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Carter L, Apte V, Shukla A, Ghose A, Mamidi R, Petohazi A, Makker S, Banerjee S, Boussios S, Banna GL. Stage 3 N2 Lung Cancer: A Multidisciplinary Therapeutic Conundrum. Curr Oncol Rep 2024; 26:65-79. [PMID: 38180692 PMCID: PMC10858814 DOI: 10.1007/s11912-023-01486-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE OF REVIEW The treatment of stage III N2 non-small cell lung cancer (NSCLC) remains debated. There is an absence of a universally agreed definition of resectability for this heterogeneous group and a lack of trial data. RECENT FINDINGS We reviewed and compared current international guidelines and evidence surrounding management of stage III N2 NSCLC. The Irish and Australian guidelines advise subcategorising N2 disease into N2a (may be resectable) and N2b (never resectable). On the contrary, American and British guidelines avoid subcategorising N2 disease, emphasising importance of local MDT decisions. It is suggested that evidence for resection of stage III tumours is relatively weak, but that stage IIIA should generally be considered for resection, and stage IIIB is not recommended for resection. For resectable disease, surgery may be combined with neoadjuvant chemoimmunotherapy, or adjuvant chemotherapy followed by immunotherapy and radiotherapy in selected patients. There is some evidence that technically resectable disease can be treated solely with radiotherapy with similar outcomes to resection. In the event of unresectable disease, chemoradiotherapy has been the traditional management option. However, recent studies with chemoradiotherapy alongside immunotherapy appear promising. There are many factors that influence the treatment pathway offered to patients with stage III N2 NSCLC, including patient factors, team expertise, and local resources. Therefore, the role of MDTs in defining resectability and formulating an individualised treatment plan is crucial.
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Affiliation(s)
- Lily Carter
- Division of Surgery, Cancer and Cardiovascular Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Vedika Apte
- University College London Medical School, London, UK
- University College London Oncology Society, London, UK
| | - Arushi Shukla
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- School of Biosciences Education, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Barts and the London Oncology Society, London, UK
| | - Aruni Ghose
- Department of Medical Oncology, Barts Cancer Centre and Cardio-Oncology, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK.
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham, Kent, UK.
- Department of Medical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK.
- Immuno-Oncology Clinical Network, Liverpool, UK.
- Future Cancer Leaders, United Kingdom and Ireland Global Cancer Network, London, UK.
- Health Systems and Treatment Optimisation Network, European Cancer Organisation, Brussels, Belgium.
- Oncology Council, Royal Society of Medicine, London, UK.
| | - Raj Mamidi
- Division of Surgery, Cancer and Cardiovascular Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Alexandra Petohazi
- Department of General Surgery, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Shania Makker
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Barts and the London Oncology Society, London, UK
- University College London Cancer Institute, London, UK
| | | | - Stergios Boussios
- Department of Medical Oncology, Medway NHS Foundation Trust, Gillingham, Kent, UK
- School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
- Kent and Medway Medical School, University of Kent, Canterbury, UK
- AELIA Organisation, 9th Km Thessaloniki - Thermi, 57001, Thessaloniki, Greece
| | - Giuseppe L Banna
- Department of Medical Oncology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- Faculty of Science and Health, School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth, UK
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Damisa J, Petohazi A, Jalil H, Richardson M. Is Cannabis Effective in the Treatment of Chronic Back Pain? Cureus 2023; 15:e43220. [PMID: 37692601 PMCID: PMC10490377 DOI: 10.7759/cureus.43220] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Cannabis is commonly recognized as a recreational substance. It has been explored for its potential therapeutic applications in addressing various conditions, such as depression, anxiety, sleep disorders, neurological disorders, and chronic low back pain, which affect a significant portion of the population. In the United Kingdom, cannabis has been recognized and licensed for medical use since November 2018, with about 12 National Health Service prescriptions in circulation largely due to patient pressure, with support from media campaigns for its use when there was growing evidence of its use in intractable epilepsy. Cannabis is beginning to gain traction as an alternative or even a complementary drug to opiates with some pre-clinical studies showing opiate-sparing effects. Despite references to its therapeutic use, cannabis as a therapeutic drug has been controversial due to the negative perception of its use as a recreational drug. As a result, there have been challenges in changing the perception of healthcare authorities and clinicians on the use of cannabis as a therapeutic tool for pain relief. The stigma associated with cannabis could be responsible for the paucity of randomized controlled trials on the efficacy of medical cannabis, further decreasing the credibility of the few trials conducted.
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Affiliation(s)
- Josiah Damisa
- Orthopedic Surgery, Royal Preston Hospital, Preston, GBR
| | | | - Hassan Jalil
- Orthopedic Surgery, Royal Preston Hospital, Preston, GBR
| | - Michelle Richardson
- Orthopedic Surgery, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, GBR
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Ali F, Musbahi O, Petohazi A, Sindhar J, Akilapa S, Bailey D, Harnett P. 974 Fragility Fractures of the Hip: A Matched Cohort Study of Acetabular Fractures and Neck of Femur Fractures. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.486] [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: 11/05/2022]
Abstract
Abstract
Aim
Due to an ageing population, acetabular fractures in the elderly are on the rise. Management of this group of patients remains controversial, especially as it is associated with high morbidity and mortality. With an ageing population, there will be an increasing trend in low energy associated acetabular fractures. We present the largest cohort of operatively treated acetabular geriatric patients in the UK, comparing complications and mortality, and also comparing them to patients with neck of femur fractures.
Method
A review of a prospectively collected acetabular database was conducted. All patients over the age of 60 that had an operative fixation for an acetabular fracture from 2015 to 2020 were identified. Demographic data, operative details and complications were recorded. We cohort-matched these patients with neck of femur fractures during the same period to compare patient outcomes and cohort demographics.
Results
204 patients were included in the study. The mean age was 76. The most common mechanism of injury was a fall from less than 1 metre (64%). The mean length of stay for acetabular fractures was 25 days. In-hospital mortality was 3% and 10% for acetabular fractures and neck of femur fractures respectively.
Conclusion
There is little difference in demographic information between geriatric acetabular fractures and neck of femur fractures. Operatively treated geriatric acetabular fractures are associated with greater length of stay than neck of femur fractures.
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Affiliation(s)
- F Ali
- King’s College Hospital NHS Trust , London , United Kingdom
| | - O Musbahi
- King’s College Hospital NHS Trust , London , United Kingdom
| | - A Petohazi
- King’s College Hospital NHS Trust , London , United Kingdom
| | - J Sindhar
- King’s College Hospital NHS Trust , London , United Kingdom
| | - S Akilapa
- King’s College Hospital NHS Trust , London , United Kingdom
| | - D Bailey
- King’s College Hospital NHS Trust , London , United Kingdom
| | - P Harnett
- King’s College Hospital NHS Trust , London , United Kingdom
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Petohazi A, Musbahi O, Akilapa O, Gee M, Harnett P. 412 Operative Fixation for Acetabular Fractures in the Elderly: A Prospective Cohort Study from a UK Major Trauma Centre. Br J Surg 2022. [DOI: 10.1093/bjs/znac039.281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aim
Due to an ageing population, acetabular fractures in the elderly is on the rise. Management of this group of patients remains controversial especially as it is associated with high morbidity and mortality. With an ageing population, there will be an increasing trend in low energy associated acetabular fractures. We present the largest cohort of operatively treated acetabular geriatric patients in the UK and compare different and emerging operative techniques and technology.
Method
A review of a prospective pelvic database was conducted. All patients over the age of 60 that had an operative fixation for an acetabular fracture from 2015 to 2020 were identified. Demographic data, operative data and complications were recorded. Length of stay and in-hospital mortality were also included.
Results
109 patients were included in the study. The mean age was 73 and the mean Injury severity score was 13. The most common mechanism of injury was a fall from less than 1 meter (42%). The mean length of stay is 25 days. In-hospital mortality was 2% and 92% of patients had no in-hospital postoperative complication. A variety of metalwork was used ranging from sacroiliac screws to pelvic infix.
Conclusions
Advancements in orthopaedic implants have changed the management of geriatric acetabular fracture patients.
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Affiliation(s)
- A. Petohazi
- Kings College Hospital, London, United Kingdom
| | - O. Musbahi
- Kings College Hospital, London, United Kingdom
| | - O. Akilapa
- Kings College Hospital, London, United Kingdom
| | - M. Gee
- Kings College Hospital, London, United Kingdom
| | - P. Harnett
- Kings College Hospital, London, United Kingdom
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Jamal MS, Hay D, Al-Tawil K, Petohazi A, Gulli V, Bednarczuk N, Baldwin-Smith R, Gibbons J, Sinha J. 257 The Effect of the COVID-19 Pandemic on Mental Health Associated Trauma, Admissions and Fractures at a London Major Trauma Centre. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.979] [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: 11/13/2022]
Abstract
Abstract
Aim
Non-injury related factors have been extensively studied in major trauma and shown to have a significant impact on patient outcomes, with mental illness and associated medication use proven to have a negative effect on bone health and fracture healing. We report the epidemiological effect of COVID-19 pandemic on mental health associated Orthopaedic trauma, fractures, and admissions to our centre.
Method
We collated data retrospectively from the electronic records of Orthopaedic inpatients in an 8-week non-COVID and COVID period analysing demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient co-morbidities including psychiatric history.
Results
here were 824 Orthopaedic referrals and 358 admissions (6/day) in the non-COVID period with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared to 473 referrals and 195 admissions (3/day) in the COVID period with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) a fracture. 22/38 (57.9%) and 52/73 (71.2%) patients were known to mental health services, respectively.
Conclusions
Whilst total numbers utilising the Orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affected those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. It is imperative that adequate support is in place for vulnerable mental health patients, particularly as we are currently experiencing the “second wave” of COVID-19.
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Affiliation(s)
- M S Jamal
- Kings College Hospital, London, United Kingdom
- Royal National Orthopaedic Hospital, London, United Kingdom
| | - D Hay
- Kings College Hospital, London, United Kingdom
| | - K Al-Tawil
- Kings College Hospital, London, United Kingdom
| | - A Petohazi
- Kings College Hospital, London, United Kingdom
| | - V Gulli
- Kings College Hospital, London, United Kingdom
| | | | | | - J Gibbons
- Kings College Hospital, London, United Kingdom
| | - J Sinha
- Kings College Hospital, London, United Kingdom
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Hay D, Jamal MS, Al-Tawil K, Petohazi A, Gulli V, Bednarczuk NF, Baldwin-Smith R, Gibbons J, Sinha J. The effect of the COVID-19 pandemic on mental health associated trauma, admissions and fractures at a London major trauma centre. Ann R Coll Surg Engl 2021; 103:114-119. [PMID: 33559558 PMCID: PMC9773921 DOI: 10.1308/rcsann.2020.7026] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Non-injury-related factors have been extensively studied in major trauma and have been shown to have a significant impact on patient outcomes. Mental illness and associated medication use has been proven to have a negative effect on bone health and fracture healing. MATERIALS AND METHODS We collated data retrospectively from the records of orthopaedic inpatients in a non-COVID and COVID period. We analysed demographic data, referral and admission numbers, orthopaedic injuries, surgery performed and patient comorbidities, including psychiatric history. RESULTS There were 824 orthopaedic referrals and 358 admissions (six/day) in the non-COVID period, with 38/358 (10.6%) admissions having a psychiatric diagnosis and 30/358 (8.4%) also having a fracture. This was compared with 473 referrals and 195 admissions (three/day) in the COVID period, with 73/195 (37.4%) admissions having a documented psychiatric diagnosis and 47/195 (24.1%) having a fracture. DISCUSSION There was a reduction in the number of admissions and referrals during the pandemic, but a simultaneous three-fold rise in admissions with a psychiatric diagnosis. The proportion of patients with both a fracture and a psychiatric diagnosis more than doubled and the number of patients presenting due to a traumatic suicide attempt almost tripled. CONCLUSION While total numbers using the orthopaedic service decreased, the impact of the pandemic and lockdown disproportionately affects those with mental health problems, a group already at higher risk of poorer functional outcomes and non-union. It is imperative that adequate support is in place for patients with vulnerable mental health during these periods, particularly as we look towards a potential 'second wave' of COVID-19.
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Affiliation(s)
- D Hay
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - MS Jamal
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - K Al-Tawil
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - A Petohazi
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - V Gulli
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - NF Bednarczuk
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - R Baldwin-Smith
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
| | - J Gibbons
- GKT School of Medical Education, Kings College London, London, UK
| | - J Sinha
- Department of Trauma and Orthopaedic Surgery, Kings College Hospital NHS Foundation Trust, London, UK
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