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Parker CC, Petersen PM, Cook AD, Clarke NW, Catton C, Cross WR, Kynaston H, Parulekar WR, Persad RA, Saad F, Bower L, Durkan GC, Logue J, Maniatis C, Noor D, Payne H, Anderson J, Bahl AK, Bashir F, Bottomley DM, Brasso K, Capaldi L, Cooke PW, Chung C, Donohue J, Eddy B, Heath CM, Henderson A, Henry A, Jaganathan R, Jakobsen H, James ND, Joseph J, Lees K, Lester J, Lindberg H, Makar A, Morris SL, Oommen N, Ostler P, Owen L, Patel P, Pope A, Popert R, Raman R, Ramani V, Røder A, Sayers I, Simms M, Srinivasan V, Sundaram S, Tarver KL, Tran A, Wells P, Wilson J, Zarkar AM, Parmar MKM, Sydes MR. Timing of Radiotherapy (RT) After Radical Prostatectomy (RP): Long-term outcomes in the RADICALS-RT trial [NCT00541047]. Ann Oncol 2024:S0923-7534(24)00105-4. [PMID: 38583574 DOI: 10.1016/j.annonc.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The optimal timing of radiotherapy (RT) after radical prostatectomy for prostate cancer has been uncertain. RADICALS-RT compared efficacy and safety of adjuvant RT versus an observation policy with salvage RT for PSA failure. METHODS RADICALS-RT was a randomised controlled trial enrolling patients with ≥1 risk factor (pT3/4, Gleason 7-10, positive margins, pre-op PSA≥10ng/ml) for recurrence after radical prostatectomy. Patients were randomised 1:1 to adjuvant RT ("Adjuvant-RT") or an observation policy with salvage RT for PSA failure ("Salvage-RT") defined as PSA≥0.1ng/ml or 3 consecutive rises. Stratification factors were Gleason score, margin status, planned RT schedule (52.5Gy/20 fractions or 66Gy/33 fractions) and treatment centre. The primary outcome measure was freedom-from-distant metastasis, designed with 80% power to detect an improvement from 90% with Salvage-RT (control) to 95% at 10yr with Adjuvant-RT. Secondary outcome measures were bPFS, freedom-from-non-protocol hormone therapy, safety and patient-reported outcomes. Standard survival analysis methods were used; HR<1 favours Adjuvant-RT. FINDINGS Between Oct-2007 and Dec-2016, 1396 participants from UK, Denmark, Canada and Ireland were randomised: 699 Salvage-RT, 697 Adjuvant-RT. Allocated groups were balanced with median age 65yr. 93% (649/697) Adjuvant-RT reported RT within 6m after randomisation; 39% (270/699) Salvage-RT reported RT during follow-up. Median follow-up was 7.8 years. With 80 distant metastasis events, 10yr FFDM was 93% for Adjuvant-RT and 90% for Salvage-RT: HR=0.68 (95%CI 0·43-1·07, p=0·095). Of 109 deaths, 17 were due to prostate cancer. Overall survival was not improved (HR=0.980, 95%CI 0.667-1.440, p=0.917). Adjuvant-RT reported worse urinary and faecal incontinence one year after randomisation (p=0.001); faecal incontinence remained significant after ten years (p=0.017). INTERPRETATION Long-term results from RADICALS-RT confirm adjuvant RT after radical prostatectomy increases the risk of urinary and bowel morbidity, but does not meaningfully improve disease control. An observation policy with salvage RT for PSA failure should be the current standard after radical prostatectomy.
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Affiliation(s)
- C C Parker
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - P M Petersen
- Dept of Oncology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A D Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - N W Clarke
- Dept of Urology, The Christie and Salford Royal Hospitals, Manchester, UK; The University of Manchester, Manchester, UK
| | - C Catton
- Dept of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - W R Cross
- Dept of Urology, St James's University Hospital, Leeds, UK
| | - H Kynaston
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - W R Parulekar
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - R A Persad
- Dept of Urology, Bristol Urological Institute, Bristol, UK
| | - F Saad
- Dept of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - L Bower
- Guy's and St Thomas' NHS Foundation Trust, London, UK; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - G C Durkan
- Dept of Urology, University Hospital Galway, Galway, Ireland
| | - J Logue
- Dept of Oncology, The Christie Hospital NHS FT, Wilmslow Road, Manchester, UK
| | - C Maniatis
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - D Noor
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - H Payne
- The Prostate Centre, London, UK
| | - J Anderson
- St James's Institute of Oncology, Leeds, UK
| | - A K Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol & Weston NHS Trust, Bristol, UK
| | - F Bashir
- Queen's Centre for Oncology, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | | | - K Brasso
- Dept of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L Capaldi
- Worcester Oncology Centre, Worcestershire Acute NHS Hospitals Trust, Worcester, UK
| | - P W Cooke
- Dept of Urology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - C Chung
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - J Donohue
- Dept of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - B Eddy
- East Kent University Hospitals Foundation Trust, Kent, UK
| | - C M Heath
- Dept of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Henderson
- Dept of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - A Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - R Jaganathan
- Dept of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Jakobsen
- Dept of Urology, Herlev University Hospital, Herlev, Denmark
| | - N D James
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - J Joseph
- Leeds Teaching Hospitals, UK; York and Scarborough Teaching Hospitals, UK
| | - K Lees
- Dept of Oncology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - J Lester
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - H Lindberg
- Dept of Oncology, Herlev University Hospital, Herlev, Denmark
| | - A Makar
- Dept of Urology, Worcestershire Acute Hospitals Trust, Worcester, UK
| | - S L Morris
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - N Oommen
- Wrexham Maelor Hospital, Wrexham, UK
| | - P Ostler
- Mount Vernon Cancer Centre, Northwood, UK
| | - L Owen
- Bradford Royal Infirmary, Bradford, UK; Leeds Cancer Centre, Leeds, UK
| | - P Patel
- Dept of Urology, University College London Hospitals, London, UK
| | - A Pope
- Mount Vernon Cancer Centre, Northwood, UK
| | - R Popert
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R Raman
- Kent Oncology Centre, Kent & Canterbury Hospital, Canterbury, UK
| | - V Ramani
- Dept of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - A Røder
- Dept of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - I Sayers
- Deanesly Centre, New Cross Hospital, Wolverhampton, UK
| | - M Simms
- Dept of Urology, Hull University Hospitals NHS Trust, UK
| | - V Srinivasan
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, UK
| | - S Sundaram
- Dept of Urology, Mid Yorkshire Teaching Hospital, Pontefract, UK
| | - K L Tarver
- Dept of Oncology, Queen's Hospital, Romford, UK
| | - A Tran
- Dept of Oncology, The Christie Hospital NHS FT, Wilmslow Road, Manchester, UK
| | - P Wells
- St Bartholomews Hospital, London UK
| | - J Wilson
- Royal Gwent Hospital, Newport, UK
| | - A M Zarkar
- Dept of Oncology, University Hospitals Birmingham, Birmingham, UK
| | - M K M Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK.
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Schmid F, Henry A, Benzerouk F, Barrière S, Portefaix C, Gondrexon J, Obert A, Kaladjian A, Gierski F. Neural activations during cognitive and affective theory of mind processing in healthy adults with a family history of alcohol use disorder. Psychol Med 2024; 54:1034-1044. [PMID: 37753626 DOI: 10.1017/s0033291723002854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
BACKGROUND Social cognition impairments are a common feature of alcohol use disorders (AUD). However, it remains unclear whether these impairments are solely the consequence of chronic alcohol consumption or whether they could be a marker of vulnerability. METHODS The present study implemented a family history approach to address this question for a key process of social cognition: theory of mind (ToM). Thirty healthy adults with a family history of AUD (FH+) and 30 healthy adults with a negative family history of AUD (FH-), matched for age, sex, and education level, underwent an fMRI cartoon-vignette paradigm assessing cognitive and affective ToM. Participants also completed questionnaires evaluating anxiety, depressive symptoms, childhood trauma, and alexithymia. RESULTS Results indicated that FH+ individuals differed from FH- individuals on affective but not cognitive ToM processing, at both the behavioral and neural levels. At the behavioral level, the FH+ group had lower response accuracy for affective ToM compared with the FH- group. At the neural level, the FH+ group had higher brain activations in the left insula and inferior frontal cortex during affective ToM processing. These activations remained significant when controlling for depressive symptoms, anxiety, and childhood trauma. CONCLUSIONS These findings highlight difficulties during affective ToM processing among first-degree relatives of AUD patients, supporting the idea that some of the impairments exhibited by these patients may already be present before the onset of AUD and may be considered a marker of vulnerability.
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Affiliation(s)
- F Schmid
- Laboratoire Cognition, Santé, Société (C2S - EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - A Henry
- Laboratoire Cognition, Santé, Société (C2S - EA 6291), University of Reims Champagne-Ardenne, Reims, France
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
| | - F Benzerouk
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
- INSERM U1247, Research Group on Alcohol and Dependences, University of Picardy Jules Verne, Amiens, France
| | - S Barrière
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
| | - C Portefaix
- Radiology Department, Maison Blanche Hospital, Reims University Hospital, Reims, France
- Centre de Recherche en Sciences et Technologies de l'Information et de la Communication (CReSTIC - EA 3804), University of Reims Champagne-Ardenne, Reims, France
| | - J Gondrexon
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
| | - A Obert
- Laboratoire Sciences de la Cognition, Technologie, Ergonomie (SCOTE - EA 7420), Champollion National University Institute, Albi, France
| | - A Kaladjian
- Laboratoire Cognition, Santé, Société (C2S - EA 6291), University of Reims Champagne-Ardenne, Reims, France
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
| | - F Gierski
- Laboratoire Cognition, Santé, Société (C2S - EA 6291), University of Reims Champagne-Ardenne, Reims, France
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
- INSERM U1247, Research Group on Alcohol and Dependences, University of Picardy Jules Verne, Amiens, France
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Najib A, Arndt C, Henry A. Frosted branch angiitis associated with Epstein-Barr virus infection. J Fr Ophtalmol 2024; 47:104034. [PMID: 38378392 DOI: 10.1016/j.jfo.2023.104034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/28/2023] [Accepted: 09/09/2023] [Indexed: 02/22/2024]
Affiliation(s)
- A Najib
- Service d'ophtalmologie, CHU de Charles-Nicolle, 1, rue de Germont, 76031 Rouen cedex, France.
| | - C Arndt
- Service d'ophtalmologie, hôpital Robert-Debré, centre hospitalier universitaire de Reims, rue du Général Koenig, 51100 Reims, France
| | - A Henry
- Service d'ophtalmologie, hôpital Robert-Debré, centre hospitalier universitaire de Reims, rue du Général Koenig, 51100 Reims, France
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Schmid F, Henry A, Benzerouk F, Barrière S, Gondrexon J, Kaladjian A, Gierski F. Patterns of executive functions and theory of mind in adults with a family history of alcohol use disorder: Combined group and single-case analyses. Alcohol Clin Exp Res (Hoboken) 2024; 48:362-374. [PMID: 38243915 DOI: 10.1111/acer.15238] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/24/2023] [Accepted: 11/26/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND Impairments in executive function and social cognition are highly prevalent in individuals with an alcohol use disorder (AUD). Some studies show that similar difficulties are displayed by individuals with a positive family history of AUD (FH+) compared with individuals with a negative family history (FH-). Yet, no studies have jointly investigated cognitive and affective theory of mind at the behavioral level. Moreover, some studies show preserved executive and socioemotional functioning in FH+ participants. One possible explanation for these divergent results is that FH+ individuals are cognitively heterogeneous. In this study, we examined the frequency and co-occurrence of difficulties in executive function and social cognition among FH+ individuals at the individual level. METHODS Sixty FH+ and 60 FH- participants matched on age, sex, and education level were included. They completed tasks assessing executive functions (Stroop, Trail Making Test) and affective and cognitive theory of mind (Movie for the Assessment of Social Cognition). They also completed self-report questionnaires measuring impulsivity, alexithymia, and empathy. Single-case analyses assessed the proportion of FH+ participants with difficulties in executive function and/or theory of mind. RESULTS FH+ individuals exhibited difficulties in response inhibition and made more errors during theory of mind processing, indicating an absence of mental state representation, compared with FH- individuals. In the FH+ sample, 53.33% had executive function and/or theory of mind difficulties. Those with lower theory of mind scores reported higher alexithymia and lower empathy on self-report measures. CONCLUSIONS FH+ individuals display heterogeneous executive function and theory of mind abilities. Given that they mostly occur independently of one another, executive function and theory of mind difficulties may be distinct vulnerability markers in AUD.
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Affiliation(s)
- F Schmid
- Laboratoire Cognition, Santé, Société (C2S - EA 6291), University of Reims Champagne-Ardenne, Reims, France
| | - A Henry
- Laboratoire Cognition, Santé, Société (C2S - EA 6291), University of Reims Champagne-Ardenne, Reims, France
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
| | - F Benzerouk
- Laboratoire Cognition, Santé, Société (C2S - EA 6291), University of Reims Champagne-Ardenne, Reims, France
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
- INSERM U1247, Research Group on Alcohol and Dependences, University of Picardy Jules Verne, Amiens, France
| | - S Barrière
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
| | - J Gondrexon
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
| | - A Kaladjian
- Laboratoire Cognition, Santé, Société (C2S - EA 6291), University of Reims Champagne-Ardenne, Reims, France
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
| | - F Gierski
- Laboratoire Cognition, Santé, Société (C2S - EA 6291), University of Reims Champagne-Ardenne, Reims, France
- Psychiatry Department, Marne Public Mental Health Institute & Reims University Hospital, Reims, France
- INSERM U1247, Research Group on Alcohol and Dependences, University of Picardy Jules Verne, Amiens, France
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Kent S, Adatia A, James P, Bains K, Henry A, Blore C, Dawoud B, Kumar D, Jefferies C, Kyzas P. Risk factors associated with short-term complications in mandibular fractures: the MANTRA study-a Maxillofacial Trainee Research Collaborative (MTReC). Oral Maxillofac Surg 2023; 27:609-616. [PMID: 35788932 PMCID: PMC10684408 DOI: 10.1007/s10006-022-01096-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 06/19/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Complications following mandibular fractures occur in 9-23% of patients. Identifying those at risk is key to prevention. Previous studies highlighted smoking, age and time from injury to presentation as risk factors but rarely recorded other possible confounders. In this paper, we use a collaborative snapshot audit to document novel risk factors and confirm established risks for complications following the treatment of mandibular fractures. METHODS The audit was carried out by 122 OMFS trainees across the UK and Ireland (49 centres) over 6 months, coordinated by the Maxillofacial Surgery Trainees Research Collaborative. Variables recorded included basic demography, medical and social history, injury mechanism and type, management and 30-day outcome. RESULTS Nine hundred and forty-seven (947) patients with fractured mandibles were recorded. Surgical management was carried out in 76.3%. Complications at 30 days occurred 65 (9%) of those who were managed surgically. Risk factors for complications included male sex, increasing age, any medical history, increasing number of cigarettes smoked per week, increasing alcohol use per week, worse oral hygiene and increased time from injury to presentation. DISCUSSION We have used a large prospective snapshot audit to confirm established risk factors and identify novel risk factors. We demonstrate that time from injury to presentation is confounded by other indicators of poor health behaviour. These results are important in designing trial protocols for management of mandibular fractures and in targeting health interventions to patients at highest risk of complications.
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Affiliation(s)
- S Kent
- University Hospital of Wales, Cardiff, UK.
| | - A Adatia
- Aintree University Hospital, Liverpool, UK
| | - P James
- Aintree University Hospital, Liverpool, UK
| | - K Bains
- Aintree University Hospital, Liverpool, UK
| | - A Henry
- Swansea Bay University Health Board, Swansea, UK
| | - C Blore
- University Hospitals of North Midlands NHS Trust, Stafford, UK
| | - B Dawoud
- North Manchester General Hospital, Manchester , UK
| | - D Kumar
- Liverpool Medical School, Liverpool, UK
| | - C Jefferies
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Kyzas
- Royal Blackburn Teaching Hospital, East Lancashire Hospitals NHS Trust, Blackburn, UK
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Zhong J, Kobus M, Maitre P, Datta A, Eccles C, Dubec M, McHugh D, Buckley D, Scarsbrook A, Hoskin P, Henry A, Choudhury A. MRI-guided Pelvic Radiation Therapy: A Primer for Radiologists. Radiographics 2023; 43:e230052. [PMID: 37796729 DOI: 10.1148/rg.230052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Radiation therapy (RT) is a core pillar of oncologic treatment, and half of all patients with cancer receive this therapy as a curative or palliative treatment. The recent integration of MRI into the RT workflow has led to the advent of MRI-guided RT (MRIgRT). Using MRI rather than CT has clear advantages for guiding RT to pelvic tumors, including superior soft-tissue contrast, improved organ motion visualization, and the potential to image tumor phenotypic characteristics to identify the most aggressive or treatment-resistant areas, which can be targeted with a more focal higher radiation dose. Radiologists should be familiar with the potential uses of MRI in planning pelvic RT; the various RT techniques used, such as brachytherapy and external beam RT; and the impact of MRIgRT on treatment paradigms. Current clinical experience with and the evidence base for MRIgRT in the settings of prostate, cervical, and bladder cancer are discussed, and examples of treated cases are illustrated. In addition, the benefits of MRIgRT, such as real-time online adaptation of RT (during treatment) and interfraction and/or intrafraction adaptation to organ motion, as well as how MRIgRT can decrease toxic effects and improve oncologic outcomes, are highlighted. MRIgRT is particularly beneficial for treating mobile pelvic structures, and real-time adaptive RT for tumors can be achieved by using advanced MRI-guided linear accelerator systems to spare organs at risk. Future opportunities for development of biologically driven adapted RT with use of functional MRI sequences and radiogenomic approaches also are outlined. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Jim Zhong
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Marta Kobus
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Priyamvada Maitre
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Anubhav Datta
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Cynthia Eccles
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Michael Dubec
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Damien McHugh
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - David Buckley
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Andrew Scarsbrook
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Peter Hoskin
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Ann Henry
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
| | - Ananya Choudhury
- From the Leeds Institute of Medical Research (J.Z., A.S., A.H.) and Department of Biomedical Imaging (D.B.), University of Leeds, 6 Clarendon Way, Woodhouse, Leeds LS2 9LH, England; Leeds Cancer Centre, St James's University Hospital, Leeds, England (J.Z., A.S., A.H.); Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany (M.K.); Radiation Therapy Research Group (M.K., P.M., A.D., C.E., M.D., P.H., A.C.) and Division of Cancer Sciences (D.M.), University of Manchester, Manchester, England; and The Christie NHS Foundation Trust, Manchester, England (P.M., C.E., M.D., D.M., P.H., A.C.)
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Henry A, Hentzien M. Chorioretinitis, pustulosis, and costochondritis in a heroin addict. J Fr Ophtalmol 2023; 46:994-995. [PMID: 37085355 DOI: 10.1016/j.jfo.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 04/23/2023]
Affiliation(s)
- A Henry
- Service d'ophtalmologie, CHU de Robert-Debré de Reims, rue du Général Koenig, 51100 Reims, France.
| | - M Hentzien
- Service de maladies infectieuses, CHU de Robert-Debré de Reims, rue du Général Koenig, 51100 Reims, France
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Swinton M, Mariam NBG, Tan JL, Murphy K, Elumalai T, Soni M, Ferrera A, Richardson C, Walshaw R, Mistry H, Ramani V, Song Y, Birtle A, Henry A, Chan J, Hoskin P, Choudhury A. Bladder-Sparing Treatment With Radical Dose Radiotherapy Is an Effective Alternative to Radical Cystectomy in Patients With Clinically Node-Positive Nonmetastatic Bladder Cancer. J Clin Oncol 2023; 41:4406-4415. [PMID: 37478391 DOI: 10.1200/jco.23.00725] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/10/2023] [Accepted: 06/08/2023] [Indexed: 07/23/2023] Open
Abstract
PURPOSE Bladder-sparing trimodal therapy (TMT) is an alternative to radical cystectomy (RC) according to international guidelines. However, there are limited data to guide management of nonmetastatic clinically node-positive bladder cancer (cN+ M0 BCa). We performed a multicenter retrospective analysis of survival outcomes in node-positive patients to inform practice. METHODS Data from patients diagnosed with cN+ M0 BCa were collected from participating UK Oncology centers offering both TMT and RC. Overall survival (OS) and progression-free survival (PFS) outcomes were collected with details of treatment and clinical factors. RESULTS A total of 287 patients with cN+ M0 BCa were included in the survival analysis. Median OS across all patients was 1.55 years (95% CI, 1.35 to 1.82 years). Receiving radical treatments was associated with improved OS (hazard ratio [HR], 0.32; 95% CI, 0.23 to 0.44; P < .001) compared with receiving palliative treatment. Radically treated patients (n = 163) received RC (n = 76) or radical dose radiotherapy (RT, n = 87); choice of radical treatment showed no association with OS (HR, 0.94; 95% CI, 0.63 to 1.41; P = .76) or PFS (HR, 0.74; 95% CI, 0.50 to 1.08; P = .12) on multivariable analysis. CONCLUSION Patient cohorts with cN+ M0 BCa had equivalent survival outcomes whether treated with surgery or radical RT. Given the known morbidities of RC-in a patient group with poor survival-this study confirms that bladder-sparing TMT treatment should be a treatment option available to all patients with cN+ M0 BCa.
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Affiliation(s)
- Martin Swinton
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | | | - Jean Ling Tan
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Katherine Murphy
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Thiraviyam Elumalai
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Manjusha Soni
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | | | - Richard Walshaw
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Hitesh Mistry
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Vijay Ramani
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Yeepei Song
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Alison Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, United Kingdom
| | - Ann Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Joachim Chan
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Peter Hoskin
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Ananya Choudhury
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
- Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
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Henry A, Olory-Garnotel L, Bouzidra G, Boulagnon-Rombi C. String of pearls: A remarkable case of atypical vitritis. J Fr Ophtalmol 2023; 46:817-818. [PMID: 37100713 DOI: 10.1016/j.jfo.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/30/2022] [Indexed: 04/28/2023]
Affiliation(s)
- A Henry
- Service d'ophtalmologie, CHU Robert-Debré, rue du Général-Koenig, 51100 Reims, France.
| | - L Olory-Garnotel
- Service d'ophtalmologie, CHU Robert-Debré, rue du Général-Koenig, 51100 Reims, France
| | - G Bouzidra
- Pôle de biologie médicale et pathologie, CHU Robert-Debré, rue du Général-Koenig, 51100 Reims, France
| | - C Boulagnon-Rombi
- Pôle de biologie médicale et pathologie, CHU Robert-Debré, rue du Général-Koenig, 51100 Reims, France
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10
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Huddart R, Hafeez S, Omar A, Alonzi R, Birtle A, Cheung KC, Choudhury A, Foroudi F, Gribble H, Henry A, Hilman S, Hindson B, Lewis R, Muthukumar D, McLaren DB, McNair H, Nikapota A, Olorunfemi A, Parikh O, Philipps L, Rimmer Y, Syndikus I, Tolentino A, Varughese M, Vassallo-Bonner C, Webster A, Griffin C, Hall E. Acute Toxicity of Hypofractionated and Conventionally Fractionated (Chemo)Radiotherapy Regimens for Bladder Cancer: An Exploratory Analysis from the RAIDER Trial. Clin Oncol (R Coll Radiol) 2023; 35:586-597. [PMID: 37225552 DOI: 10.1016/j.clon.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
AIMS Adding concurrent (chemo)therapy to radiotherapy improves outcomes for muscle-invasive bladder cancer patients. A recent meta-analysis showed superior invasive locoregional disease control for a hypofractionated 55 Gy in 20 fractions schedule compared with 64 Gy in 32 fractions. In the RAIDER clinical trial, patients undergoing 20 or 32 fractions of radical radiotherapy were randomised (1:1:2) to standard radiotherapy or to standard-dose or escalated-dose adaptive radiotherapy. Neoadjuvant chemotherapy and concomitant therapy were permitted. We report exploratory analyses of acute toxicity by concomitant therapy-fractionation schedule combination. MATERIALS AND METHODS Participants had unifocal bladder urothelial carcinoma staged T2-T4a N0 M0. Acute toxicity was assessed (Common Terminology Criteria for Adverse Events) weekly during radiotherapy and at 10 weeks after the start of treatment. Within each fractionation cohort, non-randomised comparisons of the proportion of patients reporting treatment emergent grade 2 or worse genitourinary, gastrointestinal or other adverse events at any point in the acute period were carried out using Fisher's exact tests. RESULTS Between September 2015 and April 2020, 345 (163 receiving 20 fractions; 182 receiving 32 fractions) patients were recruited from 46 centres. The median age was 73 years; 49% received neoadjuvant chemotherapy; 71% received concomitant therapy, with 5-fluorouracil/mitomycin C most commonly used: 44/114 (39%) receiving 20 fractions; 94/130 (72%) receiving 32 fractions. The acute grade 2+ gastrointestinal toxicity rate was higher in those receiving concomitant therapy compared with radiotherapy alone in the 20-fraction cohort [54/111 (49%) versus 7/49 (14%), P < 0.001] but not in the 32-fraction cohort (P = 0.355). Grade 2+ gastrointestinal toxicity was highest for gemcitabine, with evidence of significant differences across therapies in the 32-fraction cohort (P = 0.006), with a similar pattern but no significant differences in the 20-fraction cohort (P = 0.099). There was no evidence of differences in grade 2+ genitourinary toxicity between concomitant therapies in either the 20- or 32-fraction cohorts. CONCLUSION Grade 2+ acute adverse events are common. The toxicity profile varied by type of concomitant therapy; the gastrointestinal toxicity rate seemed to be higher in patients receiving gemcitabine.
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Affiliation(s)
- R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Radiotherapy Department, The Royal Marsden NHS Foundation Trust, London, UK.
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Radiotherapy Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Omar
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - R Alonzi
- Clinical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Middlesex, UK
| | - A Birtle
- Cancer Oncology, Lancashire Teaching Hospitals NHS Trust, Lancashire, UK
| | - K C Cheung
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - A Choudhury
- Translational Radiobiology, The Christie NHS Foundation Trust, Manchester, UK
| | - F Foroudi
- Radiation Oncology, Austin Health, Heidelberg, Australia
| | - H Gribble
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - A Henry
- University of Leeds and the Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - S Hilman
- Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - B Hindson
- Canterbury Regional Cancer and Haematology Service, Te Whatu Ora, Waitaha Canterbury, Christchurch, New Zealand
| | - R Lewis
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - D Muthukumar
- Oncology, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - D B McLaren
- Department of Clinical Oncology, Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK
| | - H McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Radiotherapy Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Nikapota
- Clinical Oncology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Olorunfemi
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - O Parikh
- Lancashire Teaching Hospitals NHS Trust, Burnley, UK
| | - L Philipps
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - Y Rimmer
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - I Syndikus
- Department of Radiotherapy, The Clatterbridge Cancer Centre, Liverpool, UK
| | - A Tolentino
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - M Varughese
- Department of Oncology, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - C Vassallo-Bonner
- Patient Representative, The Institute of Cancer Research, London, UK
| | - A Webster
- National Radiotherapy Trials Quality Assurance Group (RTTQA), University College Hospital, London, UK
| | - C Griffin
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - E Hall
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
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Alzahrani N, Henry A, Clark A, Murray L, Nix M, Al-Qaisieh B. Geometric evaluations of CT and MRI based deep learning segmentation for brain OARs in radiotherapy. Phys Med Biol 2023; 68:175035. [PMID: 37579753 DOI: 10.1088/1361-6560/acf023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/14/2023] [Indexed: 08/16/2023]
Abstract
Objective.Deep-learning auto-contouring (DL-AC) promises standardisation of organ-at-risk (OAR) contouring, enhancing quality and improving efficiency in radiotherapy. No commercial models exist for OAR contouring based on brain magnetic resonance imaging (MRI). We trained and evaluated computed tomography (CT) and MRI OAR autosegmentation models in RayStation. To ascertain clinical usability, we investigated the geometric impact of contour editing before training on model quality.Approach.Retrospective glioma cases were randomly selected for training (n= 32, 47) and validation (n= 9, 10) for MRI and CT, respectively. Clinical contours were edited using international consensus (gold standard) based on MRI and CT. MRI models were trained (i) using the original clinical contours based on planning CT and rigidly registered T1-weighted gadolinium-enhanced MRI (MRIu), (ii) as (i), further edited based on CT anatomy, to meet international consensus guidelines (MRIeCT), and (iii) as (i), further edited based on MRI anatomy (MRIeMRI). CT models were trained using: (iv) original clinical contours (CTu) and (v) clinical contours edited based on CT anatomy (CTeCT). Auto-contours were geometrically compared to gold standard validation contours (CTeCT or MRIeMRI) using Dice Similarity Coefficient, sensitivity, and mean distance to agreement. Models' performances were compared using paired Student's t-testing.Main results.The edited autosegmentation models successfully generated more segmentations than the unedited models. Paired t-testing showed editing pituitary, orbits, optic nerves, lenses, and optic chiasm on MRI before training significantly improved at least one geometry metric. MRI-based DL-AC performed worse than CT-based in delineating the lacrimal gland, whereas the CT-based performed worse in delineating the optic chiasm. No significant differences were found between the CTeCT and CTu except for optic chiasm.Significance.T1w-MRI DL-AC could segment all brain OARs except the lacrimal glands, which cannot be easily visualized on T1w-MRI. Editing contours on MRI before model training improved geometric performance. MRI DL-AC in RT may improve consistency, quality and efficiency but requires careful editing of training contours.
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Affiliation(s)
- Nouf Alzahrani
- King Abdulaziz University, Department of Diagnostic Radiology, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia
- University of Leeds, School of Medicine, Leeds, United Kingdom
- St James's University Hospital, Department of Medical Physics and Engineering, Leeds Cancer Centre, Leeds, United Kingdom
| | - Ann Henry
- University of Leeds, School of Medicine, Leeds, United Kingdom
- St James's University Hospital, Department of Medical Physics and Engineering, Leeds Cancer Centre, Leeds, United Kingdom
| | - Anna Clark
- St James's University Hospital, Department of Medical Physics and Engineering, Leeds Cancer Centre, Leeds, United Kingdom
| | - Louise Murray
- University of Leeds, School of Medicine, Leeds, United Kingdom
- St James's University Hospital, Department of Medical Physics and Engineering, Leeds Cancer Centre, Leeds, United Kingdom
| | - Michael Nix
- St James's University Hospital, Department of Medical Physics and Engineering, Leeds Cancer Centre, Leeds, United Kingdom
| | - Bashar Al-Qaisieh
- St James's University Hospital, Department of Medical Physics and Engineering, Leeds Cancer Centre, Leeds, United Kingdom
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Zhong J, Frood R, McWilliam A, Davey A, Shortall J, Swinton M, Hulson O, West CM, Buckley D, Brown S, Choudhury A, Hoskin P, Henry A, Scarsbrook A. Prediction of prostate tumour hypoxia using pre-treatment MRI-derived radiomics: preliminary findings. Radiol Med 2023; 128:765-774. [PMID: 37198374 PMCID: PMC10264289 DOI: 10.1007/s11547-023-01644-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/26/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE To develop a machine learning (ML) model based on radiomic features (RF) extracted from whole prostate gland magnetic resonance imaging (MRI) for prediction of tumour hypoxia pre-radiotherapy. MATERIAL AND METHODS Consecutive patients with high-grade prostate cancer and pre-treatment MRI treated with radiotherapy between 01/12/2007 and 1/08/2013 at two cancer centres were included. Cancers were dichotomised as normoxic or hypoxic using a biopsy-based 32-gene hypoxia signature (Ragnum signature). Prostate segmentation was performed on axial T2-weighted (T2w) sequences using RayStation (v9.1). Histogram standardisation was applied prior to RF extraction. PyRadiomics (v3.0.1) was used to extract RFs for analysis. The cohort was split 80:20 into training and test sets. Six different ML classifiers for distinguishing hypoxia were trained and tuned using five different feature selection models and fivefold cross-validation with 20 repeats. The model with the highest mean validation area under the curve (AUC) receiver operating characteristic (ROC) curve was tested on the unseen set, and AUCs were compared via DeLong test with 95% confidence interval (CI). RESULTS 195 patients were included with 97 (49.7%) having hypoxic tumours. The hypoxia prediction model with best performance was derived using ridge regression and had a test AUC of 0.69 (95% CI: 0.14). The test AUC for the clinical-only model was lower (0.57), but this was not statistically significant (p = 0.35). The five selected RFs included textural and wavelet-transformed features. CONCLUSION Whole prostate MRI-radiomics has the potential to non-invasively predict tumour hypoxia prior to radiotherapy which may be helpful for individualised treatment optimisation.
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Affiliation(s)
- Jim Zhong
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
- Department of Radiology, Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals National Health Service (NHS) Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - Russell Frood
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Radiology, Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals National Health Service (NHS) Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - Alan McWilliam
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, UK
| | - Angela Davey
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, UK
| | - Jane Shortall
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, UK
| | - Martin Swinton
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, UK
| | - Oliver Hulson
- Department of Radiology, Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals National Health Service (NHS) Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - Catharine M West
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - David Buckley
- Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sarah Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research (LICTR), University of Leeds, Leeds, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, UK
| | - Peter Hoskin
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
- Department of Radiotherapy Related Research, The Christie National Health Service (NHS) Foundation Trust, Manchester, UK
| | - Ann Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals National Health Service (NHS) Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - Andrew Scarsbrook
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Radiology, Leeds Cancer Centre, St James's University Hospital, Leeds Teaching Hospitals National Health Service (NHS) Trust, Beckett Street, Leeds, LS9 7TF, UK
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Hughes D, Ng SM, Smyth D, Patel H, Kent S, Henry A, Blore C, Dawoud B, Kumar D, Jefferies C, Kyzas P, Collaborators MTR. Emergency versus semi-elective management of mandible fractures: a Maxillofacial Trainee Research Collaborative (MTReC) study. Ann R Coll Surg Engl 2023; 105:461-468. [PMID: 35904336 PMCID: PMC10149241 DOI: 10.1308/rcsann.2022.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Recent evidence suggests that acute emergency management of mandible fractures does not improve surgical outcomes yet is associated with increased financial burden. Current NHS policy advocating for increased adoption of day-case and semi-elective surgical procedures to reduce bed strain must be balanced with providing timely, effective treatment. Our research aims to determine patient groups currently managed via semi-elective admission and whether this can be extended to other groups to provide safe and effective management of mandible fractures. METHODS A multi-national trainee-led audit of mandibular fractures across 49 units was completed by the Maxillofacial Trainee Research Collaborative (MTReC). Each unit prospectively collected data on fractures on admission and at follow-up. Data collected included patient demographics, behaviour, health, injury, timing to intervention and surgical complications. RESULTS Data were collected on 947 mandibular fractures. Of the surgically managed patients, 649 (90%) were managed via acute emergency admission at the time of presentation, while 68 (10%) were managed semi-electively. Patient demographics, injury pattern and mechanism appeared to significantly affect timing of management, whereas patient behaviour, health status, timing of injury and presentation did not. Semi-elective management was associated with a significantly shorter inpatient duration (0.9 versus 1.9 days, p=0.000) with no differences in readmission, antibiotic usage or surgical complications (p=1.000, RR 1.030). CONCLUSION Our study demonstrates the efficacy of planned admissions and semi-elective management of mandibular fractures. Simple mandibular fractures in compliant patients are suitable for semi-elective treatment. Holistic patient assessment and tailored surgical planning is crucial in determining admission modality to effectively manage mandibular trauma.
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Affiliation(s)
| | - SM Ng
- Kings College Hospital, UK
| | | | | | - S Kent
- University Hospital of Wales, UK
| | - A Henry
- Cwm Taf Morgannwg University Health Board, Merthyr Tydfil, UK
| | - C Blore
- University Hospitals of North Midlands NHS Trust, UK
| | | | - D Kumar
- Liverpool Medical School, UK
| | | | - P Kyzas
- East Lancashire Hospitals NHS Trust, UK
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Huddart RA, Hafeez S, Omar A, Birtle AJ, Cheung KC, Choudhury A, Foroudi F, Gribble H, Griffin C, Henry A, Hindson B, Lewis R, McLaren D, McNair H, Nikapota A, Parikh O, Syndikus I, Varughese MA, Webster A, Hall E. Randomised phase II trial of adaptive image guided radiotherapy in muscle invasive bladder cancer: Late toxicity and cancer outcomes. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.446] [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: 03/16/2023] Open
Abstract
446 Background: The bladder is a mobile, deformable structure which makes radiotherapy (RT) delivery challenging. Plan of the day (POD) adaptive image guided RT and tumour boost dose escalation can optimise treatment. We aimed to define a feasible, safe schedule for muscle invasive bladder cancer (BC) using these techniques. Methods: RAIDER (ISRCTN 26779187) is a 3-arm, international phase II trial. Participants (pts) had unifocal T2-T4a urothelial BC and were randomized (1:1:2) to: standard whole bladder RT (WBRT), standard dose adaptive tumour focused RT (SART) or dose escalated adaptive tumour boost RT (DART). Two fractionation (f) schedules recruited independently. WBRT and SART dose was 64Gy/32f or 55Gy/20f and DART was 70Gy/32f or 60Gy/20f. For SART and DART, POD (small, medium, large) was chosen daily. Neoadjuvant chemotherapy (NAC) and concomitant radiosensitising therapy (CTh) were permitted. Primary endpoint is proportion of pts with RT related CTCAE grade≥3 (G≥3) toxicity 6-18 months (m) after RT. A non-comparative design to rule out >20% G≥3 toxicity in DART pts required 57 evaluable DART pts in each fractionation cohort (90% power, 5% 1-sided alpha). Adverse events (AE) are treatment emergent with RT relatedness assessed blind to treatment allocation. In each fractionation cohort, toxicity analysis is by treatment received in the evaluable population (pts with at ≥1 toxicity assessment between 6-18m). 3m local control was assessed by cystoscopic biopsy. Cancer outcomes are analysed by intention-to-treat with fractionation cohorts combined. Results: 345 pts were randomised (Oct 2015 - Apr 2020): 46/41 WBRT, 46/41 SART and 90/81 DART pts in 32f/20f cohorts respectively. Baseline characteristics for 32f/20f were median age 73 years (IQR 67, 79)/ 72 (67, 79); 83%/ 78% T2; 46%/ 52% had NAC and 71%/ 70% CTh. Median follow-up was 32f: 38.2m (IQR 26.2, 50.2), 20f: 42.1m (35.6, 50.1). 3588/6222 (58%) fractions delivered to SART and DART pts used small or large POD. Late toxicity outcomes are shown in table. RT related G≥3 in 20f DART was 1/58 (90% CI 0.1, 7.9) and in 32f DART was 0/57. 3m local control was achieved in 44/51 (86%) WBRT, 45/53 (85%) SART and 82/92(89%) DART. 2 year survival was 79% (95% CI: 69, 86) WBRT, 74% (63, 82) SART and 80% (73, 85) DART. Conclusions: Late G≥3 toxicity was low in all treatment groups. 20f and 32f DART was safe and feasible to deliver with toxicity rates below predefined thresholds. Local control for image guided (chemo)RT was good. CTCAE G≥3 and G≥2 treatment emergent toxicity 6-18m after RT. Clinical trial information: 26779187 . [Table: see text]
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Affiliation(s)
- Robert A Huddart
- The Institute of Cancer Research, Division of Radiotherpy and Imaging and The Royal Marsden Hospital, Radiotherapy Department, London, United Kingdom
| | - Shaista Hafeez
- The Institute of Cancer Research, Division of Radiotherapy and Imaging and The Royal Marsden NHS Foundation Trust, Radiotherapy Department, London, United Kingdom
| | - Abdullahi Omar
- Institute of Cancer Research, Clinical Trials and Statistics Unit, London, United Kingdom
| | - Alison Jane Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Ka Ching Cheung
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, United Kingdom
| | - Ananya Choudhury
- The Christie NHS Foundation Trust, Translational Radiobiology and University of Manchester, Manchester, United Kingdom
| | | | - Hannah Gribble
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, United Kingdom
| | - Clare Griffin
- The Institute of Cancer Research, London, United Kingdom
| | - Ann Henry
- Leeds Teaching Hospitals NHS Trust, Division of Cancer Studies and Pathology, Leeds, United Kingdom
| | - Ben Hindson
- Canterbury District Health Board, Department of Oncology Services, Christchurch, New Zealand
| | - Rebecca Lewis
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, United Kingdom
| | - Duncan McLaren
- NHS Lothian, Department of Oncology, Edinburgh, United Kingdom
| | - Helen McNair
- The Institute of Cancer Research, Division of Radiotherapy and Imaging and The Royal Marsden NHS Foundation Trust, Radiotherapy Department, London, United Kingdom
| | | | - Omi Parikh
- Lancashire Teaching Hospitals NHS Trust, Oncology, Burnley, United Kingdom
| | - Isabel Syndikus
- Clatterbridge Cancer Centre, Department of Radiotherapy, Liverpool, United Kingdom
| | - Mohini Anna Varughese
- Royal Devon & Exeter NHS Foundation Trust, Department of Oncology, Exeter, United Kingdom
| | - Amanda Webster
- National Radiotherapy Trials Quality Assurance Group and University College Hospital, London, United Kingdom
| | - Emma Hall
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, United Kingdom
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Henry A, Khan S, Shah K, Banner R, Kittur M. A Case Report of Highly Unusual Metastasis from a Salivary Adenocarcinoma. J Maxillofac Oral Surg 2023; 22:388-390. [PMID: 37122789 PMCID: PMC10130246 DOI: 10.1007/s12663-022-01836-w] [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] [Received: 03/03/2022] [Accepted: 12/18/2022] [Indexed: 01/06/2023] Open
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16
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Es Dawoud B, Kent S, Henry A, McDonald C, Kyzas P, McCaul J, Ng T, Kawalec A, Gowrishankar S, Grant J, Elledge R, Mohindra A, Madattigowda R, O'Connor R, Tudor-Green B, Tavakoli M, Garg M, Wareing J, Kulkarni R, Exley R, Wicks C, Mitchell O, Maarouf M, Chohan P, Otukoya R, Wu E, Farooq S, Uppal S, Shaheen S, Reedy N, Vithalani G, Underwood C, Swain A, Brewer E, Cairns M, Logan G, Cashman H, Wareing S, King H, Stevenson S, Collins T, Davies R, Baniulyte G, Watson M, Murray S, Stephanus Brandsma D, Stiles E, Davies L, Nandra B, King S, Regan A, Hennedige A, McCaul J. Predictors and risk factors for admission to critical care in cervicofacial infections: a Maxillofacial Trainee Research Collaborative (MTReC) study. Br J Oral Maxillofac Surg 2023; 61:78-83. [PMID: 36513528 DOI: 10.1016/j.bjoms.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/22/2022] [Accepted: 09/23/2022] [Indexed: 11/21/2022]
Abstract
Cervicofacial infections carry significant morbidity. Patients present on a broad spectrum of severity, with some requiring outpatient management and others admission to higher level care. Recognition of risk factors is helpful in decision making regarding the need for admission to higher level care. Prospective data were captured on 1002 patients in 25 centres across 17 regions of the United Kingdom (UK) by the Maxillofacial Trainee Research Collaborative (MTReC). Patients admitted to critical care were compared with those who received ward-level care. Multivariate and receiver operating characteristic curve analyses were used to identify predictors for critical care admission. Our results show that the best predictor for critical care admission is the presence of three or more features of airway compromise (AUC 0.779), followed by C-reactive protein (CRP) >100 mg/L (OR 2.70; 95% CI 1.59 to 4.58; p < 0.005), submandibular space involvement (OR 3.82; 95% CI 1.870 to 7.81; p = 0.003), white cell count (WCC) >12 × 109/ dl (1.05; 95% CI 1.01 to 1.10; p = 0.03), and positive systemic inflammatory response syndrome criteria (OR 2.78; CI 1.35 to 5.80; p = 0.006). Admission to critical care is multifactorial, however, the presence of three or more features of airway compromise is the best predictor. Awareness of this alongside other key clinical findings in cervicofacial infections may allow for the early recognition of patients who may require escalation to critical care.
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Affiliation(s)
- B Es Dawoud
- Maxillofacial surgery Trainees Research Collaborative, Manchester University Foundation NHS Trust, United Kingdom.
| | - S Kent
- Maxillofacial surgery Trainees Research Collaborative, Morriston Hospital, Swansea, United Kingdom
| | - A Henry
- Maxillofacial surgery Trainees Research Collaborative, Morriston Hospital, Swansea, United Kingdom
| | - C McDonald
- Maxillofacial surgery Trainees Research Collaborative, Ninewells Hospital, Dundee, United Kingdom
| | - P Kyzas
- Maxillofacial surgery Trainees Research Collaborative, East Lancashire Teaching Hospital Trust, United Kingdom
| | - J McCaul
- Maxillofacial surgery Trainees Research Collaborative, Glasgow, United Kingdom
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Dos Santos LM, Arndt C, Hurtaud A, Carolet C, Kritly T, Henry A. [First- and second-line hospital management of ophthalmologic emergencies: Clinical pathway study of 1360 patients]. J Fr Ophtalmol 2023; 46:57-64. [PMID: 36470749 DOI: 10.1016/j.jfo.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/19/2022] [Indexed: 12/04/2022]
Abstract
The general practitioner (GP) might offer a good alternative for the management of certain ophthalmologic emergencies in his or her practice, given the increasing demand for ophthalmological care and difficulties with access to ophthalmologists. The main objective of the study was to describe ophthalmological complaints and their management in general emergency departments compared to ophthalmological emergency departments in order to assess which pathologies can be treated by the GP. This was a single-center retrospective study at the University Hospital of Reims, based on consultation data from the general and ophthalmological emergency departments for all adult patients presenting for an ophthalmological problem in September 2019 and September 2020. Consultations where patients were brought back following a first emergency consultation and consultations for another non-ophthalmological reason were excluded. Out of 1360 consultations recorded, 16% of patients had initially consulted their GP. The 4 most frequent diagnoses were: "ocular trauma," "conjunctivitis," "eye pain" and "visual impairment." A prescription for medication was issued in 77% of cases, 37% of which were for antibiotics. Only 29% of consultations carried out in general emergency departments led to a request for a complementary ophthalmology consultation. The GP might therefore be able to manage certain ophthalmological emergencies in his or her practice as a first line and refer certain ophthalmologic emergencies. However, the training of GPs in this specialty must be reinforced in collaboration with ophthalmologists.
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Affiliation(s)
- L-M Dos Santos
- Service des urgences, centre hospitalo-universitaire de Reims, rue du Général Koenig, 51092 Reims, France; Département de médecine générale, UFR Médecine de Reims, 51, rue Cognacq-Jay, 51100 Reims, France
| | - C Arndt
- Service d'ophtalmologie, centre hospitalo-universitaire de Reims, rue du Général Koenig, 51092 Reims, France
| | - A Hurtaud
- Département de médecine générale, UFR Médecine de Reims, 51, rue Cognacq-Jay, 51100 Reims, France
| | - C Carolet
- Service des urgences, centre hospitalo-universitaire de Reims, rue du Général Koenig, 51092 Reims, France
| | - T Kritly
- Département de médecine générale, UFR Médecine de Reims, 51, rue Cognacq-Jay, 51100 Reims, France
| | - A Henry
- Service d'ophtalmologie, centre hospitalo-universitaire de Reims, rue du Général Koenig, 51092 Reims, France.
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Lardon A, Leveque M, Martinez T, Bretagnolle C, Henry A. [Supply of sterile medical devices to an interventional technical platform via mobile RFID technology]. Ann Pharm Fr 2022; 81:568-578. [PMID: 36513150 DOI: 10.1016/j.pharma.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 12/01/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
This work presents the eight-month assessment of the mobile RFID (radio frequency identification) technology implementation for the management of sterile medical devices in an interventional cardiology department. Several indicators dedicated to stock management, organizational impact (within the pharmacy and the department) and economic impact were collected. The scope of MDS tracked by RFID was defined as well as the new supply circuit. In total, 297 (83%) references were managed by RFID. At eight months, the number of MDS units in stock has decreased by 35% and the number of overstocked references by more than 50%. The value of the inventory decreased by €30,196 (17%) in three months from an initial amount of €17,995. This decrease has been maintained at eight months. The average time spent by the pharmacy technician (PPH) was 66min/d. The paramedical team gained 180min/week. By integrating the cost of the equipment, the annual subscription and the PPH cost, the benefit is estimated at €9555 the first year (then €17,155 the following years). To conclude, RFID has allowed a significant reduction of the stock and its control over time while securing the supply circuit adjusted to the activity. The limits are the absence of interface between the dedicated software and the ordering software as well as the consequent time dedicated by the PPH to this new management mode.
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Affiliation(s)
- A Lardon
- Service pharmaceutique, hôpital de la Croix-Rousse, groupement hospitalier nord, Hospices Civils de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France.
| | - M Leveque
- Service pharmaceutique, hôpital de la Croix-Rousse, groupement hospitalier nord, Hospices Civils de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - T Martinez
- Service de cardiologie interventionnelle, hôpital de la Croix-Rousse, groupement hospitalier nord, Hospices Civils de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - C Bretagnolle
- Service pharmaceutique, hôpital de la Croix-Rousse, groupement hospitalier nord, Hospices Civils de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
| | - A Henry
- Service pharmaceutique, hôpital de la Croix-Rousse, groupement hospitalier nord, Hospices Civils de Lyon, 103, Grande rue de la Croix-Rousse, 69317 Lyon cedex 04, France
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Collinson M, Mason E, Kelley R, Griffiths A, Ashley L, Henry A, Inman H, Cowdell F, Hennell J, Jones L, Walsh M, Ogden M, Farrin A, Surr C. Characteristics and general practice resource use of people with comorbid cancer and dementia in England: a retrospective cross-sectional study. BMC Prim Care 2022; 23:281. [PMID: 36371194 PMCID: PMC9655793 DOI: 10.1186/s12875-022-01882-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022]
Abstract
Background Cancer and dementia are common in older people and management of the conditions as comorbidities can be challenging, yet little is known about the size or characteristics of this group. We aimed to estimate the prevalence, characteristics and general practice resource usage of people living with both conditions in England. Methods Anonymised electronic healthcare records from 391 National Health Service general practices across England using the TPP SystmOne general practice system were obtained from ResearchOne. Data included demographic and clinical characteristics, and general practice healthcare useage (appointments, prescriptions, referrals and secondary care contacts) for people aged 50 and over with a cancer and/or dementia diagnosis consistent with the Quality and Outcomes Framework between 2005 and 2016. Multi-level negative binomial regression was used to analyse the association between having cancer and/or dementia and the number of general practice appointments. Results Data from 162,371 people with cancer and/or dementia were analysed; 3616 (2.2%) people were identified as having comorbid cancer and dementia. Of people with cancer, 3.1% also had dementia, rising to 7.5% (1 in 13 people) in those aged 75 and over. Fewer people with both conditions were female (50.7%) compared to those with dementia alone (65.6%) and those with comorbid cancer and dementia were older than those with cancer alone [mean ages 83 (sd = 7), 69 (sd = 12) respectively]. Those with both conditions were less likely to have lung cancer than those with cancer alone (7.5% vs. 10.3%) but more likely to have prostate cancer (20.9% vs. 15.8%). Additional comorbidities were more prevalent for those with both conditions than those with cancer or dementia alone (68.4% vs. 50.2% vs. 54.0%). In the year following the first record of either condition, people with cancer and dementia had 9% more general practice appointments (IRR:1.09, 95% CI:1.01–1.17) than those with cancer alone and 37% more appointments than those with dementia alone (IRR: 1.37, 95% CI: 1.28–1.47). Conclusions A significant number of people are living with comorbid cancer and dementia in England. This group have additional comorbidity and higher general practice usage than those with cancer/dementia alone. The needs of this group should be considered in future general practice care planning and research. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01882-w.
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Zhong J, Brown S, Serra M, Shuttleworth P, Bownes P, Thompson C, Reed R, Reeves K, Dubec M, McHugh D, Eccles C, Chuter R, Tsang YM, Taylor NJ, West C, Buckley D, Scarsbrook A, Choudhury A, Hoskin P, Henry A. Reirradiation Options for Previously Irradiated Prostate cancer (RO-PIP): Feasibility study investigating toxicity outcomes following reirradiation with stereotactic body radiotherapy (SBRT) versus high-dose-rate brachytherapy (HDR-BT). BMJ Open 2022; 12:e068580. [PMID: 36351720 PMCID: PMC9644357 DOI: 10.1136/bmjopen-2022-068580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Radiotherapy is the most common curative treatment for non-metastatic prostate cancer; however, up to 13% of patients will develop local recurrence within 10 years. Patients can undergo further and potentially curative treatment including salvage surgery, brachytherapy (BT), external beam radiotherapy, high-intensity focused ultrasound and cryotherapy. Systematic review shows that high-dose-rate (HDR) BT and stereotactic body radiotherapy (SBRT) have the best outcomes in terms of biochemical control and lowest side effects. The reirradiation options for previously irradiated prostate cancer (RO-PIP) trial aims to determine the feasibility of recruitment to a trial randomising patients to salvage HDR-BT or SBRT and provide prospective data on patient recorded toxicity outcomes that will inform a future phase III trial. METHODS AND ANALYSIS The primary endpoint of the RO-PIP feasibility study is to evaluate the patient recruitment potential over 2 years to a trial randomising to either SBRT or HDR-BT for patients who develop local recurrence of prostate cancer following previous radiation therapy. The aim is to recruit 60 patients across 3 sites over 2 years and randomise 1:1 to SBRT or HDR-BT. Secondary objectives include recording clinician and patient-reported outcome measures to evaluate treatment-related toxicity. In addition, the study aims to identify potential imaging, genomic and proteomic biomarkers that are predictive of toxicity and outcome based on hypoxia status, a prognostic marker of prostate cancer. ETHICS AND DISSEMINATION This study has been approved by the Yorkshire and The Humber-Bradford Leeds Research Ethics Committee (Reference: 21/YH/0305, IRAS: 297060, January 2022). The results will be presented in national and international conferences, published in peer-reviewed journals and will be communicated to relevant stakeholders. A plain English report will be shared with the study participants, patients' organisations and media. TRIAL REGISTRATION NUMBER ISRCTN 12238218 (Amy Ackroyd NIHR CPMS Team).
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Affiliation(s)
- Jim Zhong
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Radiology, St James's University Hospital, Leeds, UK
| | - Sarah Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - Maria Serra
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Pam Shuttleworth
- Department of Clinical Oncology, St James's University Hospital, Leeds, UK
| | - Peter Bownes
- Department of Clinical Oncology, St James's University Hospital, Leeds, UK
| | | | - Rachel Reed
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Kimberley Reeves
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Michael Dubec
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Damien McHugh
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Cynthia Eccles
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Robert Chuter
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - Yat Man Tsang
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - N Jane Taylor
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - Catharine West
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - David Buckley
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Andrew Scarsbrook
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Radiology, St James's University Hospital, Leeds, UK
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Peter Hoskin
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
- Department of Clinical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Ann Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, St James's University Hospital, Leeds, UK
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Swinton M, Mariam N, Tan J, Murphy K, Elumalai T, Soni M, Ferrera A, Richardson C, Walshaw R, Mistry H, Ramani V, Song Y, Birtle A, Henry A, Chan J, Hoskin P, Choudhury A. Clinical Outcomes in cN+M0 Bladder Cancer Patients: Can Bladder be Spared? Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2022.07.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Crowley R, Youssef G, Henry A, Roberts L, Brown MA, Hoffman A, Mangos G, O'Sullivan A, Petit F, Xu L, Davis GK. Echocardiographic assessment of left ventricular structure and function in hypertensive disorders of pregnancy at six months and two years postpartum. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
Hypertensive disorders of pregnancy (HDP) are associated with longer term postpartum cardiovascular sequelae, including double the risk of ischaemic heart disease and cardiovascular mortality (1).
Transthoracic echocardiograms (TTE) were performed in women with pregnancies complicated by gestational hypertension and pre-eclampsia, or uncomplicated pregnancy, at six months and two years postpartum. The aim was to longitudinally assess cardiac structure and function in women with HDP and compare this to women who had a normotensive pregnancy. The six-month results have been previously reported, we now present the two-year data.
Methods
A prospective cohort study was conducted in a pre-specified subgroup of 126 patients within a single, tertiary referral centre as part of the P4 (Post Partum, Physiology, Psychology, and Paediatric Follow Up) study (2). 74 (59%) women had a normotensive pregnancy, and 52 (41%) had a pregnancy complicated by HDP.
Women with pre-existing hypertension were excluded from the study. The mean patient age at time of six-month postpartum TTE was 32 years (range 22–47 years). TTEs were performed by blinded experienced sonographers and reported by a single blinded imaging cardiologist.
Results
Six months postpartum. 126 women underwent TTE at six months postpartum. Although all results fell within normal ranges, compared to women with a normotensive pregnancy, those with HDP had increased left ventricle (LV) wall thickness, higher relative wall thickness, and increased LV mass. E/A ratio was lower, and E/E' ratios higher in the group with pregnancy complicated by HDP, indicating a trend towards poorer diastolic function (2,3).
Two years postpartum. 35 women completed a two year postpartum TTE (18 normotensive, 17 HDP). Measurements fell within normal ranges in both groups of women.
At two years postpartum, women with HDP had larger BSA (1.9 vs 1.71 m2 p=0.003), larger LV internal diastolic diameter (48.4 vs 45.5mm p=0.017) and increased inter-ventricular septum thickness (8.5 vs 7.7mm p=0.007) compared to those with normotensive pregnancy. LV mass was greater in women with HDP (98.1 vs 81.5g), as was LA volume indexed (25.4 vs 23.4 cm3/m3), however these differences did not reach significance (p=0.053 and 0.196 respectively). Compared to normotensive women, those with HDP had higher septal (8.7 vs 7.3 p=0.014) and lateral (6.6 vs 5.4 p=0.017) E/E' ratios, indicating a trend towards diastolic dysfunction.
Conclusion
Despite measurements falling within normal ranges, our results indicate that women with HDP have changes in cardiac structure and function that persist out to two years postpartum. Limitations exist due to incomplete follow up, leading to small sample size; this was partially due to restrictions on service provision in the context of the COVID-19 pandemic.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The St George and Sutherland Research Foundation.Philanthropic donation from Emeritus Professor Richard Henry.
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Affiliation(s)
- R Crowley
- St George Hospital , Sydney , Australia
| | - G Youssef
- St George Hospital , Sydney , Australia
| | - A Henry
- St George Hospital , Sydney , Australia
| | - L Roberts
- St George Hospital , Sydney , Australia
| | - M A Brown
- St George Hospital , Sydney , Australia
| | - A Hoffman
- St George Hospital , Sydney , Australia
| | - G Mangos
- St George Hospital , Sydney , Australia
| | | | - F Petit
- St George Hospital , Sydney , Australia
| | - L Xu
- St George Hospital , Sydney , Australia
| | - G K Davis
- St George Hospital , Sydney , Australia
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Slevin F, Rieu R, Beasley M, Speight R, Aitken K, Good J, McDonald F, Rackley T, Radhakrishna G, Haridass A, Murray L, Tree A, Henry A. Evaluation of the impact of teaching on delineation variation during a virtual SABR contouring workshop. Clin Oncol (R Coll Radiol) 2022. [DOI: 10.1016/j.clon.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Henry A, Dormegnie LP, Ferreira de Moura T, Olory-Garnotel L, Ramoul CE, Maffre C, Celerier I, Arndt C, Denoyer A. Mise en place des examens cliniques objectifs structurés (ECOS) facultaires en ophtalmologie. J Fr Ophtalmol 2022; 45:803-811. [DOI: 10.1016/j.jfo.2022.02.018] [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] [Received: 12/27/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 11/17/2022]
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Rojas-Bracho L, Taylor B, Booth C, Thomas L, Jaramillo-Legorreta A, Nieto-García E, Cárdenas Hinojosa G, Barlow J, Mesnick SL, Gerrodette T, Olson P, Henry A, Rizo H, Hidalgo-Pla E, Bonilla-Garzón A. More vaquita porpoises survive than expected. ENDANGER SPECIES RES 2022. [DOI: 10.3354/esr01197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In 2018, it was estimated that fewer than 20 of Mexico’s endemic vaquita porpoise Phocoena sinus remained, and the species was declining by 47% yr-1. Entanglement in gillnets is the sole threat to the species, and since the last population size estimate, gillnetting has increased in the small area where most vaquitas remain—a 12 × 24 km area in the Gulf of California near San Felipe, Mexico. We conducted research efforts in 2019 and 2021 in that area to estimate the minimum numbers of adults and calves and look for any signs that vaquitas are unhealthy. Through expert elicitation, we estimated between 7 and 15 unique individuals were seen in 2019 and 5-13 were seen in 2021. Calves were seen in both years, and all vaquitas appeared healthy. Population projections from the last full survey indicated that more vaquitas have survived than expected. We suggest that these surviving adult vaquitas may have learned to avoid entanglement in gillnets. These vaquitas and their calves provide hope that the species can survive. However, given the high levels of illegal gillnetting and the theft of equipment which hindered our monitoring efforts, and with only around 10 individuals remaining, survival can only be assured if vaquita habitat is made gillnet-free.
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Affiliation(s)
- L Rojas-Bracho
- PNUD/Sinergiaen en la Comisión Nacional de Áreas Naturales Protegidas, Ensenada, BC, México
| | - B Taylor
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - C Booth
- SMRU Consulting, St Andrews, Fife KY16 8LB, UK
| | - L Thomas
- Centre for Research into Ecological and Environmental Modelling, University of St Andrews, St Andrews, Fife KY16 9LZ, UK
| | | | - E Nieto-García
- Comisión Natural de Áreas Naturales Protegidas, Ensenada, BC, México
| | | | - J Barlow
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - SL Mesnick
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - T Gerrodette
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - P Olson
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - A Henry
- Southwest Fisheries Science Center, National Marine Fisheries Service, National Oceanic and Atmospheric Administration, La Jolla, CA 92037, USA
| | - H Rizo
- Museo de la Ballena y Ciencias del Mar, La Paz, BC 23000, México
| | - E Hidalgo-Pla
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla, CA 92037, USA
| | - A Bonilla-Garzón
- K. Lisa Yang Center for Conservation Bioacoustics, Ithaca, NY 14850, USA
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Ferreira de Moura T, Henry A, Arndt C, Denoyer A, Collot L. Schlaegel lines in a pediatric case of idiopathic multifocal choroiditis. J Fr Ophtalmol 2022; 45:e415-e416. [DOI: 10.1016/j.jfo.2022.05.004] [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] [Received: 03/17/2022] [Revised: 04/27/2022] [Accepted: 05/05/2022] [Indexed: 10/17/2022]
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Theophanous S, Samuel R, Lilley J, Henry A, Sebag-Montefiore D, Gilbert A, Appelt AL. Prognostic factors for patients with anal cancer treated with conformal radiotherapy-a systematic review. BMC Cancer 2022; 22:607. [PMID: 35659632 PMCID: PMC9164501 DOI: 10.1186/s12885-022-09729-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 02/03/2022] [Accepted: 05/30/2022] [Indexed: 02/07/2023] Open
Abstract
AIMS Anal cancer is primarily treated using concurrent chemoradiotherapy (CRT), with conformal techniques such as intensity modulated radiotherapy (IMRT) and volumetric arc therapy (VMAT) now being the standard techniques utilised across the world. Despite this, there is still very limited consensus on prognostic factors for outcome following conformal CRT. This systematic review aims to evaluate the existing literature to identify prognostic factors for a variety of oncological outcomes in anal cancer, focusing on patients treated with curative intent using contemporary conformal radiotherapy techniques. MATERIALS AND METHODS A literature search was conducted using Medline and Embase to identify studies reporting on prognostic factors for survival and cancer-related outcomes after conformal CRT for anal cancer. The prognostic factors which were identified as significant in univariable and multivariable analysis, along with their respective factor effects (where available) were extracted. Only factors reported as prognostic in more than one study were included in the final results. RESULTS The results from 19 studies were analysed. In both univariable and multivariable analysis, N stage, T stage, and sex were found to be the most prevalent and reliable clinical prognostic factors for the majority of outcomes explored. Only a few biomarkers have been identified as prognostic by more than one study - pre-treatment biopsy HPV load, as well as the presence of leukocytosis, neutrophilia and anaemia at baseline measurement. The results also highlight the lack of studies with large cohorts exploring the prognostic significance of imaging factors. CONCLUSION Establishing a set of prognostic and potentially predictive factors for anal cancer outcomes can guide the risk stratification of patients, aiding the design of future clinical trials. Such trials will in turn provide us with greater insight into how to effectively treat this disease using a more personalised approach.
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Affiliation(s)
- Stelios Theophanous
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK.
| | - Robert Samuel
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK
| | - John Lilley
- Department of Medical Physics, Leeds Cancer Centre, St James's University Hospitals, Beckett Street, Leeds, LS9 7TF, UK
| | - Ann Henry
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK
| | - David Sebag-Montefiore
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK
| | - Alexandra Gilbert
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK
| | - Ane L Appelt
- Leeds Institute of Medical Research, University of Leeds, Beckett Street, Leeds, LS9 7TF, UK
- Department of Medical Physics, Leeds Cancer Centre, St James's University Hospitals, Beckett Street, Leeds, LS9 7TF, UK
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Ibrahim M, Henry A, Khaled KJA, Bensa C, Moreau T, Montreuil M, Tourbah A. Health related quality of life and perceived social support in French and Lebanese MS patients: A comparative study. Mult Scler Relat Disord 2022; 61:103758. [PMID: 35378396 DOI: 10.1016/j.msard.2022.103758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 03/07/2022] [Accepted: 03/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The perception of diagnosis announcement, the social support and the coping strategies seem to be determining factors for the quality of life of multiple sclerosis (MS) patients, with possible transcultural variations. This study explores these psychosocial dimensions in Lebanese and French MS patients. METHODS For this cross-sectional multi-center study, 8 questionnaires were used to assess quality of life, family support, coping strategies, mood, fatigue, stress, and hopelessness in MS patients. 7 were translated into Arabic and then back translated into French. These were administered to a group of Lebanese MS patients and compared to an MS sample from France. The data was collected for both populations and analyzed. RESULTS A total of 107 patients were included, 46 Lebanese and 61 French. The majority of MS patients were young females with a high level of education, relapsing remitting form of MS and a low level of disability. Both populations exhibited comparable quality of life and answers on the questionnaires regarding mood disorders, hopelessness, and perceived stress. However, the French patients had significantly more fatigue. Perceived social support given by family was considered greater in the French group compared to the Lebanese one. Also, maladaptive coping strategies (such as self-distraction, denial, behavioral disengagement, substance use, self-blame, venting) were used more frequently by the French population compared to the Lebanese, and this correlated with higher anxiety scores. Diagnosis communication was overall brief, informative, and satisfying in both populations. CONCLUSION This study highlighted transcultural differences between French and Lebanese MS patients mainly in social support and coping strategies.
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Affiliation(s)
- Michella Ibrahim
- Neurology, Hotel Dieu de France, Beirut, Lebanon; Université Saint Joseph, Beirut, Lebanon
| | - A Henry
- Université Reims-Champagne Ardenne, Laboratoire Cognition Santé, Société (C2S - EA 6291), Reims, France; Laboratoire de Psychopathologie et de Neuropsychologie, EA 2027, Paris, France
| | - K J Abou Khaled
- Neurology, Hotel Dieu de France, Beirut, Lebanon; Université Saint Joseph, Beirut, Lebanon
| | - C Bensa
- Neurology, Fondation Rothschild Hospital, Paris, France
| | - T Moreau
- Neurology, CHU de Dijon, Dijon, France
| | - M Montreuil
- Laboratoire de Psychopathologie et de Neuropsychologie, EA 2027, Paris, France
| | - A Tourbah
- Neurology, Hôpital Raymond Poincaré, Garches, APHP, France; UFR Simone Veil, UVSQ, Université Paris Saclay, France; INSERM U 1195 Université Paris Saclay, France.
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Dearnaley D, Hinder V, Hijab A, Horan G, Srihari N, Rich P, Houston G, Henry A, Gibbs S, Venkitaraman R, Cruickshank C, Hassan S, Mason M, Pedley I, Payne H, Brock S, Wade R, Robinson A, Din O, Lees K, Murray J, Parker C, Griffin C, Sohaib A, Hall E. OC-0105 PROMPTS RCT of screening MRI for spinal cord compression in prostate cancer (ISRCTN74112318). Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02481-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Henry A, Allain P, Potard C. Relationships between Theory of Mind and Attachment Styles in Emerging Adulthood. J Adult Dev 2022. [DOI: 10.1007/s10804-022-09399-3] [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: 12/01/2022]
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Velikova G, Absolom K, Hewison J, Holch P, Warrington L, Avery K, Richards H, Blazeby J, Dawkins B, Hulme C, Carter R, Glidewell L, Henry A, Franks K, Hall G, Davidson S, Henry K, Morris C, Conner M, McParland L, Walker K, Hudson E, Brown J. Electronic self-reporting of adverse events for patients undergoing cancer treatment: the eRAPID research programme including two RCTs. Programme Grants Appl Res 2022. [DOI: 10.3310/fdde8516] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
Cancer is treated using multiple modalities (e.g. surgery, radiotherapy and systemic therapies) and is frequently associated with adverse events that affect treatment delivery and quality of life. Regular adverse event reporting could improve care and safety through timely detection and management. Information technology provides a feasible monitoring model, but applied research is needed. This research programme developed and evaluated an electronic system, called eRAPID, for cancer patients to remotely self-report adverse events.
Objectives
The objectives were to address the following research questions: is it feasible to collect adverse event data from patients’ homes and in clinics during cancer treatment? Can eRAPID be implemented in different hospitals and treatment settings? Will oncology health-care professionals review eRAPID reports for decision-making? When added to usual care, will the eRAPID intervention (i.e. self-reporting with tailored advice) lead to clinical benefits (e.g. better adverse event control, improved patient safety and experiences)? Will eRAPID be cost-effective?
Design
Five mixed-methods work packages were conducted, incorporating co-design with patients and health-care professionals: work package 1 – development and implementation of the electronic platform across hospital centres; work package 2 – development of patient-reported adverse event items and advice (systematic and scoping reviews, patient interviews, Delphi exercise); work package 3 – mapping health-care professionals and care pathways; work package 4 – feasibility pilot studies to assess patient and clinician acceptability; and work package 5 – a single-centre randomised controlled trial of systemic treatment with a full health economic assessment.
Setting
The setting was three UK cancer centres (in Leeds, Manchester and Bristol).
Participants
The intervention was developed and evaluated with patients and clinicians. The systemic randomised controlled trial included 508 participants who were starting treatment for breast, colorectal or gynaecological cancer and 55 health-care professionals. The radiotherapy feasibility pilot recruited 167 patients undergoing treatment for pelvic cancers. The surgical feasibility pilot included 40 gastrointestinal cancer patients.
Intervention
eRAPID is an online system that allows patients to complete adverse event/symptom reports from home or hospital. The system provides immediate severity-graded advice based on clinical algorithms to guide self-management or hospital contact. Adverse event data are transferred to electronic patient records for review by clinical teams. Patients complete an online symptom report every week and whenever they experience symptoms.
Main outcome measures
In systemic treatment, the primary outcome was Functional Assessment of Cancer Therapy – General, Physical Well-Being score assessed at 6, 12 and 18 weeks (primary end point). Secondary outcomes included cost-effectiveness assessed through the comparison of health-care costs and quality-adjusted life-years. Patient self-efficacy was measured (using the Self-Efficacy for Managing Chronic Diseases 6-item Scale). The radiotherapy pilot studied feasibility (recruitment and attrition rates) and selection of outcome measures. The surgical pilot examined symptom report completeness, system actions, barriers to using eRAPID and technical performance.
Results
eRAPID was successfully developed and introduced across the treatments and centres. The systemic randomised controlled trial found no statistically significant effect of eRAPID on the primary end point at 18 weeks. There was a significant effect at 6 weeks (adjusted difference least square means 1.08, 95% confidence interval 0.12 to 2.05; p = 0.028) and 12 weeks (adjusted difference least square means 1.01, 95% confidence interval 0.05 to 1.98; p = 0.0395). No between-arm differences were found for admissions or calls/visits to acute oncology or chemotherapy delivery. Health economic analyses over 18 weeks indicated no statistically significant difference between the cost of the eRAPID information technology system and the cost of usual care (£12.28, 95% confidence interval –£1240.91 to £1167.69; p > 0.05). Mean differences were small, with eRAPID having a 55% probability of being cost-effective at the National Institute for Health and Care Excellence-recommended cost-effectiveness threshold of £20,000 per quality-adjusted life-year gained. Patient self-efficacy was greater in the intervention arm (0.48, 95% confidence interval 0.13 to 0.83; p = 0.0073). Qualitative interviews indicated that many participants found eRAPID useful for support and guidance. Patient adherence to adverse-event symptom reporting was good (median compliance 72.2%). In the radiotherapy pilot, high levels of consent (73.2%) and low attrition rates (10%) were observed. Patient quality-of-life outcomes indicated a potential intervention benefit in chemoradiotherapy arms. In the surgical pilot, 40 out of 91 approached patients (44%) consented. Symptom report completion rates were high. Across the studies, clinician intervention engagement was varied. Both patient and staff feedback on the value of eRAPID was positive.
Limitations
The randomised controlled trial methodology led to small numbers of patients simultaneously using the intervention, thus reducing overall clinician exposure to and engagement with eRAPID. Furthermore, staff saw patients across both arms, introducing a contamination bias and potentially reducing the intervention effect. The health economic results were limited by numbers of missing data (e.g. for use of resources and EuroQol-5 Dimensions).
Conclusions
This research provides evidence that online symptom monitoring with inbuilt patient advice is acceptable to patients and clinical teams. Evidence of patient benefit was found, particularly during the early phases of treatment and in relation to self-efficacy. The findings will help improve the intervention and guide future trial designs.
Future work
Definitive trials in radiotherapy and surgical settings are suggested. Future research during systemic treatments could study self-report online interventions to replace elements of traditional follow-up care in the curative setting. Further research during modern targeted treatments (e.g. immunotherapy and small-molecule oral therapy) and in metastatic disease is recommended.
Trial registration
The systemic randomised controlled trial is registered as ISRCTN88520246. The radiotherapy trial is registered as ClinicalTrials.gov NCT02747264.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Galina Velikova
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate Absolom
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Patricia Holch
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Psychology Group, School of Social Sciences, Leeds Beckett University, Leeds, UK
| | - Lorraine Warrington
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Kerry Avery
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Hollie Richards
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane Blazeby
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bryony Dawkins
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Claire Hulme
- Health Economics Group, Institute of Health Research, University of Exeter, Exeter, UK
| | - Robert Carter
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
| | - Liz Glidewell
- Department of Health Sciences, University of York, York, UK
| | - Ann Henry
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kevin Franks
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Geoff Hall
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Karen Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Lucy McParland
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Katrina Walker
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Eleanor Hudson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julia Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
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Henry A, Pieters BR, André Siebert F, Hoskin P. GEC-ESTRO ACROP prostate brachytherapy guidelines. Radiother Oncol 2022; 167:244-251. [PMID: 34999134 DOI: 10.1016/j.radonc.2021.12.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 12/09/2021] [Accepted: 12/31/2021] [Indexed: 02/07/2023]
Abstract
This is an evidence-based guideline for prostate brachytherapy. Throughout levels of evidence quoted are those from the Oxford Centre for Evidence based Medicine (https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009). Prostate interstitial brachytherapy using either permanent or temporary implantation is an established and evolving treatment technique for non-metastatic prostate cancer. Permanent brachytherapy uses Low Dose Rate (LDR) sources, most commonly I-125, emitting photon radiation over months. Temporary brachytherapy involves first placing catheters within the prostate and, on confirmation of accurate positioning, temporarily introducing the radioactive source, generally High Dose Rate (HDR) radioactive sources of Ir-192 or less commonly Co-60. Pulsed dose rate (PDR) brachytherapy has also been used for prostate cancer [1] but few centres have adopted this approach. Previous GEC ESTRO recommendations have considered LDR and HDR separately [2-4] but as there is considerable overlap, this paper provides updated guidance for both treatment techniques. Prostate brachytherapy allows safe radiation dose escalation beyond that achieved using external beam radiotherapy alone as it has greater conformity around the prostate, sparing surrounding rectum, bladder, and penile bulb. In addition there are fewer issues with changes in prostate position during treatment delivery. Systematic review and randomised trials using both techniques as boost treatments demonstrate improved PSA control when compared to external beam radiotherapy alone [5-7].
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Affiliation(s)
- Ann Henry
- St James University Hospital, Leeds, UK
| | - Bradley R Pieters
- Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank André Siebert
- University of Kiel/University Hospital Schleswig-Holstein Campus Kiel, Germany
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; University of Manchester, Manchester, UK.
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Branney P, Walters E, Bryant E, Hollhead C, Njoku K, Vyas L, Modica C, Kayes O, Eardley I, Henry A. The feasibility of patient reported outcome measures for the care of penile cancer. Int J of Uro Nursing 2021. [DOI: 10.1111/ijun.12307] [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] [Indexed: 11/28/2022]
Affiliation(s)
- Peter Branney
- Division of Psychology University of Bradford Bradford UK
| | | | - Eleanor Bryant
- Division of Psychology University of Bradford Bradford UK
| | - Cyan Hollhead
- Division of Psychology University of Bradford Bradford UK
| | - Kelechi Njoku
- Pyrah Department of Urology Leeds NHS Teaching Hospitals Leeds UK
| | - Lona Vyas
- Pyrah Department of Urology Leeds NHS Teaching Hospitals Leeds UK
| | - Ciara Modica
- Pyrah Department of Urology Leeds NHS Teaching Hospitals Leeds UK
| | - Olly Kayes
- Pyrah Department of Urology Leeds NHS Teaching Hospitals Leeds UK
| | - Ian Eardley
- Pyrah Department of Urology Leeds NHS Teaching Hospitals Leeds UK
| | - Ann Henry
- Leeds Institute of Medical Research, University of Leeds Leeds UK
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Henry A, Lee C, Haniff W, Isa W, Mohamed MS, Kader MA, Ghazi AM, Fegade M, Mukundadevan V, Kim H, Lim J, Queck G. Malaysian Heart Failure (MYHF) Registry substantiates high burden of comorbidities across the continuum of ejection fraction in Malaysian HF patients. Int J Cardiol 2021. [DOI: 10.1016/j.ijcard.2021.10.055] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kennedy R, Roberts L, Davis G, Mangos G, Pettit F, Brown MA, O'Sullivan AJ, Henry A. The P4 study: Subsequent pregnancy maternal physiology after hypertensive and normotensive pregnancies. Pregnancy Hypertens 2021; 27:29-34. [PMID: 34864294 DOI: 10.1016/j.preghy.2021.10.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/09/2021] [Accepted: 10/22/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Hypertensive disorders of pregnancy are associated with subsequent increased risk of cardiometabolic disease. Adverse cardiometabolic measures are noted soon after hypertensive versus normotensive pregnancy (NP); to what degree these persist into a subsequent pregnancy (SP) is unknown. This study aimed to assess women's physiology early in SP after hypertensive pregnancy (HP: preeclampsia or gestational hypertension) or NP and compare SP to 6 months postpartum findings from the index pregnancy. STUDY DESIGN Prospective sub-study of the P4 (Postpartum, Physiology, Psychology and Paediatric) observational cohort. Measurements six months after NP versus HP, and the SP at 11-13 weeks gestation. MAIN OUTCOME MEASURES Blood pressure (BP), blood and urine tests (urine ACR, HOMA-IR, LDL cholesterol), body composition, and contribution of maternal characteristics and inter-pregnancy factors to BP and body fat (FM%) in SP. RESULTS 49 women (34 NP, 15 HP). In the SP, post-HP women had higher BP (112/70 mmHg HP vs 102/64 mmHg NP; p < .001), with no significant drop from six months postpartum to early SP. On regression analysis, systolic and diastolic BP at 6-months were the major predictors for SP systolic (p < 0.001) and diastolic (p = 0.009) BP respectively in the SP. Longer interpregnancy interval and increased FM% 6-months postpartum were associated with higher SP FM% (p < 0.001). CONCLUSIONS BP and body fat six months postpartum were similar early in the SP for HP group, and postpartum BP and FM% were major predictors of their corresponding SP measurements. Postpartum/inter-pregnancy intervention programs to improve these cardiometabolic risk markers might help improve women's long-term health and require investigation.
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Affiliation(s)
- R Kennedy
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia; St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia.
| | - L Roberts
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Women and Children's Health, St George Hospital, Sydney, Australia
| | - G Davis
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia; St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Women and Children's Health, St George Hospital, Sydney, Australia
| | - G Mangos
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Renal Medicine, St George Hospital, Sydney, Australia
| | - F Pettit
- Department of Renal Medicine, St George Hospital, Sydney, Australia
| | - M A Brown
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Renal Medicine, St George Hospital, Sydney, Australia
| | - A J O'Sullivan
- St George and Sutherland Clinical School, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Endocrinology, St George Hospital, Sydney, Australia
| | - A Henry
- School of Women's and Children's Health, UNSW Medicine and Health, UNSW Sydney, Australia; Department of Women and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, Sydney, Australia.
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Brown S, Beasley M, Aznar MC, Belderbos J, Chuter R, Cobben D, Faivre-Finn C, Franks K, Henry A, Murray L, Price G, van Herk M. The Impact of Intra-thoracic Anatomical Changes upon the Delivery of Lung Stereotactic Ablative Radiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:e413-e421. [PMID: 34001380 DOI: 10.1016/j.clon.2021.04.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 01/23/2021] [Revised: 03/29/2021] [Accepted: 04/21/2021] [Indexed: 12/25/2022]
Abstract
AIMS So far, the impact of intra-thoracic anatomical changes (ITACs) on patients treated with stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer is unknown. Studying these is important, as ITACs have the potential to impact the workflow and reduce treatment quality. The aim of this study was to assess and categorise ITACs, as detected on cone beam computed tomography scans (CBCT), and their subsequent impact upon treatment in lung cancer patients treated with SABR. MATERIALS AND METHODS CBCTs from 100 patients treated with SABR for early non-small cell lung cancer were retrospectively reviewed. The presence of the following ITACs was assessed: atelectasis, infiltrative change, pleural effusion, baseline shift and gross tumour volume (GTV) increase and decrease. ITACs were graded using a traffic light protocol. This was adapted from a tool previously developed to assesses potential target undercoverage or organ at risk overdose. The frequency of physics or clinician review was noted. A linear mixed effects model was used to assess the relationship between ITAC grade and set-up time (time from first CBCT to beam delivery). RESULTS ITACs were observed in 22% of patients. Twenty-one per cent of these were categorised as 'red', implying a risk of underdosage to the GTV. Most were 'yellow' (51%), indicating little impact upon planning target volume coverage of the GTV. Physics or clinician review was required in 10% of all treatment fractions overall. Three patients needed their treatment replanned. The mixed effect model analysis showed that ITACs cause a significant prolongation of set-up time (Χ2(3) = 9.22, P = 0.02). CONCLUSION Most ITACs were minor, but associated with unplanned physics or clinician review, representing a potentially significant resource burden. ITACs also had a significant impact upon set-up time, with consequences for the wider workflow and intra-fraction motion. Detailed guidance on the management of ITACs is needed to provide support for therapeutic radiographers delivering lung SABR.
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Affiliation(s)
- S Brown
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Gloucestershire Oncology Centre, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK.
| | - M Beasley
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M C Aznar
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - J Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - R Chuter
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - D Cobben
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - C Faivre-Finn
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - K Franks
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Henry
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - L Murray
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - G Price
- Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - M van Herk
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Ager M, Njoku K, Serra M, Robinson A, Pickering L, Afshar M, Vyas L, Eardley I, Kayes O, Elmamoun M, Khoo V, Ayres B, Henry A, Watkin N, Tree AC. Long-term multicentre experience of adjuvant radiotherapy for pN3 squamous cell carcinoma of the penis. BJU Int 2021; 128:451-459. [PMID: 33249744 DOI: 10.1111/bju.15309] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To present the long-term adjuvant radiotherapy outcomes of patients with pN3 squamous cell carcinoma of the penis (SCCp) treated at two UK centres. PATIENTS AND METHODS We conducted a retrospective audit of all pN3 SCCp patients, deemed suitable for adjuvant therapy by a specialist multidisciplinary team at St George's and Leeds Hospitals, who received adjuvant radiotherapy. Primary outcomes were recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Secondary outcomes were time to adjuvant treatment, frequency of in-field recurrence, site and side of recurrence, and dose and schedule of radiotherapy. RESULTS A total of 146 patients were included: 121 completed radiotherapy, 4 did not complete radiotherapy and 21 did not start it. The median (interquartile range [IQR]) age was 59 (54-70)years. The 5-year RFS was 51%, CSS was 51% and OS was 44%. Adjuvant radiotherapy was started at a median (IQR) of 75 (48-106) days. A dose of 45 Gy in 20 fractions was most commonly used. Of the 125 patients who started adjuvant treatment, 55 relapsed. Of these relapses, 30 occurred in an inguinal or pelvic nodal station and 26 of the 30 were in a radiation field. Relapses in 18 of the 55 cases were in visceral sites only and seven were in both nodal (non-irradiated sites) and visceral sites. Doses of <50 Gy were used more commonly before 2013 and higher doses (>50 Gy) were more commonly used after 2013. CONCLUSIONS Application of a standard radiotherapy protocol within a centralized supra-network setting has achieved survival outcomes that would appear better than those previously documented for either radiotherapy or chemotherapy in a cohort with solely pN3 disease. The addition of adjuvant chemotherapy may improve these outcomes further. These data suggest that adjuvant radiotherapy has a role to play in the management of men with pN3 SCCp.
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Affiliation(s)
| | | | - Maria Serra
- Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | | | | | | | - Lona Vyas
- Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Ian Eardley
- Leeds Teaching Hospital NHS Trust, Leeds, UK
| | | | | | - Vincent Khoo
- Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | | | - Ann Henry
- Leeds Teaching Hospital NHS Trust, Leeds, UK
- University of Leeds, Leeds, UK
| | | | - Alison C Tree
- Royal Marsden Hospital and the Institute of Cancer Research, London, UK
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Schmid F, Huyghebaert T, Bertrand A, Cartier M, Deleau K, Henry A, Stefaniak N. Le burn-out est-il une entité nosographique distincte ? Psychologie Française 2021. [DOI: 10.1016/j.psfr.2020.07.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Brown M, Roberts L, Hoffman A, Mangos G, Pettit F, Henry A, Worboys J, Ryan H, Davis G. SY7-4. Blood pressure after normal and pre-eclamptic pregnancy. Pregnancy Hypertens 2021. [DOI: 10.1016/j.preghy.2021.07.281] [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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Griffiths AW, Ashley L, Kelley R, Cowdell F, Collinson M, Mason E, Inman H, Henry A, Farrin A, Surr C. Balancing the needs of individuals and services in cancer treatment for people with dementia: A focused ethnographic study. Int J Nurs Stud 2021; 121:104006. [PMID: 34271462 PMCID: PMC8404043 DOI: 10.1016/j.ijnurstu.2021.104006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 05/26/2021] [Accepted: 06/14/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Managing multiple conditions is difficult for patients and their families, increasing complexity in care. Two of the most common long-term conditions, cancer and dementia, both disproportionately affect older adults. However, little is known about the needs and experiences of those living with both conditions, which could inform practice in the area. OBJECTIVES This focused ethnographic study sought to understand how oncology services balance the unique and complex needs of these patients with those of the service more widely. DESIGN Focused ethnography. SETTING Two National Health Service hospital trusts. PARTICIPANTS Seventeen people with dementia and cancer, 22 relatives and 19 staff members participated. METHODS Participant observation, informal conversations, semi-structured interviews, and medical notes review. RESULTS Improved satisfaction and outcomes of care were reported when staff were delivering person-centred care. Staff tried to balance the need for personalised and flexible support for individuals with dementia with managing targets and processes of cancer care and treatment. The importance of continuity of people, places, and processes was consistently highlighted. CONCLUSION Navigating and managing the delicate balance between the needs of the individual and the needs of services more widely was difficult for both staff and patients. Improved awareness, identification and documentation of dementia would help to ensure that staff are aware of any specific patient needs. Consistency in staffing and appointment locations should develop familiarity and routine for people with dementia.
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Affiliation(s)
| | | | | | - Fiona Cowdell
- Birmingham City University, Birmingham, United Kingdom
| | - Michelle Collinson
- Leeds Institute of Clinical Trials Research, University of Leeds, United Kingdom
| | - Ellen Mason
- Leeds Institute of Clinical Trials Research, University of Leeds, United Kingdom
| | - Hayley Inman
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, United Kingdom
| | - Ann Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Amanda Farrin
- Leeds Institute of Clinical Trials Research, University of Leeds, United Kingdom
| | - Claire Surr
- Leeds Beckett University, Leeds, United Kingdom
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Huddart R, Hafeez S, Omar A, Choudhury A, Birtle A, Syndikus I, Hindson B, Varughese M, Henry A, McLaren D, Foroud F, Webster A, McNair H, Tolentino A, Webster L, Gribble H, Philipps L, Nikapota A, Parikh O, Alonzi R, Mahmood R, Hilman S, Rimmer Y, Griffin C, Hall E. OC-0513 Acute toxicity of hypo- and conventionally-fractionated radiosensitised bladder radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Defourny N, Spencer K, Tunstall D, Cosgrove V, Kirkby K, Henry A, Lievens Y, Hall P. OC-0058 Impact of increased hypofractionation on treatment cost. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06752-9] [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: 10/20/2022]
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43
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Choi SKY, Gordon A, Hilder L, Henry A, Hyett JA, Brew BK, Joseph F, Jorm L, Chambers GM. Performance of six birth-weight and estimated-fetal-weight standards for predicting adverse perinatal outcome: a 10-year nationwide population-based study. Ultrasound Obstet Gynecol 2021; 58:264-277. [PMID: 32672406 DOI: 10.1002/uog.22151] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/17/2020] [Accepted: 07/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To evaluate three birth-weight (BW) standards (Australian population-based, Fenton and INTERGROWTH-21st ) and three estimated-fetal-weight (EFW) standards (Hadlock, INTERGROWTH-21st and WHO) for classifying small-for-gestational age (SGA) and large-for-gestational age (LGA) and predicting adverse perinatal outcomes in preterm and term babies. METHODS This was a nationwide population-based study conducted on a total of 2.4 million singleton births that occurred from 24 + 0 to 40 + 6 weeks' gestation between 2004 and 2013 in Australia. The performance of the growth charts was evaluated according to SGA and LGA classification, and relative risk (RR) and diagnostic accuracy based on the areas under the receiver-operating-characteristics curves (AUCs) for stillbirth, neonatal death, perinatal death, composite morbidity and a composite of perinatal death and morbidity outcomes. The analysis was stratified according to gestational age at delivery (< 37 + 0 vs ≥ 37 + 0 weeks). RESULTS Following exclusions, 2 392 782 singleton births were analyzed. There were significant differences in the SGA and LGA classification and risk of adverse outcomes between the six BW and EFW standards evaluated. For the term group, compared with the other standards, the INTERGROWTH-21st BW and EFW standards classified half the number of SGA (< 10th centile) babies (3-4% vs 7-11%) and twice the number of LGA (> 90th centile) babies (24-25% vs 8-15%), resulting in a smaller cohort of term SGA at higher risk of adverse outcome and a larger LGA cohort at lower risk of adverse outcome. For term SGA (< 3rd centile) babies, the RR of perinatal death using the two INTERGROWTH-21st standards was up to 1.5-fold higher than those of the other standards (including the WHO-EFW and Hadlock-EFW), while the INTERGROWTH-21st -EFW standard indicated a 12-26% reduced risk of perinatal death for LGA cases across centile thresholds. Conversely, for the preterm group, the WHO-EFW and Hadlock-EFW standards identified a higher SGA classification rate than did the other standards (18-19% vs 10-11%) and a 20-65% increased risk of perinatal death in term LGA babies. All BW and EFW charts had similarly poor performance in predicting adverse outcomes, including the composite outcome (AUC range, 0.49-0.62) for both preterm (AUC range, 0.58-0.62) and term (AUC range, 0.49-0.50) cases and across centiles. Furthermore, specific centile thresholds for identifying adverse outcomes varied markedly by chart between BW and EFW standards. CONCLUSIONS This study addresses the recurrent problem of identifying fetuses at risk of morbidity and perinatal mortality associated with growth disorders and provides new insights into the applicability of international growth standards. Our findings of marked variation in classification and the similarly poor performance of prescriptive international standards and the other commonly used standards raise questions about whether the prescriptive international standards that were constructed for universal adoption are indeed applicable to a multiethnic population such as that of Australia. Thus, caution is needed when adopting universal standards for clinical and epidemiological use. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- S K Y Choi
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - A Gordon
- Newborn Care, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Charles Perkins Centre, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - L Hilder
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - A Henry
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Women's and Children's Health, St George Hospital, Sydney, New South Wales, Australia
| | - J A Hyett
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - B K Brew
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - F Joseph
- Department of High Risk Obstetrics, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - L Jorm
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - G M Chambers
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- National Perinatal Epidemiology and Statistics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Henry A, Berquand A, Terryn C, Maurice P, Bennasroune A, Blaise S, Romier-Crouzet B, Sartelet H, Gillery P, Jaisson S, Duca L. Effect of elastin-derived peptides (EDPS) and carbamylated-EDPS on vascular smooth muscle cells phenotype in relation to atherosclerosis development. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.192] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Speight R, Dubec M, Eccles C, George B, Henry A, Herbert T, Johnstone R, Liney G, McCallum H, Schmidt M. PO-1732 IPEM Guidelines on the use of MRI for external beam radiotherapy treatment planning. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08183-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zhong J, Slevin F, Scarsbrook A, Serra M, Choudhury A, Hoskin P, Brown S, Henry A. PO-1346 Systematic Review of Salvage Reirradiation Options for Locally Recurrent Prostate Cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07797-5] [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: 10/20/2022]
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Moris L, Gandaglia G, Vilaseca A, Van den Broeck T, Briers E, De Santis M, Gillessen S, Grivas N, O'Hanlon S, Henry A, Lam TB, Lardas M, Mason M, Oprea-Lager D, Ploussard G, Rouviere O, Schoots IG, van der Poel H, Wiegel T, Willemse PP, Yuan CY, Grummet JP, Tilki D, van den Bergh RCN, Cornford P, Mottet N. Evaluation of Oncological Outcomes and Data Quality in Studies Assessing Nerve-sparing Versus Non-Nerve-sparing Radical Prostatectomy in Nonmetastatic Prostate Cancer: A Systematic Review. Eur Urol Focus 2021; 8:690-700. [PMID: 34147405 DOI: 10.1016/j.euf.2021.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/10/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Surgical techniques aimed at preserving the neurovascular bundles during radical prostatectomy (RP) have been proposed to improve functional outcomes. However, it remains unclear if nerve-sparing (NS) surgery adversely affects oncological metrics. OBJECTIVE To explore the oncological safety of NS versus non-NS (NNS) surgery and to identify factors affecting the oncological outcomes of NS surgery. EVIDENCE ACQUISITION Relevant databases were searched for English language articles published between January 1, 1990 and May 8, 2020. Comparative studies for patients with nonmetastatic prostate cancer (PCa) treated with primary RP were included. NS and NNS techniques were compared. The main outcomes were side-specific positive surgical margins (ssPSM) and biochemical recurrence (BCR). Risk of bias (RoB) and confounding assessments were performed. EVIDENCE SYNTHESIS Out of 1573 articles identified, 18 studies recruiting a total of 21 654 patients were included. The overall RoB and confounding were high across all domains. The most common selection criteria for NS RP identified were characteristic of low-risk disease, including low core-biopsy involvement. Seven studies evaluated the link with ssPSM and showed an increase in ssPSM after adjustment for side-specific confounders, with the relative risk for NS RP ranging from 1.50 to 1.53. Thirteen papers assessing BCR showed no difference in outcomes with at least 12 mo of follow-up. Lack of data prevented any subgroup analysis for potentially important variables. The definitions of NS were heterogeneous and poorly described in most studies. CONCLUSIONS Current data revealed an association between NS surgery and an increase in the risk of ssPSM. This did not translate into a negative impact on BCR, although follow-up was short and many men harbored low-risk PCa. There are significant knowledge gaps in terms of how various patient, disease, and surgical factors affect outcomes. Adequately powered and well-designed prospective trials and cohort studies accounting for these issues with long-term follow-up are recommended. PATIENT SUMMARY Neurovascular bundles (NVBs) are structures containing nerves and blood vessels. The NVBs close to the prostate are responsible for erections. We reviewed the literature to determine if a technique to preserve the NVBs during removal of the prostate causes worse cancer outcomes. We found that NVB preservation was poorly defined but, if applied, was associated with a higher risk of cancer at the margins of the tissue removed, even in patients with low-risk prostate cancer. The long-term importance of this finding for patients is unclear. More data are needed to provide recommendations.
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Affiliation(s)
- Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antoni Vilaseca
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Maria De Santis
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland
| | - Nikos Grivas
- Department of Urology, Hatzikosta General Hospital, Ioannina, Greece
| | - Shane O'Hanlon
- Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland
| | - Ann Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Thomas B Lam
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | - Malcolm Mason
- Division of Cancer & Genetics, School of Medicine Cardiff University, UK
| | - Daniela Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | | | - Olivier Rouviere
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul Willemse
- Department of Oncological Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cathy Y Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | - Jeremy P Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Philip Cornford
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
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Potard C, Pochon R, Henry A, Combes C, Kubiszewski V, Roy A. Relationships Between School Bullying and Frustration Intolerance Beliefs in Adolescence: A Gender-Specific Analysis. J Rat-Emo Cognitive-Behav Ther 2021. [DOI: 10.1007/s10942-021-00402-6] [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: 01/20/2023]
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Moris L, Gandaglia G, Vilaseca A, Van Den Broeck T, Briers E, De Santis M, Gillessen S, Grivas N, Henry A, Lam T, Lardas M, Mason M, Oprea-Lager D, Ploussard G, Rouvière O, Schoots I, Van Der Poel H, Wiegel T, Willemse PP, Grummet J, Tilke D, Van Den Bergh R, Cornford P, Mottet N. Evaluation of oncological outcomes and data quality in studies assessing nerve sparing versus non-nerve sparing radical prostatectomy in non-metastatic prostate cancer: A systematic review. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00684-9] [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: 11/15/2022]
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Huddart R, Hafeez S, Lewis R, McNair H, Syndikus I, Henry A, Staffurth J, Dewan M, Vassallo-Bonner C, Moinuddin SA, Birtle A, Horan G, Rimmer Y, Venkitaraman R, Khoo V, Mitra A, Hughes S, Gibbs S, Kapur G, Baker A, Hansen VN, Patel E, Hall E. Clinical Outcomes of a Randomized Trial of Adaptive Plan-of-the-Day Treatment in Patients Receiving Ultra-hypofractionated Weekly Radiation Therapy for Bladder Cancer. Int J Radiat Oncol Biol Phys 2021; 110:412-424. [PMID: 33316362 PMCID: PMC8114997 DOI: 10.1016/j.ijrobp.2020.11.068] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/18/2020] [Accepted: 11/25/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE Hypofractionated radiation therapy can be used to treat patients with muscle-invasive bladder cancer unable to have radical therapy. Toxicity is a key concern, but adaptive plan-of the day (POD) image-guided radiation therapy delivery could improve outcomes by minimizing the volume of normal tissue irradiated. The HYBRID trial assessed the multicenter implementation, safety, and efficacy of this strategy. METHODS HYBRID is a Phase II randomized trial that was conducted at 14 UK hospitals. Patients with T2-T4aN0M0 muscle-invasive bladder cancer unsuitable for radical therapy received 36 Gy in 6 weekly fractions, randomized (1:1) to standard planning (SP) or adaptive planning (AP) using a minimization algorithm. For AP, a pretreatment cone beam computed tomography (CT) was used to select the POD from 3 plans (small, medium, and large). Follow-up included standard cystoscopic, radiologic, and clinical assessments. The primary endpoint was nongenitourinary Common Terminology Criteria for Adverse Events (CTCAE) grade ≥ 3 (≥G3) toxicity within 3 months of radiation therapy. A noncomparative single stage design aimed to exclude ≥30% toxicity rate in each planning group in patients who received ≥1 fraction of radiation therapy. Local control at 3-months (both groups combined) was a key secondary endpoint. RESULTS Between April 15, 2014, and August 10, 2016, 65 patients were enrolled (SP, n = 32; AP, n = 33). The median follow-up time was 38.8 months (interquartile range [IQR], 36.8-51.3). The median age was 85 years (IQR, 81-89); 68% of participants (44 of 65) were male; and 98% of participants had grade 3 urothelial cancer. In 63 evaluable participants, CTCAE ≥G3 nongenitourinary toxicity rates were 6% (2 of 33; 95% confidence interval [CI], 0.7%-20.2%) for the AP group and 13% (4 of 30; 95% CI, 3.8%-30.7%) for the SP group. Disease was present in 9/48 participants assessed at 3 months, giving a local control rate of 81.3% (95% CI, 67.4%-91.1%). CONCLUSIONS POD adaptive radiation therapy was successfully implemented across multiple centers. Weekly ultrahypofractionated 36 Gy/6 fraction radiation therapy is safe and provides good local control rates in this older patient population.
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Affiliation(s)
- Robert Huddart
- The Institute of Cancer Research, London, United Kingdom; Royal Marsden NHS Foundation Trust, London, United Kingdom.
| | - Shaista Hafeez
- The Institute of Cancer Research, London, United Kingdom; Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Rebecca Lewis
- The Institute of Cancer Research, London, United Kingdom
| | - Helen McNair
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Isabelle Syndikus
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ann Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Monisha Dewan
- The Institute of Cancer Research, London, United Kingdom
| | | | - Syed Ali Moinuddin
- Academic unit of Oncology, Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, United Kingdom
| | - Alison Birtle
- Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Gail Horan
- Queen Elizabeth Hospital Kings Lynn NHS Trust, Kings Lynn, United Kingdom
| | - Yvonne Rimmer
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | | | - Vincent Khoo
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Anita Mitra
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Simon Hughes
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Stephanie Gibbs
- Barking, Havering and Redbridge University Hospitals NHS Trust, Romford, United Kingdom
| | - Gaurav Kapur
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Angela Baker
- Radiotherapy Department, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | - Emma Patel
- Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
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