more than one trait, illustrating pleiotropic effects. Among the SNP associations, 12 had not previously been described in non-African studies. Discussion: The limited number of relevant studies highlights the dearth of genomic association studies on participants with African-ancestry, especially those located within Africa. Variations in study methodology, participant inclusion, adjustment for covariates (e.g., antihypertensive medication) and relatively small sample sizes make comparisons challenging, and have resulted in fewer significant associations, compared to large European studies. Regional variation in the prevalence and associated risk factors of hypertension across Africa makes a compelling argument to develop African cohorts to facilitate large genomic studies, using African-centric arrays. Data harmonisation and comparable study designs, such as described in the H3Africa CHAIR initiative, provide a good example toward achieving this goal. Other relevant information: SS and J-TB were funded by the South African National Research Foundation. MR is a South African Research Chair in Genomics and Bioinformatics of African populations hosted by the University of the Witwatersrand, funded by the Department of Science and Innovation, and administered by the NRF. This review was registered at PROSPERO (registration number: CRD42020179221) and OSF (registration DOI: 10.17605/OSF.IO/QT2HA).
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Affiliation(s)
- S Singh
- Sydney Brenner Institute for Molecular Bioscience (SBIMB), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Human Genetics, School of Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - J-T Brandenburg
- Sydney Brenner Institute for Molecular Bioscience (SBIMB), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - A Choudhury
- Sydney Brenner Institute for Molecular Bioscience (SBIMB), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - F X Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - M Ramsay
- Sydney Brenner Institute for Molecular Bioscience (SBIMB), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Division of Human Genetics, School of Pathology, National Health Laboratory Service and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Choudhury A, Magill S, Eaton C, Prager B, Chen W, Seo K, Lucas C, Villanueva-Meyer J, Vasudevan H, Liu S, Cady M, Zhang M, Braunstein S, Oberheim N, Perry A, Solomon D, Costello J, McDermott M, Rich J, Raleigh D. Meningioma DNA Methylation Grouping Reveals Biologic Drivers and Therapeutic Vulnerabilities. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.1513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chen W, Choudhury A, Vasudevan H, Lucas C, Lam T, Pu J, Li L, Leung G, Chan J, Nguyen M, Oberheim N, Villanueva-Meyer J, Schulte J, Braunstein S, Butowski N, Sneed P, Berger M, Perry A, Solomon D, McDermott M, Magill S, Raleigh D. A Targeted Gene Expression Risk Score Predicts Meningioma Outcomes and Responses to Radiotherapy. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Portner R, Bajaj A, Elumalai T, Huddart R, Murthy V, Nightingale H, Patel K, Sargos P, Song Y, Hoskin P, Choudhury A. A practical approach to bladder preservation with hypofractionated radiotherapy for localised muscle-invasive bladder cancer. Clin Transl Radiat Oncol 2021; 31:1-7. [PMID: 34466667 PMCID: PMC8385113 DOI: 10.1016/j.ctro.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Bladder preservation with trimodality treatment (TMT) is an alternative strategy to radical cystectomy (RC) for the management of localised muscle invasive bladder cancer (MIBC). TMT comprises of transurethral resection of the bladder tumour (TURBT) followed by radiotherapy with concurrent radiosensitisation. TMT studies have shown neo-adjuvant chemotherapy with cisplatin-based regimens is often given to further improve survival outcomes. A hypofractionated radiotherapy regimen is preferable due to its non-inferiority in local control and late toxicities. Radiosensitisation can comprise concurrent chemotherapy (with gemcitabine, cisplatin or combination fluorouracil and mitomycin), CON (carbogen and nicotinomide) or hyperthermic treatment. Radiotherapy techniques are continuously improving and becoming more personalised. As the bladder is a mobile structure subject to volumetric changes from filling, an adaptive approach can optimise bladder coverage and reduce dose to normal tissue. Adaptive radiotherapy (ART) is an evolving field that aims to overcome this. Improved knowledge of tumour biology and advances in imaging techniques aims to further optimise and personalise treatment.
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Affiliation(s)
- R. Portner
- The Christie NHS Foundation Trust, Manchester, UK
| | - A. Bajaj
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - T. Elumalai
- The Christie NHS Foundation Trust, Manchester, UK
| | - R. Huddart
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, UK
| | - V. Murthy
- Department of Radiation Oncology, ACTREC and Tata Memorial Hospital, Homi Bhabha National University, Mumbai, India
| | | | - K. Patel
- The Christie NHS Foundation Trust, Manchester, UK
| | - P. Sargos
- Department of Radiation Oncology, Institut Bergonié, F-33076 Bordeaux Cedex, France
| | - Y. Song
- The Christie NHS Foundation Trust, Manchester, UK
| | - P. Hoskin
- Mount Vernon Cancer Centre, Northwood, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - A. Choudhury
- The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
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Rupasinghe T, Silva DC, Balawardena J, Perera K, Gunasekera D, Weerasinghe S, Jeyakumaran N, Abeysinghe P, Skandarajah T, Choudhury A, Joseph N. Curative-Intent Radiotherapy for Squamous Cell Carcinoma of the Head and Neck in Sri Lanka: The Impact of Radiotherapy Technique on Survival. Clin Oncol (R Coll Radiol) 2021; 33:765-772. [PMID: 34642066 DOI: 10.1016/j.clon.2021.09.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/13/2021] [Accepted: 09/28/2021] [Indexed: 12/24/2022]
Abstract
AIMS We conducted a retrospective analysis of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with curative-intent radiotherapy at the National Cancer Institute of Sri Lanka to determine the impact of the treatment technique on disease-free survival (DFS). MATERIALS AND METHODS SCCHN patients treated with radical radiotherapy or adjuvant postoperative radiotherapy from 2016 to 2017 were included in the study. Data on the following variables were collected by reviewing clinical and radiotherapy treatment records: age, gender, tumour site, stage, time to delivery of radiotherapy, use of neoadjuvant chemotherapy, use of concurrent radiosensitising chemotherapy and treatment technique. DFS, defined as the time to death, tumour recurrence or loss to follow-up, was the primary end point and outcomes were compared between patients treated with intensity-modulated radiotherapy (IMRT) in linear accelerators and those treated with conventional radiotherapy in cobalt teletherapy units. Univariate and multivariate analyses were carried out on known prognostic variables. RESULTS In total, 408 patients were included in the study, with 138 (34%) being treated with IMRT in the linear accelerator. More than 75% of patients were of stage III or IV at diagnosis. The 2-year DFS of the whole cohort was 25% (95% confidence interval 21-30%). Patients treated with IMRT in the linear accelerator had a superior DFS in comparison with those treated with conventional radiotherapy in the cobalt teletherapy units (P < 0.001, hazard ratio 0.64, 95% confidence interval 0.5-0.82). Higher stage, cobalt treatment and use of neoadjuvant chemotherapy were adversely associated with DFS on multivariate analysis. CONCLUSION A large proportion of patients with SCCHN treated with curative-intent radiotherapy in Sri Lanka had locally advanced disease and DFS was superior in patients treated with IMRT in the linear accelerator.
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Affiliation(s)
- T Rupasinghe
- National Cancer Institute, Maharagama, Sri Lanka; Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka
| | - D C Silva
- Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka
| | - J Balawardena
- Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka; General Sir John Kotalawela Defence University, Kandawala, Sri Lanka
| | - K Perera
- National Cancer Institute, Maharagama, Sri Lanka; Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka
| | - D Gunasekera
- National Cancer Institute, Maharagama, Sri Lanka; Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka
| | - S Weerasinghe
- National Cancer Institute, Maharagama, Sri Lanka; Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka
| | - N Jeyakumaran
- National Cancer Institute, Maharagama, Sri Lanka; Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka
| | - P Abeysinghe
- National Cancer Institute, Maharagama, Sri Lanka; Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka
| | - T Skandarajah
- National Cancer Institute, Maharagama, Sri Lanka; Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka
| | - A Choudhury
- The Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - N Joseph
- Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka; Teaching Hospital, Batticaloa, Sri Lanka.
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Sanderson B, Joseph N, Elumalai T, Cree A, van Herk M, Hoskin P, McWilliam A, Song Y, Choudhury A. PO-1518 Effect of bladder filling protocols on bladder volume variation in the age of adaptive radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07969-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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48
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Datta A, Forker L, McWilliam A, Mistry H, Zhong J, Wylie J, Coyle C, Saunders D, Kennedy S, O’Connor J, Hoskin P, West C, Choudhury A. PO-1415 Association of radiomic features with aggressive phenotypes in soft tissue sarcomas. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07866-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Huddart R, Hafeez S, Omar A, Choudhury A, Birtle A, Syndikus I, Hindson B, Varughese M, Henry A, McLaren D, Foroud F, Webster A, McNair H, Tolentino A, Webster L, Gribble H, Philipps L, Nikapota A, Parikh O, Alonzi R, Mahmood R, Hilman S, Rimmer Y, Griffin C, Hall E. OC-0513 Acute toxicity of hypo- and conventionally-fractionated radiosensitised bladder radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Nelder C, Chuter R, Berresford J, Benson R, Clough A, McDaid L, Barraclough L, Haslett K, Hoskin P, Choudhury A, Eccles C. PO-1940 Variation in bladder filling for cervical cancer patients undergoing radical radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08391-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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