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Tan IZ, Mitchell A, McNair H, Dunlop A, Herbert T, Nartey J, Lawes R, O'Connell N, De-Colle C, Han K, Hahn E, Nelms B, Russell N, Kirby A. A Multicenter Study of Clinical to Planning Target Volume Margins for Adjuvant Partial Breast Irradiation Delivered on the 1.5T MR-Linear Accelerator. Int J Radiat Oncol Biol Phys 2023; 117:e725. [PMID: 37786112 DOI: 10.1016/j.ijrobp.2023.06.2237] [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) Adjuvant partial breast irradiation (APBI) for early-stage breast cancer patients delivered on a conventional Linac commonly uses a clinical to planning target volume (CTV-PTV) margin of 10 mm. Published data suggest this margin could be reduced using an MR-guided workflow. This study quantifies the CTV to PTV margin for APBI delivered on the 1.5T MR-Linac (MRL) using an Adapt to Position (ATP) workflow. MATERIALS/METHODS All target contouring was done as per the IMPORT LOW trial and MRL Consortium guidelines. The CTV is the tumor bed defined by surgical clips including postsurgical changes. A single center cohort of ten patients was used to assess delineation error on ProKnow DS v1.28.0 by measuring CTV contour displacements on the CT planning scans (pCT) delineated by five breast radiation oncologists. All other error components were measured on treatment planning software on another single center cohort of ten patients. Target deformation error was measured as surgical clip displacements between the pCT and daily pre-treatment (pre-Tx) MRI scans. Intrafraction motion was determined by the CTV displacement between pre- and post-treatment MRIs (post-Tx) in available paired images from five patients. Matching error was estimated as the interobserver variation of three MRL radiographers registering the pCT with daily pre-Tx MRI. Technical delivery accuracy was estimated using the results from routine quality assurance measurements. Beam penumbral width (p) was estimated from the clinical treatment plans. The systematic (Σ) and random errors (σ) for each component were calculated in the left/right (X), superior/inferior (Y) and anterior/posterior (Z) directions. The contribution of these errors to the PTV margin, M was calculated using van Herk's formula with α and β being 2.50 and 1.64 respectively. RESULTS For APBI using an MRL ATP workflow, a CTV-PTV margin of 5.7 to 7.6 mm is required to achieve a 90% confidence of CTV coverage by the 95% isodose. Individual error components are in. Table 1 delineation error remains the largest component of error. CONCLUSION A minimum CTV-PTV margin of 6-8 mm is required for APBI using an MRL ATP workflow. Although smaller than margins used in conventional Linacs, the clinical benefits (in terms of fibrosis risk) of treating APBI patients on an MRL are likely to be modest. Further margin reductions may be possible using an "Adapt to Shape" workflow with daily online recontouring.
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Affiliation(s)
- I Z Tan
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A Mitchell
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - H McNair
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - A Dunlop
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - T Herbert
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - J Nartey
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - R Lawes
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | | | - C De-Colle
- Tübingen University Hospital, Tübingen, Germany
| | - K Han
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - E Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - B Nelms
- Canis Lupus LLC, Merrimac, WI
| | - N Russell
- Dutch Cancer Institute, Amsterdam, The Netherlands
| | - A Kirby
- The Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
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Young JR, Galla JT, Polick CS, Deng ZD, Dannhauer M, Kirby A, Dennis M, Papanikolas CW, Evans MK, Moore SD, Dedert EA, Addicott MA, Appelbaum LG, Beckham JC. Multimodal smoking cessation treatment combining transcranial magnetic stimulation, cognitive behavioral therapy, and nicotine replacement therapy in veterans with posttraumatic stress disorder: A feasibility randomized controlled trial protocol. medRxiv 2023:2023.09.06.23294958. [PMID: 37886548 PMCID: PMC10602046 DOI: 10.1101/2023.09.06.23294958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Tobacco-related deaths exceed those resulting from homicides, suicides, motor vehicle accidence, alcohol consumption, illicit substance use, and acquired immunodeficiency syndrome (AIDS), combined. Amongst U.S. veterans, this trend is particularly concerning given that those suffering from posttraumatic stress disorder (PTSD)-about 11% of those receiving care from the Department of Veterans Affairs (VA)-have triple the risk of developing tobacco use disorder (TUD). The most efficacious strategies being used at the VA for smoking cessation only result in a 23% abstinence rate, and veterans with PTSD only achieve a 4.5% abstinence rate. Therefore, there is a critical need to develop more effective treatments for smoking cessation. Recent studies have revealed the insula as integrally involved in the neurocircuitry of TUD, specifically showing that individuals with brain lesions involving this region had drastically improved quit rates. Some of these studies show a probability of quitting up to 5 times greater compared to non-insula lesioned regions). Altered activity of the insula may be involved in the disruption of the salience network's (SN) connectivity to the executive control network (ECN), which compromises that patient's ability to switch between interoceptive states focused on cravings to executive and cognitive control. Thus, we propose a feasibility phase II randomized controlled trial (RCT) to study a patterned form of repetitive transcranial magnetic stimulation (rTMS), intermittent theta burst stimulation (iTBS), at 90% of the subject's resting motor threshold (rMT) applied over a region in the right post-central gyrus most functionally connected to the right posterior insula. We hypothesize that by increasing functional connectivity between the SN with the ECN to enhance executive control and by decreasing connectivity with the default mode network (DMN) to reduce interoceptive focus on withdrawal symptoms, we will improve smoking cessation outcomes. Fifty eligible veterans with comorbid TUD and PTSD will be randomly assigned to two conditions: active-iTBS + cognitive behavioral therapy (CBT) + nicotine replacement therapy (NRT) (n=25) or sham-iTBS + CBT + NRT (n=25). The primary outcome, feasibility, will be determined by achieving a recruitment of 50 participants and retention rate of 80%. The success of iTBS will be evaluated through self-reported nicotine use, cravings, withdrawal symptoms, and abstinence following quit date (confirmed by bioverification) along with evaluation for target engagement through neuroimaging changes, specifically connectivity differences between the insula and other regions of interest.
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Affiliation(s)
- Jonathan R. Young
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC
- Durham VA Health Care System, Durham, NC
| | - Jeffrey T. Galla
- Department of Psychology and Neuroscience, Trinity College of Arts and Sciences, Duke University, Durham, NC
| | - Carri S. Polick
- Durham VA Health Care System, Durham, NC
- School of Nursing, Duke University, Durham, NC
| | - Zhi-De Deng
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Moritz Dannhauer
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- Computational Neurostimulation Research Program, Noninvasive Neuromodulation Unit, Experimental Therapeutics & Pathophysiology Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD
| | - Angela Kirby
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- Durham VA Health Care System, Durham, NC
| | - Michelle Dennis
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- Durham VA Health Care System, Durham, NC
| | - Claire W. Papanikolas
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- Durham VA Health Care System, Durham, NC
| | - Mariah K. Evans
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- Durham VA Health Care System, Durham, NC
| | - Scott D. Moore
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC
- Durham VA Health Care System, Durham, NC
| | - Eric A. Dedert
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC
- Durham VA Health Care System, Durham, NC
| | - Merideth A. Addicott
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Lawrence G. Appelbaum
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA
| | - Jean C. Beckham
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
- VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham, NC
- Durham VA Health Care System, Durham, NC
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De-Colle C, Kirby A, Russell N, Shaitelman S, Currey A, Donovan E, Hahn E, Han K, Anandadas C, Mahmood F, Lorenzen E, van den Bongard D, Groot Koerkamp M, Houweling A, Nachbar M, Thorwarth D, Zips D. Adaptive radiotherapy for breast cancer. Clin Transl Radiat Oncol 2023; 39:100564. [PMID: 36632056 PMCID: PMC9826896 DOI: 10.1016/j.ctro.2022.100564] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/30/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/24/2022] Open
Abstract
Research in the field of local and locoregional breast cancer radiotherapy aims to maintain excellent oncological outcomes while reducing treatment-related toxicity. Adaptive radiotherapy (ART) considers variations in target and organs at risk (OARs) anatomy occurring during the treatment course and integrates these in re-optimized treatment plans. Exploiting ART routinely in clinic may result in smaller target volumes and better OAR sparing, which may lead to reduction of acute as well as late toxicities. In this review MR-guided and CT-guided ART for breast cancer patients according to different clinical scenarios (neoadjuvant and adjuvant partial breast irradiation, whole breast, chest wall and regional nodal irradiation) are reviewed and their advantages as well as challenging aspects discussed.
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Affiliation(s)
- C. De-Colle
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - A. Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Sutton, United Kingdom
| | - N. Russell
- Department of Radiotherapy, The Netherlands Cancer Institute–Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - S.F. Shaitelman
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - A. Currey
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI, United States
| | - E. Donovan
- Department of Radiation Oncology, Odette Cancer Centre - Sunnybrook Health Sciences Centre, Toronto, Canada
| | - E. Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - K. Han
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Canada
| | - C.N. Anandadas
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - F. Mahmood
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - E.L. Lorenzen
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | | | - M.L. Groot Koerkamp
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - A.C. Houweling
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands
| | - M. Nachbar
- Section for Biomedical Physics, Department of Radiation Oncology. University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
| | - D. Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology. University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - D. Zips
- Department of Radiation Oncology, University Hospital and Medical Faculty, Eberhard Karls University Tübingen, Tübingen, Germany
- German Cancer Consortium (DKTK), partner site Tübingen; and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Holt F, Probert J, Liu Z, Duane F, Ntentas G, Darby S, Dodwell D, Coles C, Haviland J, Kirby A, Taylor C. Proton beam therapy for early breast cancer: a systematic review and quantitative synthesis of adverse clinical outcomes. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01474-5] [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: 11/19/2022]
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Webb K, Gothard L, Mohammed K, Kirby A, Locke I, Somaiah N. PD-0748 Local control and toxicity after hypofractionated accelerated palliative RT in breast cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02943-7] [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: 10/18/2022]
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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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7
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Wheatley D, Haviland J, Patel J, Sydenham M, Alhasso A, Chan C, Cleator S, Coles C, Donovan E, Kirby A, Kirwan C, Nabi Z, Sawyer E, Somaiah N, Syndikus I, Venables K, Yarnold J, Brunt A, Bliss J. OC-0101 First results of FAST-Forward phase 3 RCT nodal substudy: 3-year normal tissue effects. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02477-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: 11/29/2022]
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8
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Kirby A. SP-0710 How to get involved in ESTRO leadership. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)04031-2] [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: 11/28/2022]
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9
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Thompson PL, Hui J, Beilby J, Palmer LJ, Watts GF, West MJ, Kirby A, Marschner S, Simes RJ, Sullivan DR, White HD, Stewart R, Tonkin AM. Common genetic variants do not predict recurrent events in coronary heart disease patients. BMC Cardiovasc Disord 2022; 22:96. [PMID: 35264114 PMCID: PMC8908687 DOI: 10.1186/s12872-022-02520-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/07/2022] [Indexed: 11/15/2022] Open
Abstract
Background It is unclear whether genetic variants identified from single nucleotide polymorphisms (SNPs) strongly associated with coronary heart disease (CHD) in genome-wide association studies (GWAS), or a genetic risk score (GRS) derived from them, can help stratify risk of recurrent events in patients with CHD. Methods Study subjects were enrolled at the close-out of the LIPID randomised controlled trial of pravastatin vs placebo. Entry to the trial had required a history of acute coronary syndrome 3–36 months previously, and patients were in the trial for a mean of 36 months. Patients who consented to a blood sample were genotyped with a custom designed array chip with SNPs chosen from known CHD-associated loci identified in previous GWAS. We evaluated outcomes in these patients over the following 10 years. Results Over the 10-year follow-up of the cohort of 4932 patients, 1558 deaths, 898 cardiovascular deaths, 727 CHD deaths and 375 cancer deaths occurred. There were no significant associations between individual SNPs and outcomes before or after adjustment for confounding variables and for multiple testing. A previously validated 27 SNP GRS derived from SNPs with the strongest associations with CHD also did not show any independent association with recurrent major cardiovascular events. Conclusions Genetic variants based on individual single nucleotide polymorphisms strongly associated with coronary heart disease in genome wide association studies or an abbreviated genetic risk score derived from them did not help risk profiling in this well-characterised cohort with 10-year follow-up. Other approaches will be needed to incorporate genetic profiling into clinically relevant stratification of long-term risk of recurrent events in CHD patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02520-0.
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Affiliation(s)
- P L Thompson
- Heart and Vascular Research Institute, Harry Perkins Institute of Medical Research, Faculty of Health and Medical Sciences, Sir Charles Gairdner Hospital, University of Western Australia, Hospital Ave, Perth, Nedlands, WA, 6009, Australia.
| | - J Hui
- Health Department of Western Australia, PathWest, Perth, Australia.,School of Population and Global Health, University of Western Australia, Perth, Australia
| | - J Beilby
- Health Department of Western Australia, PathWest, Perth, Australia.,School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - L J Palmer
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - G F Watts
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, Australia
| | - M J West
- Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Australia
| | - A Kirby
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - S Marschner
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - R J Simes
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - D R Sullivan
- Department of Chemical Pathology, Royal Prince Alfred Hospital, Sydney, Australia
| | - H D White
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - R Stewart
- Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand
| | - A M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Kha R, Melov S, Alahakoon T, Kirby A, Choudhary P. Predicting Cardiac and Pregnancy Outcomes in Women With Adult Congenital Heart Disease: How Much Does Physiology Matter? Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.462] [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: 10/16/2022]
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11
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Settatree S, Dunlop A, Mohajer J, Brand D, Mooney L, Ross G, Gulliford S, Harris E, Kirby A. What Can Proton Beam Therapy Achieve for Patients with Pectus Excavatum Requiring Left Breast, Axilla and Internal Mammary Nodal Radiotherapy? Clin Oncol (R Coll Radiol) 2021; 33:e570-e577. [PMID: 34226114 DOI: 10.1016/j.clon.2021.06.011] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/12/2021] [Accepted: 06/18/2021] [Indexed: 12/25/2022]
Abstract
AIMS Exposure of the heart to radiation increases the risk of ischaemic heart disease, proportionate to the mean heart dose (MHD). Radiotherapy techniques including proton beam therapy (PBT) can reduce MHD. The aims of this study were to quantify the MHD reduction achievable by PBT compared with volumetric modulated arc therapy in breath hold (VMAT-BH) in patients with pectus excavatum (PEx), to identify an anatomical metric from a computed tomography scan that might indicate which patients will achieve the greatest MHD reductions from PBT. MATERIALS AND METHODS Sixteen patients with PEx (Haller Index ≥2.7) were identified from radiotherapy planning computed tomography images. Left breast/chest wall, axilla (I-IV) and internal mammary node (IMN) volumes were delineated. VMAT and PBT plans were prepared, all satisfying target coverage constraints. Signed-rank comparisons of techniques were undertaken for the mean dose to the heart, ipsilateral lung and contralateral breast. Spearman's rho correlations were calculated for anatomical metrics against MHD reduction achieved by PBT. RESULTS The mean MHD for VMAT-BH plans was 4.1 Gy compared with 0.7 Gy for PBT plans. PBT reduced MHD by an average of 3.4 Gy (range 2.8-4.4 Gy) compared with VMAT-BH (P < 0.001). PBT significantly reduced the mean dose to the ipsilateral lung (4.7 Gy, P < 0.001) and contralateral breast (2.7 Gy, P < 0.001). The distance (mm) at the most inferomedial extent of IMN volume (IMN to heart distance) negatively correlated with MHD reduction achieved by PBT (Spearman's rho -0.88 (95% confidence interval -0.96 to -0.67, P < 0.001)). CONCLUSION For patients with PEx requiring left-sided breast and IMN radiotherapy, a clinically significant MHD reduction is achievable using PBT, compared with the optimal photon technique (VMAT-BH). This is a patient group in whom PBT could have the greatest benefit.
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Affiliation(s)
- S Settatree
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK.
| | - A Dunlop
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - J Mohajer
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - D Brand
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - L Mooney
- The Royal Marsden Hospital, London, UK
| | - G Ross
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - S Gulliford
- Department of Radiotherapy Physics, University College London Hospital, UK; Department of Medical Physics and Bioengineering, University College London, UK
| | - E Harris
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - A Kirby
- The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
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Archibald SJ, Luk D, Potts S, Davis S, Kirby A. Reflections on the experiences of attending peer support groups for fathers of children with cancer. Clin Child Psychol Psychiatry 2021; 26:1208-1213. [PMID: 34372668 DOI: 10.1177/13591045211038668] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Fathers appear to be less researched than mothers, in particular with regard to their emotional well-being during their child's cancer diagnosis and treatment. This study investigates a small-scale service evaluation of a father's support group for fathers of children with cancer in a paediatric oncology and haematology service. The group was set up in October 2017 to enable a safe and supportive reflective space for fathers of children with cancer. The group was open to fathers with a child on the ward on treatment, as well as fathers with children out of treatment, and in remission in the community. Data were analysed using Interpretive Phenomenological Analysis. A number of themes are identified and discussed, including the emotional impact, ways of coping, gender roles, loss and feeling part of an oncology family. The fathers valued hearing each other's stories about their child's cancer diagnosis and experiences as this appeared to empower them in helping each other to feel a sense of normalisation for their feelings. They appreciated the group structure and discussed further ways for group improvement. Suggestions are made for developing services to meet emotional support needs of fathers of children with cancer.
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Affiliation(s)
- Sarah-Jane Archibald
- Department of Psychological Medicine for Children, Young People and Families, Barton House, 2153Addenbrooke's Hospital, Cambridge, UK
| | - Diana Luk
- Department of Psychological Medicine for Children, Young People and Families, Barton House, 2153Addenbrooke's Hospital, Cambridge, UK
| | - Susan Potts
- Department of Psychological Medicine for Children, Young People and Families, Barton House, 2153Addenbrooke's Hospital, Cambridge, UK
| | - Sally Davis
- Department of Psychological Medicine for Children, Young People and Families, Barton House, 2153Addenbrooke's Hospital, Cambridge, UK
| | - Angela Kirby
- Department of Psychological Medicine for Children, Young People and Families, Barton House, 2153Addenbrooke's Hospital, Cambridge, UK
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13
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Kirby A. SP-0707 Adjuvant nodal irradiation in breast cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08685-0] [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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14
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Kirby A. Comment on: Systemic versus oral and systemic antibiotic prophylaxis (SOAP) study in colorectal surgery: prospective randomized multicentre trial. Br J Surg 2021; 108:e314. [PMID: 34077495 DOI: 10.1093/bjs/znab189] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 11/13/2022]
Affiliation(s)
- A Kirby
- Leeds Institute of Medical Research, The University of Leeds, Leeds, UK
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15
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Marta GN, Ramiah D, Kaidar-Person O, Kirby A, Coles C, Jagsi R, Hijal T, Sancho G, Zissiadis Y, Pignol JP, Ho AY, Cheng SHC, Offersen BV, Meattini I, Poortmans P. The Financial Impact on Reimbursement of Moderately Hypofractionated Postoperative Radiation Therapy for Breast Cancer: An International Consortium Report. Clin Oncol (R Coll Radiol) 2021; 33:322-330. [PMID: 33358283 DOI: 10.1016/j.clon.2020.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 08/21/2020] [Revised: 11/06/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022]
Abstract
AIMS Moderately hypofractionated breast irradiation has been evaluated in several prospective studies, resulting in wide acceptance of shorter treatment protocols for postoperative breast irradiation. Reimbursement for radiation therapy varies between private and public systems and between countries, impacting variably financial considerations in the use of hypofractionation. The aim of this study was to evaluate the financial impact of moderately hypofractionated breast irradiation by reimbursement system in different countries. MATERIALS AND METHODS The study was designed by an international group of radiation oncologists. A web-questionnaire was distributed to representatives from each country. The participants were asked to involve the financial consultant at their institution. RESULTS Data from 13 countries from all populated continents were collected (Europe: Denmark, France, Italy, the Netherlands, Spain, UK; North America: Canada, USA; South America: Brazil; Africa: South Africa; Oceania: Australia; Asia: Israel, Taiwan). Clinicians and/or departments in most of the countries surveyed (77%) receive remuneration based on the number of fractions delivered to the patient. The financial loss per patient estimated resulting from applying moderately hypofractionated breast irradiation instead of conventional fractionation ranged from 5-10% to 30-40%, depending on the healthcare provider. CONCLUSION Although a generalised adoption of moderately hypofractionated breast irradiation would allow for a considerable reduction in social and economic burden, the financial loss for the healthcare providers induced by fee-for-service remuneration may be a factor in the slow uptake of these regimens. Therefore, fee-for-service reimbursement may not be preferable for radiation oncology. We propose that an alternative system of remuneration, such as bundled payments based on stage and diagnosis, may provide more value for all stakeholders.
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Affiliation(s)
- G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil.
| | - D Ramiah
- Department of Radiation Oncology, Donald Gordon Medical Centre, Johannesburg, South Africa
| | - O Kaidar-Person
- Breast Cancer Radiation Unit, Radiation Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
| | - A Kirby
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - C Coles
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - R Jagsi
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA
| | - T Hijal
- Division of Radiation Oncology, McGill University Health Centre, Montréal, Quebec, Canada
| | - G Sancho
- Department of Radiation Oncology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Y Zissiadis
- Department of Radiation Oncology, Genesis Cancer Care, Wembley, WA, Australia
| | - J-P Pignol
- Department of Radiation Oncology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - A Y Ho
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - S H-C Cheng
- Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - B V Offersen
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - I Meattini
- Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Department of Biomedical, Experimental, and Clinical Sciences "M. Serio", University of Florence, Florence, Italy
| | - P Poortmans
- Department of Radiation Oncology, Iridium Kankernetwerk, Wilrijk-Antwerp, Belgium; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
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Ahmed S, Bonnett L, Melhuish A, Adil MT, Aggarwal I, Ali W, Bennett J, Boldock E, Burns FA, Czarniak E, Dennis R, Flower B, Fok R, Goodman AL, Halai S, Hanna T, Hashem M, Hodgson SH, Hughes G, Hurndall KH, Hyland R, Iqbal MR, Jarchow-MacDonald A, Kailavasan M, Klimovskij M, Laliotis A, Lambourne J, Lawday S, Lee F, Lindsey B, Lund JN, Mabayoje DA, Malik KI, Muir A, Narula HS, Ofor U, Parsons H, Pavelle T, Prescott K, Rajgopal A, Roy I, Sagar J, Scarborough C, Shaikh S, Smart CJ, Snape S, Tabaqchali MA, Tennakoon A, Tilley R, Vink E, White L, Burke D, Kirby A. Development and internal validation of clinical prediction models for outcomes of complicated intra-abdominal infection. Br J Surg 2021; 108:441-447. [PMID: 33615351 DOI: 10.1093/bjs/znaa117] [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: 07/27/2020] [Accepted: 11/05/2020] [Indexed: 11/14/2022]
Abstract
BACKGROUND Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse. METHODS A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further. RESULTS Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was -0.19 (95 per cent c.i. -0.39 to -0.12) and - 0.01 (- 0.17 to -0.03) respectively. CONCLUSION Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, these now require external validation.
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Affiliation(s)
- S Ahmed
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Bonnett
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - A Melhuish
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M T Adil
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - I Aggarwal
- Infection Unit, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - W Ali
- Department of Surgery, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston, UK
| | - J Bennett
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge, UK
| | - E Boldock
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - F A Burns
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Czarniak
- Department of Microbiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - R Dennis
- Colorectal Surgery Department, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - B Flower
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - R Fok
- Department of Microbiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - A L Goodman
- Department of Infection, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK
| | - S Halai
- Department of Surgery, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - T Hanna
- Department of Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - M Hashem
- Department of Surgery, Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK
| | - S H Hodgson
- Department of Infection, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - G Hughes
- Infectious Diseases and Microbiology, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | - K-H Hurndall
- Department of Surgery, Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK
| | - R Hyland
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M R Iqbal
- Department of Surgery, Maidstone and Tunbridge Wells NHS Foundation Trust, Kent, UK
| | | | - M Kailavasan
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - M Klimovskij
- Department of Surgery, Conquest Hospital, East Sussex NHS Healthcare Trust, East Sussex, UK
| | - A Laliotis
- Cambridge Oesophago-Gastric Centre, Addenbrooke's Hospital, Cambridge, UK
| | - J Lambourne
- Division of Infection, Barts Health NHS Trust, London, UK
| | - S Lawday
- Department of Surgery, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - F Lee
- Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - B Lindsey
- Department of Microbiology, The Whittington Hospital, Whittington Health NHS Trust, London, UK
| | - J N Lund
- Division of Medical Sciences and Graduate Entry Medicine, Royal Derby Hospital, University of Nottingham, Derby, UK
| | - D A Mabayoje
- Division of Infection, Barts Health NHS Trust, London, UK
| | - K I Malik
- Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Muir
- Department of Microbiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - H S Narula
- Department of Surgery, Chesterfield Royal Hospital NHS Trust Hospital, Chesterfield, UK
| | - U Ofor
- Department of Surgery, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston, UK
| | - H Parsons
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - T Pavelle
- Shrewsbury and Telford NHS Trust, Shrewsbury, UK
| | - K Prescott
- Microbiology and Infectious Diseases, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - A Rajgopal
- Department of Microbiology, Calderdale and Huddersfield NHS Trust, Huddersfield, UK
| | - I Roy
- Colorectal Surgery Department, North West Anglia NHS Foundation Trust, Peterborough, UK
| | - J Sagar
- Department of Upper GI and Bariatric Surgery, Luton and Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - C Scarborough
- Department of Infection, Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - S Shaikh
- Department of Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
| | - C J Smart
- Department of Surgery, Macclesfield District General Hospital, East Cheshire NHS Trust, Cheshire, UK
| | - S Snape
- Microbiology and Infectious Diseases, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - M A Tabaqchali
- Department of Surgery, University Hospital North Tees, Stockton on Tees, UK
| | - A Tennakoon
- Department of Surgery, Pilgrim Hospital, United Lincolnshire Hospitals NHS Trust, Boston, UK
| | - R Tilley
- Department of Microbiology, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - E Vink
- Department of Microbiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - L White
- Department of Microbiology, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - D Burke
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Surgery, University Hospital North Tees, Stockton on Tees, UK
| | - A Kirby
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK.,Department of Surgery, University Hospital North Tees, Stockton on Tees, UK
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Patin NV, Peña-Gonzalez A, Hatt JK, Moe C, Kirby A, Konstantinidis KT. The Role of the Gut Microbiome in Resisting Norovirus Infection as Revealed by a Human Challenge Study. mBio 2020; 11:e02634-20. [PMID: 33203758 PMCID: PMC7683401 DOI: 10.1128/mbio.02634-20] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/16/2020] [Indexed: 12/11/2022] Open
Abstract
Norovirus infections take a heavy toll on worldwide public health. While progress has been made toward understanding host responses to infection, the role of the gut microbiome in determining infection outcome is unknown. Moreover, data are lacking on the nature and duration of the microbiome response to norovirus infection, which has important implications for diagnostics and host recovery. Here, we characterized the gut microbiomes of subjects enrolled in a norovirus challenge study. We analyzed microbiome features of asymptomatic and symptomatic individuals at the genome (population) and gene levels and assessed their response over time in symptomatic individuals. We show that the preinfection microbiomes of subjects with asymptomatic infections were enriched in Bacteroidetes and depleted in Clostridia relative to the microbiomes of symptomatic subjects. These compositional differences were accompanied by differences in genes involved in the metabolism of glycans and sphingolipids that may aid in host resilience to infection. We further show that microbiomes shifted in composition following infection and that recovery times were variable among human hosts. In particular, Firmicutes increased immediately following the challenge, while Bacteroidetes and Proteobacteria decreased over the same time. Genes enriched in the microbiomes of symptomatic subjects, including the adenylyltransferase glgC, were linked to glycan metabolism and cell-cell signaling, suggesting as-yet unknown roles for these processes in determining infection outcome. These results provide important context for understanding the gut microbiome role in host susceptibility to symptomatic norovirus infection and long-term health outcomes.IMPORTANCE The role of the human gut microbiome in determining whether an individual infected with norovirus will be symptomatic is poorly understood. This study provides important data on microbes that distinguish asymptomatic from symptomatic microbiomes and links these features to infection responses in a human challenge study. The results have implications for understanding resistance to and treatment of norovirus infections.
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Affiliation(s)
- N V Patin
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - A Peña-Gonzalez
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
- Max Planck Tandem Group in Computational Biology, Department of Biological Sciences, Universidad de los Andes, Bogotá, Colombia
| | - J K Hatt
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - C Moe
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - A Kirby
- Waterborne Disease Prevention Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - K T Konstantinidis
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
- School of Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
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18
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Chick J, Mitchell A, Sullivan J, Herbert T, Lawes R, McNair H, Schmidt M, Nill S, Kirby A, Oelfke U. PO-1766: A clinical solution for electron streaming shielding for partial breast treatments on Unity MRlinac. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01784-9] [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: 11/27/2022]
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19
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Mitchell R, Dunlop A, Chick J, Mohajer J, Goodwin E, Nill S, Lawes R, Herbert T, Kirby A, Oelfke U. PO-1437: Treatment plan robustness analysis for high field MR-linac partial breast plans. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01455-9] [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: 10/22/2022]
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Grimison P, Mersiades A, Kirby A, Lintzeris N, Morton R, Haber P, Olver I, Walsh A, McGregor I, Cheung Y, Tognela A, Hahn C, Briscoe K, Aghmesheh M, Fox P, Abdi E, Clarke S, Della-Fiorentina S, Shannon J, Gedye C, Begbie S, Simes J, Stockler M. Oral THC:CBD cannabis extract for refractory chemotherapy-induced nausea and vomiting: a randomised, placebo-controlled, phase II crossover trial. Ann Oncol 2020; 31:1553-1560. [DOI: 10.1016/j.annonc.2020.07.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 07/14/2020] [Accepted: 07/27/2020] [Indexed: 10/23/2022] Open
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21
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Kirby A. SP-0262: Management of extracranial disease with stereotactic radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00286-3] [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: 11/17/2022]
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22
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Settatree S, Brand D, Ranger A, Dunlop A, Harris E, Gulliford S, Kirby A. Estimating Contralateral Breast Cancer Risk from Photons versus Protons in Patients Undergoing Internal Mammary Nodal Breast Cancer Radiotherapy. Clin Oncol (R Coll Radiol) 2020; 32:342. [PMID: 31948769 DOI: 10.1016/j.clon.2019.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/13/2019] [Indexed: 11/22/2022]
Affiliation(s)
- S Settatree
- The Royal Marsden Hospital, London, UK; The Institute Cancer Research, London, UK
| | - D Brand
- The Royal Marsden Hospital, London, UK; The Institute Cancer Research, London, UK
| | - A Ranger
- The Royal Marsden Hospital, London, UK; The Institute Cancer Research, London, UK
| | - A Dunlop
- The Royal Marsden Hospital, London, UK; The Institute Cancer Research, London, UK
| | - E Harris
- The Institute Cancer Research, London, UK
| | - S Gulliford
- University College London Hospital, London, UK
| | - A Kirby
- The Royal Marsden Hospital, London, UK; The Institute Cancer Research, London, UK
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23
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Coles CE, Aristei C, Bliss J, Boersma L, Brunt AM, Chatterjee S, Hanna G, Jagsi R, Kaidar Person O, Kirby A, Mjaaland I, Meattini I, Luis AM, Marta GN, Offersen B, Poortmans P, Rivera S. International Guidelines on Radiation Therapy for Breast Cancer During the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 32:279-281. [PMID: 32241520 PMCID: PMC7270774 DOI: 10.1016/j.clon.2020.03.006] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- C E Coles
- Oncology Department, University of Cambridge, UK.
| | - C Aristei
- University of Perugia, Italy; Perugia General Hospital Sant'Andrea delle Fratte, Italy
| | - J Bliss
- The Institute of Cancer Research Clinical Trials and Statistics Unit, London, UK
| | - L Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - A M Brunt
- University Hospitals of North Midlands & Keele University, Stoke-on-Trent, UK
| | | | - G Hanna
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - R Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, USA
| | - O Kaidar Person
- Breast Radiation Unit, Sheba Tel Ha'shomer, Ramat Gan, Israel
| | - A Kirby
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, UK
| | - I Mjaaland
- Department of Hematology and Oncology, Stavanger University Hospital, Norway
| | - I Meattini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - A M Luis
- University Hospital HM Sanchinarro, Madrid, Spain
| | - G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Division of Radiation Oncology, Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - B Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - P Poortmans
- Paris Sciences et Lettres University, Paris, France
| | - S Rivera
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Molecular Radiotherapy and Innovative Therapeutics, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
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Curtis E, Kirby A, Hlohovsky S, O'Donnell C. A011 Performance of CARPREG, ZAHARA and MWHO Risk Scores for Predicting Cardiovascular and Offspring Adverse Outcomes in Pregnancies of Patients With Congenital Heart Disease. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.05.016] [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: 11/24/2022]
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Mawer D, Byrne F, Drake S, Brown C, Prescott A, Warne B, Bousfield R, Skittrall JP, Ramsay I, Somasunderam D, Bevan M, Coslett J, Rao J, Stanley P, Kennedy A, Dobson R, Long S, Obisanya T, Esmailji T, Petridou C, Saeed K, Brechany K, Davis-Blue K, O'Horan H, Wake B, Martin J, Featherstone J, Hall C, Allen J, Johnson G, Hornigold C, Amir N, Henderson K, McClements C, Liew I, Deshpande A, Vink E, Trigg D, Guilfoyle J, Scarborough M, Scarborough C, Wong THN, Walker T, Fawcett N, Morris G, Tomlin K, Grix C, O'Cofaigh E, McCaffrey D, Cooper M, Corbett K, French K, Harper S, Hayward C, Reid M, Whatley V, Winfield J, Hoque S, Kelly L, King I, Bradley A, McCullagh B, Hibberd C, Merron M, McCabe C, Horridge S, Taylor J, Koo S, Elsanousi F, Saunders R, Lim F, Bond A, Stone S, Milligan ID, Mack DJF, Nagar A, West RM, Wilcox MH, Kirby A, Sandoe JAT. Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea. J Hosp Infect 2019; 103:200-209. [PMID: 31077777 DOI: 10.1016/j.jhin.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 04/06/2019] [Accepted: 05/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 h were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea onset >48 h after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% confidence interval (CI) 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. Nine of 75 tested patients were Clostridium difficile toxin positive (4%). Eighty (35%) patients had a documented medical assessment of diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested vs 38% not tested, P<0.001). One-hundred and forty-four (63%) patients were not isolated following diarrhoea onset. CONCLUSION HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients had multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.
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Affiliation(s)
- D Mawer
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.
| | - F Byrne
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - S Drake
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - C Brown
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - A Prescott
- Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - B Warne
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - R Bousfield
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - J P Skittrall
- Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK
| | - I Ramsay
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - D Somasunderam
- Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK
| | - M Bevan
- Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - J Coslett
- Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK
| | - J Rao
- Department of Microbiology, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK
| | - P Stanley
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - A Kennedy
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - R Dobson
- Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK
| | - S Long
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - T Obisanya
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - T Esmailji
- Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK
| | - C Petridou
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Saeed
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Brechany
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - K Davis-Blue
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - H O'Horan
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - B Wake
- Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK
| | - J Martin
- Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK
| | - J Featherstone
- Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK
| | - C Hall
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - J Allen
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - G Johnson
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - C Hornigold
- Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK
| | - N Amir
- Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK
| | - K Henderson
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - C McClements
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - I Liew
- Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - A Deshpande
- Department of Microbiology, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK
| | - E Vink
- Department of Microbiology, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK
| | - D Trigg
- Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - J Guilfoyle
- Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK
| | - M Scarborough
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - C Scarborough
- Nuffield Department of Medicine, University of Oxford, OX3 7FZ, UK
| | - T H N Wong
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - T Walker
- Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - N Fawcett
- Department of Medicine, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK
| | - G Morris
- Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - K Tomlin
- Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - C Grix
- Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF, UK
| | - E O'Cofaigh
- Department of Medicine, Friarage Hospital, South Tees Hospital NHS Foundation Trust, Northallerton, DL6 1JG, UK
| | - D McCaffrey
- Department of Infection Prevention & Control, James Cook University Hospital, South Tees Hospital NHS Foundation Trust, Middlesborough, TS4 3BW, UK
| | - M Cooper
- Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - K Corbett
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - K French
- Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - S Harper
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - C Hayward
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - M Reid
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - V Whatley
- Corporate Support Services, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - J Winfield
- Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK
| | - S Hoque
- Department of Microbiology, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - L Kelly
- Department of Infection Prevention & Control, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK
| | - I King
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - A Bradley
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - B McCullagh
- Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - C Hibberd
- Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - M Merron
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - C McCabe
- Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK
| | - S Horridge
- Department of Microbiology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK
| | - J Taylor
- Department of Virology and Molecular Pathology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK
| | - S Koo
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - F Elsanousi
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - R Saunders
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - F Lim
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK
| | - A Bond
- Department of Microbiology, York Teaching Hospital NHS Foundation Trust, York, YO31 8HE, UK
| | - S Stone
- Royal Free Campus, University College Medical School, London, NW3 2QG, UK
| | - I D Milligan
- Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - D J F Mack
- Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK
| | - A Nagar
- Department of Microbiology, Antrim Area Hospital, Northern Health and Social Care Trust, Bush Road, Antrim, BT41 2RL, UK
| | - R M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - M H Wilcox
- Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, LS2 9JT, UK
| | - A Kirby
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
| | - J A T Sandoe
- Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK
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Cattrall JWS, Asín-Prieto E, Freeman J, Trocóniz IF, Kirby A. A pharmacokinetic-pharmacodynamic assessment of oral antibiotics for pyelonephritis. Eur J Clin Microbiol Infect Dis 2019; 38:2311-2321. [PMID: 31494827 PMCID: PMC6858297 DOI: 10.1007/s10096-019-03679-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 06/03/2019] [Accepted: 08/11/2019] [Indexed: 11/30/2022]
Abstract
Antibiotic resistance to oral antibiotics recommended for pyelonephritis is increasing. The objective was to determine if there is a pharmacological basis to consider alternative treatments/novel dosing regimens for the oral treatment of pyelonephritis. A systematic review identified pharmacokinetic models of suitable quality for a selection of antibiotics with activity against Escherichia coli. MIC data was obtained for a population of E. coli isolates derived from patients with pyelonephritis. Pharmacokinetic/pharmacodynamic (PK/PD) simulations determined probability of target attainment (PTA) and cumulative fraction response (CFR) values for sub-populations of the E. coli population at varying doses. There are limited high-quality models available for the agents investigated. Pharmacokinetic models of sufficient quality for simulation were identified for amoxicillin, amoxicillin-clavulanic acid, cephalexin, ciprofloxacin, and fosfomycin trometamol. These antibiotics were predicted to have PTAs ≥ 0.85 at or below standard doses for the tested E. coli population including cephalexin 1500 mg 8 hourly for 22% of the population (MIC ≤ 4 mg/L) and ciprofloxacin 100 mg 12 hourly for 71% of the population (MIC ≤ 0.06 mg/L). For EUCAST-susceptible E. coli isolates, doses achieving CFRs ≥ 0.9 included amoxicillin 2500 mg 8 hourly, cephalexin 4000 mg 6 hourly, ciprofloxacin 200 mg 12 hourly, and 3000 mg of fosfomycin 24 hourly. Limitations in the PK data support carrying out additional PK studies in populations of interest. Oral antibiotics including amoxicillin, amoxicillin-clavulanic acid, and cephalexin have potential to be effective for a proportion of patients with pyelonephritis. Ciprofloxacin may be effective at lower doses than currently prescribed.
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Affiliation(s)
| | - E Asín-Prieto
- Pharmacometrics & Systems Pharmacology Research Unit, Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - J Freeman
- University of Leeds, Leeds, LS2 9JT, UK.,Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK
| | - I F Trocóniz
- Pharmacometrics & Systems Pharmacology Research Unit, Department of Pharmaceutical Technology and Chemistry, School of Pharmacy and Nutrition, University of Navarra, Pamplona, Spain.,IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - A Kirby
- University of Leeds, Leeds, LS2 9JT, UK. .,Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK. .,Department of Microbiology, Old Medical School, Leeds General Infirmary, Leeds, LS1 3EX, UK.
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Ranger A, Dunlop A, Donovan E, Harris E, DeSouza N, McNair H, Kirby A. EP-1323 HeartSpare Plus: A comparison of the feasibility and acute toxicity of internal mammary chain RT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31743-8] [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: 10/26/2022]
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Stick L, Lorenzen E, Yates E, Anandadas C, Andersen K, Aristei C, Byrne O, Hoi S, Jensen I, Kirby A, Kirova Y, Marrazzo L, Matías-Pérez A, Nielsen M, Nissen H, Oliveros S, Verhoeven K, Vikström J, Offersen B. PV-0046 Patient selection for proton therapy of early breast cancer - the DBCG phase II study strategy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30466-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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29
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Vasmel J, Koerkamp MG, Kirby A, Russell N, Shaitelman S, Vesprini D, Anandadas C, Currey A, Keller B, Braunstein L, Han K, Kotte A, De Waard S, Philippens M, Houweling A, Verkooijen H, Van den Bongard D. EP-1312 Evaluation of MRI-based guidelines for contouring tumors for preoperative partial breast irradiation. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31732-3] [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: 10/26/2022]
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30
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Blasiak-Wal I, Dunlop A, Colgan R, Ranger A, Kirby A. EP-1889 Evaluation of organ-motion based robust optimisation for RT of the breast, axilla, and IMC. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32309-6] [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: 10/26/2022]
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31
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Mant J, Kirby A, Cox KJ, Burke A. Children's experiences of being diagnosed with cancer at the early stages of treatment; an interpretive phenomenological analysis. Clin Child Psychol Psychiatry 2019; 24:3-18. [PMID: 30145911 DOI: 10.1177/1359104518788400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Being given a diagnosis of cancer is a significant and highly distressing event for both children and their families, but little research has been done to explore and understand children's feelings. This study aims to understand from the child's perspective what it feels like to be told you have cancer, with the hope that increased understanding can lead to improved communication and support for children and families. The study uses qualitative methodology. Six children aged 8-12 years with a new diagnosis of cancer took part in two semi-structured interviews at least one week apart. The interviews were conducted using the draw and write technique. The results were analysed using interpretative phenomenological analysis. The report describes the five super-ordinate themes that were identified; initially I felt shocked and scared, chemo is an awful thing, please talk to me; the more I know the better I feel, I will accept treatment and quickly get used to it because I know I will get better and, finally, my family are vital. Implications for clinical practice are discussed. The report highlights the research limitations and areas for future studies.
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Affiliation(s)
- Jill Mant
- 1 Department of Paediatrics, Scarborough General Hospital, UK
| | - Angela Kirby
- 2 Department of Paediatric Oncology and Haematology, Addenbrooke's Hospital, UK
| | - Kathy J Cox
- 3 School of Psychology, University of Plymouth, UK
| | - Amos Burke
- 2 Department of Paediatric Oncology and Haematology, Addenbrooke's Hospital, UK
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Kirby A, Mau J, Hooks D, Webber M. Radiofrequency Ablation for Ventricular Tachycardia at Wellington Regional Hospital. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.217] [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: 10/26/2022]
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Tal Saban M, Kirby A. Empathy, social relationship and co-occurrence in young adults with DCD. Hum Mov Sci 2018; 63:62-72. [PMID: 30503983 DOI: 10.1016/j.humov.2018.11.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 11/14/2018] [Accepted: 11/20/2018] [Indexed: 12/30/2022]
Abstract
Empathy is defined as an emotional or cognitive response to another's emotional state. It is considered essential for navigating meaningful social interactions and is closely linked to prosocial behavior. Developmental coordination disorder (DCD) is characterized by an impairment of motor coordination that has a marked impact on both academic and day-to-day living activities. Children and adolescents with DCD have been shown to have less developed social support and friendships. The research linking empathy and DCD is scarce. The aims of this study are to gain an understanding of the relationship between DCD and empathy in young adults with DCD only, and with DCD coupled with other neurodevelopmental disorders, in comparison with typically developing adults. METHODS The study included 212 young adults aged 18-40 years. The subjects in this study were from mainstream populations in the UK. The study groups included: (a) "DCD only" with 42 individuals; (b) "DCD + ASD" with 21 individuals; (c) "DCD + ADHD" with 45 individuals; (d) "DCD + ASD + ADHD" with 29 individuals; and (e) the control group of 75 individuals. RESULTS ANOVA on the Empathy Questionnaire (EQ) showed a statistically significant difference between groups (F [4,257] = 35.63; p < 0.001; ηp2 = 0.409). No significant differences were found between the DCD-only and the control. MANOVA was performed to assess differences in the Socialising and Friendship Questionnaire (SAF-Q) scores. The results showed a statistically significant difference between groups (F [8,257] = 9.98; p < 0.001; η = 0.162). Pearson correlation coefficients were performed, revealing significant high correlations between the EQ and the two parts of the SAF-Q ("past" and "currently"). CONCLUSION The results of this study indicate that social difficulties in the DCD-only group are not due to lack of empathy, but may be driven by an accumulation of external factors. In this study we also concluded that DCD does not appear to be the factor that reduces the ability to empathize, but rather the presence of ADHD and/or ASD.
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Affiliation(s)
- M Tal Saban
- School of Occupational Therapy, Hebrew University Hadassah Medical School, Jerusalem, Israel.
| | - A Kirby
- The Dyscovery Centre Innovation House Treforest CF37 1DL, University of South Wales, UK
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D'Urso A, Mastroyannopoulou K, Kirby A, Meiser-Stedman R. Posttraumatic stress symptoms in young people with cancer and their siblings: results from a UK sample. J Psychosoc Oncol 2018; 36:768-783. [PMID: 30358521 DOI: 10.1080/07347332.2018.1494664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/28/2022]
Abstract
PURPOSE This study investigated levels of posttraumatic stress symptoms (PTSS) in children with cancer and their siblings from a British sample. It also examined aspects of the Ehlers and Clark 1 model of posttraumatic stress disorder in the current population. METHODS Sixty participants (34 children with cancer and 26 siblings) aged between 8 and 18 years completed measures of PTSS, maladaptive appraisals, trauma-centered identity, perceived social support and family functioning. RESULTS Over a quarter of the sample scored above the clinical cutoff on the Impact of Events Scale-Revised. No differences were observed between patients and siblings with respect to levels of PTSS. Maladaptive appraisals and age were found to account for unique variance in levels of PTSS for the overall sample. CONCLUSIONS Rates of PTSS in the sample were relatively high. Support was found for aspects of the Ehlers and Clark 1 model in explaining PTSS for the current population.
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Affiliation(s)
- Anita D'Urso
- a Department of Clinical Psychology , University of East Anglia , Norwich , UK.,b Department of Paediatric Clinical Psychology , Cambridge University Hospitals , Cambridge , UK
| | | | - Angela Kirby
- b Department of Paediatric Clinical Psychology , Cambridge University Hospitals , Cambridge , UK
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Mersiades A, Tognela A, Haber P, Stockler M, Lintzeris N, Simes J, McGregor I, Olver I, Allsop D, Gedye C, Kirby A, Morton R, Briscoe K, Fox P, Aghmesheh M, Wong N, Bhardwaj A, Tran A, Hahn C, Grimison P. Pilot and definitive randomised double-blind placebo-controlled trials evaluating an oral cannabinoid-rich THC/CBD cannabis extract for secondary prevention of chemotherapy-induced nausea and vomiting (CINV). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy300.119] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
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36
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Meikle P, Jayawardana KS, Mundra PA, Nestel PJ, Barnes EH, Kirby A, Thompson P, Sullivan DR, Alshehry ZH, Huynh K, Giles C, Marschner IC, Kingwell BA, Simes J, Tonkin AM. P1875Changes in plasma lipid species following pravastatin treatment predict cardiovascular outcomes and represent a measure of the relative risk reduction in secondary prevention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1875] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- P Meikle
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - K S Jayawardana
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - P A Mundra
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - P J Nestel
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - A Kirby
- University of Sydney, Sydney, Australia
| | - P Thompson
- Sir Charles Gairdner Hospital, Perth, Australia
| | | | | | - K Huynh
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - C Giles
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | | | - B A Kingwell
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - J Simes
- University of Sydney, Sydney, Australia
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37
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Armstrong G, Croft J, Corrigan N, Brown JM, Goh V, Quirke P, Hulme C, Tolan D, Kirby A, Cahill R, O'Connell PR, Miskovic D, Coleman M, Jayne D. IntAct: intra-operative fluorescence angiography to prevent anastomotic leak in rectal cancer surgery: a randomized controlled trial. Colorectal Dis 2018; 20:O226-O234. [PMID: 29751360 PMCID: PMC6099475 DOI: 10.1111/codi.14257] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/02/2018] [Indexed: 02/06/2023]
Abstract
AIM Anastomotic leak (AL) is a major complication of rectal cancer surgery. Despite advances in surgical practice, the rates of AL have remained static, at around 10-15%. The aetiology of AL is multifactorial, but one of the most crucial risk factors, which is mostly under the control of the surgeon, is blood supply to the anastomosis. The MRC/NIHR IntAct study will determine whether assessment of anastomotic perfusion using a fluorescent dye (indocyanine green) and near-infrared laparoscopy can minimize the rate of AL leak compared with conventional white-light laparoscopy. Two mechanistic sub-studies will explore the role of the rectal microbiome in AL and the predictive value of CT angiography/perfusion studies. METHOD IntAct is a prospective, unblinded, parallel-group, multicentre, European, randomized controlled trial comparing surgery with intra-operative fluorescence angiography (IFA) against standard care (surgery with no IFA). The primary end-point is rate of clinical AL at 90 days following surgery. Secondary end-points include all AL (clinical and radiological), change in planned anastomosis, complications and re-interventions, use of stoma, cost-effectiveness of the intervention and quality of life. Patients should have a diagnosis of adenocarcinoma of the rectum suitable for potentially curative surgery by anterior resection. Over 3 years, 880 patients from 25 European centres will be recruited and followed up for 90 days. DISCUSSION IntAct will rigorously evaluate the use of IFA in rectal cancer surgery and explore the role of the microbiome in AL and the predictive value of preoperative CT angiography/perfusion scanning.
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Affiliation(s)
| | - J. Croft
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - N. Corrigan
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - J. M. Brown
- Clinical Trials Research UnitLeeds Institute of Clinical Trials ResearchUniversity of LeedsLeedsUK
| | - V. Goh
- School of Biomedical Engineering and Imaging SciencesKing's College London and Honorary Consultant RadiologistGuy's and St Thomas’ Hospitals NHS Foundation TrustLondonUK
| | | | - C. Hulme
- Academic Unit of Health EconomicsLeeds Institute of Health SciencesUniversity of LeedsLeedsUK
| | - D. Tolan
- Leeds Teaching Hospital TrustLeedsUK
| | | | - R. Cahill
- University College DublinDublinIreland
| | | | | | - M. Coleman
- Derriford HospitalPlymouth NHS TrustPlymouthUK
| | - D. Jayne
- Leeds Institute of Biological and Clinical SciencesSt James's University HospitalLeedsUK
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Murphy A, Kirby A, Bradley C. Knowledge is power: general practitioners prescribing of new oral anticoagulants in Ireland. BMC Res Notes 2018; 11:478. [PMID: 30012204 PMCID: PMC6048694 DOI: 10.1186/s13104-018-3597-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 04/17/2018] [Accepted: 07/12/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE New oral anticoagulants (NOACs) aim to overcome warfarin's shortcomings, however their pharmacokinetic characteristics make prescribing complex. Thus it is imperative that general practitioners (GPs) are aware of specific treatments so as to maximise their benefits and minimise their pitfalls. This study explores GPs attitudes and experiences with prescribing NOACs in Ireland where, despite clear national prescribing guidelines advocating warfarin as first line therapy, the number of patients being prescribed NOACs for the first time is growing. RESULTS Using primary data collected from GPs in Ireland the factors influencing the likelihood of a GP initiating a prescription for a NOAC are determined using a probit model. Results indicate 46% of the sample initiated NOAC prescriptions and GP practice size is a significant factor influencing this. Analysis revealed no difference regarding the sources of information considered important amongst GPs when prescribing new drugs. However, there were differences in which factors were considered important when prescribing anticoagulants between initiating and non-initiating NOAC prescribers. The results of this study suggest better utilisation of existing information and education tools for GPs prescribing NOACs and managing NOAC patients is imperative, to ensure the right anticoagulant is prescribed for the right patient at the right time.
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Affiliation(s)
- A Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland.
| | - A Kirby
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - C Bradley
- Department of General Practice, College of Medicine, University College Cork, Cork, Ireland
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Hreha K, Kirby A, Molton I, Nagata N, Terrill A. Resilience through adaptive recreation in stroke survivors: A biopsychosocial approach. Ann Phys Rehabil Med 2018. [DOI: 10.1016/j.rehab.2018.05.484] [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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40
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Khoo V, Hawkins M, Ahmed M, Kirby A, van As N, McDonald F, Franks K, Syndikus I, Jain S, Tree A, Patel R, Hall E. A Randomised Trial of Conventional Care versus Radioablation (Stereotactic Body Radiotherapy) for Extracranial Oligometastases. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.061] [Citation(s) in RCA: 3] [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] [Indexed: 10/17/2022]
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Ranger A, Dunlop A, Hutchinson K, Convery H, Maclennan MK, Chantler H, Twyman N, Rose C, McQuaid D, Amos RA, Griffin C, deSouza NM, Donovan E, Harris E, Coles CE, Kirby A. A Dosimetric Comparison of Breast Radiotherapy Techniques to Treat Locoregional Lymph Nodes Including the Internal Mammary Chain. Clin Oncol (R Coll Radiol) 2018; 30:346-353. [PMID: 29483041 DOI: 10.1016/j.clon.2018.01.017] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [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: 11/16/2017] [Revised: 01/02/2018] [Accepted: 01/03/2018] [Indexed: 10/17/2022]
Abstract
AIMS Radiotherapy target volumes in early breast cancer treatment increasingly include the internal mammary chain (IMC). In order to maximise survival benefits of IMC radiotherapy, doses to the heart and lung should be minimised. This dosimetry study compared the ability of three-dimensional conformal radiotherapy, arc therapy and proton beam therapy (PBT) techniques with and without breath-hold to achieve target volume constraints while minimising dose to organs at risk (OARs). MATERIALS AND METHODS In 14 patients' datasets, seven IMC radiotherapy techniques were compared: wide tangent (WT) three-dimensional conformal radiotherapy, volumetric-modulated arc therapy (VMAT) and PBT, each in voluntary deep inspiratory breath-hold (vDIBH) and free breathing (FB), and tomotherapy in FB only. Target volume coverage and OAR doses were measured for each technique. These were compared using a one-way ANOVA with all pairwise comparisons tested using Bonferroni's multiple comparisons test, with adjusted P-values ≤ 0.05 indicating statistical significance. RESULTS One hundred per cent of WT(vDIBH), 43% of WT(FB), 100% of VMAT(vDIBH), 86% of VMAT(FB), 100% of tomotherapy FB and 100% of PBT plans in vDIBH and FB passed all mandatory constraints. However, coverage of the IMC with 90% of the prescribed dose was significantly better than all other techniques using VMAT(vDIBH), PBT(vDIBH) and PBT(FB) (mean IMC coverage ± 1 standard deviation = 96.0% ± 4.3, 99.8% ± 0.3 and 99.0% ± 0.2, respectively). The mean heart dose was significantly reduced in vDIBH compared with FB for both the WT (P < 0.0001) and VMAT (P < 0.0001) techniques. There was no advantage in target volume coverage or OAR doses for PBT(vDIBH) compared with PBT(FB). CONCLUSIONS Simple WT radiotherapy delivered in vDIBH achieves satisfactory coverage of the IMC while meeting heart and lung dose constraints. However, where higher isodose coverage is required, VMAT(vDIBH) is the optimal photon technique. The lowest OAR doses are achieved by PBT, in which the use of vDIBH does not improve dose statistics.
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Affiliation(s)
- A Ranger
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - A Dunlop
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - K Hutchinson
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - H Convery
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | | | - H Chantler
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - N Twyman
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - C Rose
- Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - D McQuaid
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - R A Amos
- University College London, London, UK
| | - C Griffin
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - N M deSouza
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - E Donovan
- CVSSP, University of Surrey, Guildford, UK
| | - E Harris
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - C E Coles
- University of Cambridge, Cambridge, UK
| | - A Kirby
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
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Nimalasena S, Gothard L, Kothari G, Allen S, Sinnett V, Musallam A, Kirby A, Ross G, Lucy C, Castell F, Cleator S, Locke I, Sawyer E, Tait D, Westbury C, Wolstenholme V, Box C, Robinson S, Yarnold J, Somaiah N. EP-1315: KORTUC phase I/II trial testing a novel radiation sensitiser in breast cancer: preliminary results. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31625-6] [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: 11/27/2022]
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Ranger A, Perotti C, Dunlop A, Donovan E, McNair H, Harris E, Kirby A. EP-1283: Lung sparing techniques for internal mammary chain radiotherapy in right breast cancer patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31593-7] [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: 11/25/2022]
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Brunt A, Haviland J, Sydenham M, Al-hasso A, Bloomfield D, Chan C, Churn M, Cleator S, Coles C, Emson M, Goodman A, Griffin C, Harnett A, Hopwood P, Kirby A, Kirwan C, Morris C, Sawyer E, Somaiah N, Syndikus I, Wilcox M, Zotova R, Wheatley D, Bliss J, Yarnold J. OC-0595: FAST-Forward phase 3 RCT of 1-week hypofractionated breast radiotherapy:3-year normal tissue effects. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30905-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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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Tal Saban M, Kirby A. Adulthood in Developmental Coordination Disorder (DCD): a Review of Current Literature Based on ICF Perspective. Curr Dev Disord Rep 2018. [DOI: 10.1007/s40474-018-0126-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Millow H, Hooks D, Mau J, Kirby A. Wellington Regional Hospital Experience of His-Bundle Pacing. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.362] [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: 10/28/2022]
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O’Connor M, Harding S, Kirby A, Wilkins B, Larsen P. Current Anticoagulant and Antiplatelet Prescribing Practice in Acute Coronary Syndromes With Concurrent Atrial Fibrillation Across Australia And New Zealand. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.914] [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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Kirby A, Holley A, Aitken A, Larsen P, Harding S. Family History of Premature Coronary Artery Disease: Accuracy and Predictor of Risk. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.611] [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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Khoo V, Hawkins M, McDonald F, Ahmed M, Kirby A, Van As N, Franks K, Syndikus I, Jain S, Tree A, Eaton D, Patel R, Goubar A, Kilburn L, Toms C, Hall E. CORE: A randomised trial of COventional care versus Radioablation (stereotactic body radiotherapy) for Extracranial oligometastases. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30219-8] [Citation(s) in RCA: 2] [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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50
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Kirby A, Lewbart GA, Hancock-Ronemus A, Papich MG. Pharmacokinetics of enrofloxacin and ciprofloxacin in Atlantic horseshoe crabs (Limulus polyphemus) after single injection. J Vet Pharmacol Ther 2017; 41:349-353. [PMID: 29067728 DOI: 10.1111/jvp.12462] [Citation(s) in RCA: 7] [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] [Received: 06/06/2017] [Accepted: 09/11/2017] [Indexed: 11/26/2022]
Abstract
The pharmacokinetics of enrofloxacin and the metabolite ciprofloxacin were studied in horseshoe crabs after a single injection of 5 mg/kg. Twelve Atlantic horseshoe crabs (Limulus polyphemus) of undetermined age were injected with enrofloxacin into the dorsal cardiac sinus. Hemolymph samples were collected by syringe and needle at regular intervals for 120 hr. Samples were analyzed by high-pressure liquid chromatography and compartmental analysis performed on the results. Following injection, the elimination half-life (T½), peak concentration, area under the curve (AUC), and volume of distribution (VD) for enrofloxacin were 27.9 (29.13) hr, 8.98 (18.09) μg/ml, 367.38 (35.41) hr μg/ml, and 0.575 (20.48) L/kg, respectively (mean value, CV%). For ciprofloxacin, the elimination T½, peak concentration, and AUC were 61.36 (34.55) hr, 2.34 (24.11) μg/ml, and 304.46 (24.69) μg hr/ml. In these animals, the ciprofloxacin concentrations comprised an average of 45.8% of the total fluoroquinolone concentrations, which is substantial compared to other marine invertebrates. The total AUC produced (sum of enrofloxacin and ciprofloxacin) was 682.69 ± 180.61 μg hr/ml. Concentrations that were achieved after a single dose of 5 mg/kg horseshoe crabs were sufficient to treat bacteria susceptible to enrofloxacin and ciprofloxacin.
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Affiliation(s)
- A Kirby
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | - G A Lewbart
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
| | | | - M G Papich
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA
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