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Yasar B, Suh YE, Chapman E, Nicholls L, Henderson D, Jones C, Morrison K, Wells E, Henderson J, Meehan C, Sohaib A, Taylor H, Tree A, van As N. Simultaneous Focal Boost With Stereotactic Radiation Therapy for Localized Intermediate- to High-Risk Prostate Cancer: Primary Outcomes of the SPARC Phase 2 Trial. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)00425-5. [PMID: 38499253 DOI: 10.1016/j.ijrobp.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/20/2024] [Accepted: 03/07/2024] [Indexed: 03/20/2024]
Abstract
PURPOSE Dose-escalated radiation therapy is associated with better biochemical control at the expense of toxicity. Stereotactic body radiation therapy (SBRT) with dose escalation to the dominant intraprostatic lesion (DIL) provides a logical approach to improve outcomes in high-risk disease while limiting toxicity. This study evaluated the toxicity and quality of life (QoL) with CyberKnife-based SBRT and simultaneous integrated boost in localized prostate cancer. METHODS AND MATERIALS Eligible participants included newly diagnosed, biopsy-proven unfavorable intermediate- to high-risk localized prostate cancer (at least 1 of the following: Gleason ≥4+3, magnetic resonance imaging(MRI)-defined T3a N0, prostate-specific antigen ≥20) with up to 2 MRI-identified DILs. Participants received 36.25 Gy in 5 fractions on alternative days with a simultaneous boost to DIL up to 47.5 Gy as allowed by organ-at-risk constraints delivered by CyberKnife. All participants received androgen deprivation therapy. The primary outcome measure was acute grade 2+ genitourinary toxicity. Acute and late genitourinary and gastrointestinal toxicity using Radiation Therapy Oncology Group scoring, biochemical parameters, International Prostate Symptom Score, International Index of Erectile Function 5, and EQ-5D QoL outcomes were assessed. RESULTS Between 2013 and 2023, 20 participants were enrolled with a median follow-up of 30 months. The median D95 dose to DIL was 47.43 Gy. Cumulative acute grade 2+ genitourinary and gastrointestinal toxicity were 25% and 30%, respectively. One patient developed acute grade 3 genitourinary toxicity (5%). There is no late grade 3 genitourinary or gastrointestinal toxicity to date. International Prostate Symptom Score and urinary QoL scores recovered to baseline by 6 months. Patient-reported outcomes showed no significant change in EQ-5D QoL scores at 12 weeks and 1 year. There are no cases of biochemical relapse reported to date. CONCLUSIONS CyberKnife SBRT-delivered dose of 36.25 Gy to the prostate with a simultaneous integrated boost up to 47.5 Gy is well tolerated. Acute and late genitourinary and gastrointestinal toxicity rates are comparable to other contemporary SBRT trials and series with focal boost.
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Affiliation(s)
- Binnaz Yasar
- Royal Marsden NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom.
| | - Yae-Eun Suh
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ewan Chapman
- St Bartholomew's Hospital, London, United Kingdom
| | | | - Daniel Henderson
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Caroline Jones
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kirsty Morrison
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Emma Wells
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Carole Meehan
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Aslam Sohaib
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Helen Taylor
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alison Tree
- Royal Marsden NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
| | - Nicholas van As
- Royal Marsden NHS Foundation Trust, London, United Kingdom; Institute of Cancer Research, London, United Kingdom
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Sritharan K, Akhiat H, Cahill D, Choi S, Choudhury A, Chung P, Diaz J, Dysager L, Hall W, Huddart R, Kerkmeijer LGW, Lawton C, Mohajer J, Murray J, Nyborg CJ, Pos FJ, Rigo M, Schytte T, Sidhom M, Sohaib A, Tan A, van der Voort van Zyp J, Vesprini D, Zelefsky MJ, Tree AC. Development of Prostate Bed Delineation Consensus Guidelines for Magnetic Resonance Image-Guided Radiotherapy and Assessment of Its Effect on Interobserver Variability. Int J Radiat Oncol Biol Phys 2024; 118:378-389. [PMID: 37633499 DOI: 10.1016/j.ijrobp.2023.08.051] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE The use of magnetic resonance imaging (MRI) in radiotherapy planning is becoming more widespread, particularly with the emergence of MRI-guided radiotherapy systems. Existing guidelines for defining the prostate bed clinical target volume (CTV) show considerable heterogeneity. This study aimed to establish baseline interobserver variability (IOV) for prostate bed CTV contouring on MRI, develop international consensus guidelines, and evaluate its effect on IOV. METHODS AND MATERIALS Participants delineated the CTV on 3 MRI scans, obtained from the Elekta Unity MR-Linac, as per their normal practice. Radiation oncologist contours were visually examined for discrepancies, and interobserver comparisons were evaluated against simultaneous truth and performance level estimation (STAPLE) contours using overlap metrics (Dice similarity coefficient and Cohen's kappa), distance metrics (mean distance to agreement and Hausdorff distance), and volume measurements. A literature review of postradical prostatectomy local recurrence patterns was performed and presented alongside IOV results to the participants. Consensus guidelines were collectively constructed, and IOV assessment was repeated using these guidelines. RESULTS Sixteen radiation oncologists' contours were included in the final analysis. Visual evaluation demonstrated significant differences in the superior, inferior, and anterior borders. Baseline IOV assessment indicated moderate agreement for the overlap metrics while volume and distance metrics demonstrated greater variability. Consensus for optimal prostate bed CTV boundaries was established during a virtual meeting. After guideline development, a decrease in IOV was observed. The maximum volume ratio decreased from 4.7 to 3.1 and volume coefficient of variation reduced from 40% to 34%. The mean Dice similarity coefficient rose from 0.72 to 0.75 and the mean distance to agreement decreased from 3.63 to 2.95 mm. CONCLUSIONS Interobserver variability in prostate bed contouring exists among international genitourinary experts, although this is lower than previously reported. Consensus guidelines for MRI-based prostate bed contouring have been developed, and this has resulted in an improvement in contouring concordance. However, IOV persists and strategies such as an education program, development of a contouring atlas, and further refinement of the guidelines may lead to additional improvements.
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Affiliation(s)
- Kobika Sritharan
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom.
| | | | - Declan Cahill
- Department of Urology, Royal Marsden Hospital NHS Trust, London, United Kingdom
| | - Seungtaek Choi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Ananya Choudhury
- Christie National Health Service Foundation Trust, Manchester, United Kingdom; University of Manchester, Manchester, United Kingdom
| | - Peter Chung
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - Lars Dysager
- Department of Oncology, Odense University Hospital, Odense, Denmark
| | - William Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Robert Huddart
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Colleen Lawton
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Julia Murray
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
| | | | - Floris J Pos
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michele Rigo
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar Di Valpolicella, Italy
| | - Tine Schytte
- Department of Oncology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mark Sidhom
- Cancer Therapy Centre, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Aslam Sohaib
- Department of Radiology, Royal Marsden Hospital NHS Trust, Sutton, United Kingdom
| | - Alex Tan
- Sunshine Coast Hospital and Health Service, Queensland, Australia; James Cook University, Townsville, Queensland, Australia
| | | | - Danny Vesprini
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alison C Tree
- Royal Marsden NHS Foundation Trust, Sutton, United Kingdom; Division of Radiotherapy and Imaging, Institute of Cancer Research, Sutton, United Kingdom
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Fagan PJ, Gomes N, Heath OM, Chandrasekaran D, Yao SE, Satchwell L, George A, Banerjee S, Sohaib A, Barton DP, Nobbenhuis M, Ind T, Butler J. The peritoneal cancer index as a predictor of complete cytoreduction at primary and interval cytoreductive surgery in advanced ovarian cancer. Int J Gynecol Cancer 2023; 33:1757-1763. [PMID: 37890875 DOI: 10.1136/ijgc-2022-004093] [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] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE The peritoneal cancer index quantitatively assesses cancer distribution and tumor burden in the peritoneal cavity. The aim of this study is to evaluate the association between the peritoneal cancer index and completeness of surgical cytoreduction for ovarian cancer and to identify a cut-off above which complete cytoreduction is unlikely. METHODS This is a single-center prospective cohort observational study. A total of 100 consecutive patients who underwent ovarian cancer surgery were included. Peritoneal cancer index scores prior to and after surgery were calculated, and a cut-off value for incomplete cytoreduction was identified using a receiver operator characteristic (ROC) curve. Surgical complexity, blood loss, length of surgery, and complications were analyzed and associations with the peritoneal cancer index score were evaluated. RESULTS The overall median peritoneal cancer index score was 9.5 (range 0-36). The median age of the patients was 61 years (range 24-85). The most common stage was III (13% stage II, 53% stage III, 34% stage IV) and the most common histologic sub-type was high-grade serous (76% high-grade serous, 8% low-grade serous, 5% clear cell, 4% serous borderline, 2% endometrioid, 2% adult granulosa cell, 2% adenocarcinoma, 1% carcinosarcoma). Complete cytoreduction was achieved in 82% of patients, with a median score of 9 (range 0-30). The remaining 18% had a median score of 28.5 (range 0-36). The best predictor of incomplete cytoreduction was the peritoneal cancer index score, with an area under the curve (AUC) of 0.928 (95% CI 0.85 to 1.00). ROC curve analysis determined a peritoneal cancer index cut-off score of 20. Major complications occurred in 15% of patients with peritoneal cancer index scores >20 and in 2.5% of patients with scores ≤20, which was statistically significant (p=0.014). CONCLUSIONS In our study we found that a peritoneal cancer index score of ≤20 was associated with a high likelihood of complete cytoreduction. Incorporating the peritoneal cancer index into routine surgical practice and research may impact treatment plans.
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Affiliation(s)
- Paula J Fagan
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
- Gynaecological Cancer Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Nana Gomes
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research (ICR), London, UK
| | - Owen M Heath
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Dhivya Chandrasekaran
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
- Department of Gynaecological Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Shih-Ern Yao
- Department of Gynaecological Oncology, Monash Cancer Centre, Bentleigh East, Victoria, Australia
| | - Laura Satchwell
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Angela George
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research (ICR), London, UK
| | - Susana Banerjee
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research (ICR), London, UK
| | - Aslam Sohaib
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Desmond P Barton
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
- Gynaecological Cancer Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Marielle Nobbenhuis
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Thomas Ind
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
- St George's University of London, London, UK
| | - John Butler
- Department of Gynaecological Oncology, The Royal Marsden NHS Foundation Trust, London, UK
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Hafeez S, Koh M, Jones K, Ghzal AE, D’Arcy J, Kumar P, Khoo V, Lalondrelle S, McDonald F, Thompson A, Scurr E, Sohaib A, Huddart RA. Diffusion-weighted MRI to determine response and long-term clinical outcomes in muscle-invasive bladder cancer following neoadjuvant chemotherapy. Front Oncol 2022; 12:961393. [PMID: 36452501 PMCID: PMC9702046 DOI: 10.3389/fonc.2022.961393] [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] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/29/2022] [Indexed: 09/05/2023] Open
Abstract
Objective This study aims to determine local treatment response and long-term survival outcomes in patients with localised muscle-invasive bladder cancer (MIBC) patients receiving neoadjuvant chemotherapy (NAC) using diffusion-weighted MRI (DWI) and apparent diffusion coefficient (ADC) analysis. Methods Patients with T2-T4aN0-3M0 bladder cancer suitable for NAC were recruited prospectively. DWI was performed prior to NAC and was repeated following NAC completion. Conventional response assessment was performed with cystoscopy and tumour site biopsy. Response was dichotomised into response ( Results Forty-eight patients (96 DWI) were evaluated. NAC response was associated with significant increase in mean ΔADC and %ΔADC compared to poor response (ΔADCall 0.32×10-3 versus 0.11×10-3 mm2/s; p=0.009, and %ΔADCall 21.70% versus 8.23%; p=0.013). Highest specificity predicting response was seen at 75th percentile ADC (AUC, 0.8; p=0.01). Sensitivity, specificity, positive predictive power, and negative predictive power of %ΔADCb100 75th percentile was 73.7%, 90.0%, 96.6%, and 52.9%, respectively. %ΔADCb100 75th percentile >15.5% was associated with significant improvement in OS (HR, 0.40; 95% CI, 0.19-0.86; p=0.0179), bCSS (HR, 0.26; 95% CI, 0.08-0.82; p=0.0214), PFS (HR, 0.16; 95% CI, 0.05-0.48; p=0.0012), and time to cystectomy (HR, 0.19; 95% CI, 0.07-0.47; p=0.0004). Conclusions Quantitative ADC analysis can successfully identify NAC response and improved long-term clinical outcomes. Multi-centre validation to assess reproducibility and repeatability is required before testing within clinical trials to inform MIBC treatment decision making. Advances in knowledge We successfully demonstrated that measured change in DWI can successfully identify NAC response and improved long-term survival outcomes.
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Affiliation(s)
- Shaista Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Diagnostic Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Kelly Jones
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Amir El Ghzal
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - James D’Arcy
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Pardeep Kumar
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Vincent Khoo
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Susan Lalondrelle
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Fiona McDonald
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alan Thompson
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Erica Scurr
- Department of Diagnostic Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Aslam Sohaib
- Department of Diagnostic Radiology, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Robert Anthony Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Urology Unit, The Royal Marsden National Health Service (NHS) Foundation Trust, London, United Kingdom
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Patel M, Ali S, Robson J, Clements R, Theodoulou A, Wright P, Kearney M, Patel R, Sohaib A, Antoniou S. Pharmacist-led multidisciplinary approach in preventing strokes in people with atrial fibrillation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.613] [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: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Targets set by Public Health England (PHE) state that 90% of patients with atrial fibrillation (AF) are expected to receive anticoagulation by 2029. In 2019/2020, across three London boroughs serving a population of 770,000, the percentage of AF patients at high risk of stroke (CHA2DS2VASc>2) anticoagulated was below the target set by PHE. In addition, optimisation of risk factors can significantly reduce the risk of cardiovascular disease and associated mortality in these patients.
Purpose
To provide specialist input from a cardiovascular pharmacist to prevent AF-related strokes through improvement of anticoagulation rates and optimisation of cardiovascular risk factors in patients with AF across three London boroughs over one year, as well as minimising bleed risk in patients on dual antithrombotic therapy.
Methods
A specialist cardiovascular pharmacist was commissioned to identify high-risk AF patients (CHA2DS2VASc>2) by working with primary care clinicians. Utilising “proactive care frameworks” created by UCLPartners and Clinical Effectiveness Group Queen Mary University of London, patients were stratified and prioritised for review. Patients not on anticoagulation were deemed to be at highest risk, requiring an urgent review to assess suitability for anticoagulation. A virtual multidisciplinary team (MDT) would review any complex patients and agree an action plan. Patients on dual antithrombotic therapy were also assessed to determine if antiplatelet therapy was indicated to minimise risk of major bleeding. All AF patients were reviewed for suitability of statin initiation to optimise cardiovascular risk prevention.
Results
At baseline, 86% (7581/8582) of AF patients with a CHA2DS2VASc>2 across the three boroughs were anticoagulated. 1001 patients were reviewed by a specialist pharmacist, with 84% (841/1001) of patients having a CHA2DS2VASc between 2–5, and 28% (280/1001) on antiplatelet monotherapy. Analysis at 12 months following intervention reported that 95% (7888/8280) of AF patients with a CHA2DS2VASc>2 were suitably anticoagulated, an improvement of 9%. 6% (61/1001) of patients were switched from antiplatelets and 25% (246/1001) were newly initiated on anticoagulation. 13% (130/1001) of patients required specialist MDT input to determine appropriateness for anticoagulation initiation. There was also a reduction in dual anticoagulation and antiplatelet therapy from 429 to 252 patients (41% reduction). Lastly of those reviewed, 2609 patients received a recommendation to start a statin for either primary (n=1981) or secondary prevention (n=628).
Conclusion(s)
Provision of a specialist cardiovascular pharmacist supported a multidisciplinary workforce to significantly improve and optimise cardiovascular risk, and reduce the risk of stroke in this high-risk population for people with AF across all three boroughs. By extrapolating these results nationally, 3600 strokes could be averted over 18 months.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Patel
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom
| | - S Ali
- NHS Redbridge Clinical Commissioning Group , London , United Kingdom
| | - J Robson
- Queen Mary University of London, Clinical Effectiveness Group , London , United Kingdom
| | - R Clements
- NHS North East London Clinical Commissioning Group , London , United Kingdom
| | - A Theodoulou
- Barts Health NHS Trust, Haematology , London , United Kingdom
| | - P Wright
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom
| | - M Kearney
- UCLPartners , London , United Kingdom
| | - R Patel
- Barts Heart Centre, Cardiology , London , United Kingdom
| | - A Sohaib
- Barking Havering and Redbridge Hospitals NHS trust, Cardiology , London , United Kingdom
| | - S Antoniou
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom
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Hafeez S, Koh M, Jones K, El Ghzal A, D'Arcy J, Kumar P, Khoo V, Lalondrelle S, McDonald F, Thompson A, Scurr E, Sohaib A, Huddart R. Assessing Bladder Radiotherapy Response With Quantitative Diffusion-Weighted Magnetic Resonance Imaging Analysis. Clin Oncol (R Coll Radiol) 2022; 34:630-641. [PMID: 35534398 DOI: 10.1016/j.clon.2022.04.001] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/13/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
AIMS Radiotherapy with radiosensitisation offers opportunity for cure with organ preservation in muscle-invasive bladder cancer (MIBC). Treatment response assessment and follow-up are reliant on regular endoscopic evaluation of the retained bladder. In this study we aim to determine the role of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) analysis to assess bladder radiotherapy response. MATERIALS AND METHODS Patients with T2-T4aN0-3M0 MIBC suitable for radical radiotherapy were recruited prospectively to an ethics approved protocol. Following transurethral resection of the bladder tumour and prior to any treatment, magnetic resonance imaging including DWI was performed on a 1.5T system using b values of 0, 100, 150, 250, 500, 750 s/mm2. DWI was repeated 3 months after completing radiotherapy. Cystoscopy and tumour site biopsy were undertaken following this. The response was dichotomised into response ( RESULTS Thirty-four patients were evaluated. Response was associated with a significant increase in ΔADC mean compared with poor response at ΔADCall (0.57 × 10-3 mm2/s versus -0.01 × 10-3 mm2/s; P < 0.0001) and ΔADCb100 (0.58 × 10-3 mm2/s versus -0.10 x 10-3 mm2/s; P = 0.007). A 48.50% increase in %ΔADCall mean was seen in response compared with a 1.37% decrease in poor response (P < 0.0001). This corresponded to a %ΔADCb100 mean increase of 50.34% in response versus a 7.36% decrease for poor response (P < 0.0001). Significant area under the curve (AUC) values predictive of radiotherapy response were identified at ΔADC and %ΔADC for ADCall and ADCb100 mean, 10th, 25th, 50th, 75th and 90th percentiles (AUC >0.9, P < 0.01). ΔADCall mean of 0.16 × 10-3 mm2/s and ΔADCb100 mean 0.12 × 10-3 mm2/s predicted radiotherapy response with sensitivity/specificity/positive predictive value/negative predictive value of 92.9%/100.0%/100.0%/75.0% and 89.3%/100.0%/100.0%/66.7%, respectively. CONCLUSIONS Quantitative DWI analysis can successfully provide non-invasive assessment of bladder radiotherapy response. Multicentre validation is required before prospective testing to inform MIBC radiotherapy follow-up schedules and decision making.
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Affiliation(s)
- S Hafeez
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | - M Koh
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - K Jones
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - A El Ghzal
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - J D'Arcy
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - P Kumar
- The Royal Marsden NHS Foundation Trust, London, UK
| | - V Khoo
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S Lalondrelle
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - F McDonald
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - A Thompson
- The Royal Marsden NHS Foundation Trust, London, UK
| | - E Scurr
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A Sohaib
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R Huddart
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
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7
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Patel M, Ali S, Robson J, Clements R, Theodoulou A, Wright P, Kearney M, Patel R, Sohaib A, Antoniou S. Pharmacist-led multidisciplinary approach in preventing strokes in people with atrial fibrillation. Eur J Cardiovasc Nurs 2022. [DOI: 10.1093/eurjcn/zvac060.001] [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: 11/13/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
In England, 90% of patients with atrial fibrillation (AF) are expected to receive anticoagulation as part of targets set by Public Health England by 2029. In 2019/2020, across three London boroughs serving a population of 770,000, the percentage of AF patients at high risk of stroke (CHA2DS2VASc>2) anticoagulated was 87%, 83% and 84%. This placed two of the three localities in the bottom 10% compared to others in England. In addition, optimising cholesterol and lifestyle choices can significantly reduce the risk of cardiovascular disease and associated mortality in these patients.
Purpose
To prevent AF-related strokes by improving anticoagulation rates and optimising cardiovascular risk factors in patients with AF in all general practices across three London boroughs over one year, and to minimise risk of bleeding in patients on concurrent anticoagulation and antiplatelet therapy.
Methods
A specialist cardiovascular pharmacist was commissioned to systemically identify high-risk AF patients (CHA2DS2VASc>2) by working with primary care clinicians, including up-skilling of primary care pharmacists. Through utilisation of ‘proactive care frameworks’ created by the Clinical Effectiveness Group Queen Mary University of London and UCL Partners, patients were able to be stratified and prioritised for review. AF patients not on anticoagulation or on antiplatelet monotherapy were deemed to be at highest risk, and these patients were reviewed to assess suitability for anticoagulation. Subsequently, patients on concurrent anticoagulation and antiplatelets were assessed to determine if dual antithrombotic prescribing was still indicated to minimise risk of major bleeding. Lastly, to optimise cardiovascular risk prevention, all AF patients were reviewed for suitability of statin initiation for primary or secondary prevention. A virtual multidisciplinary team was convened for complex patients, which included a cardiologist, haematologist, general practitioner and pharmacist to review and agree an action plan.
Results
An interim analysis at 9 months reported that 94% (6745/7145) of patients with a CHA2DS2VASc>2 across the three boroughs were suitably anticoagulated, an improvement of 6% on the initial 88% (6585/7391). There was a reduction in concurrent anticoagulation and antiplatelet therapy from 381 to 262 patients (31.2% reduction) following specialist review. Lastly 2285 patients were reviewed with a recommendation to start a statin for either primary (n=1783) or secondary prevention (n=502).
Conclusion(s)
Provision of a specialist cardiovascular pharmacist supported a multidisciplinary workforce with significant improvement in anticoagulation rates across all three boroughs, reducing the risk of stroke in this high-risk population. In addition, we were able to reduce the risk of bleeding in this cohort of patients by stopping inappropriate antiplatelet therapy, and reduced the risk of cardiovascular disease through statin initiation.
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Affiliation(s)
- M Patel
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom of Great Britain & Northern Ireland
| | - S Ali
- NHS Redbridge Clinical Commissioning Group , London , United Kingdom of Great Britain & Northern Ireland
| | - J Robson
- Queen Mary University of London, Clinical Effectiveness Group , London , United Kingdom of Great Britain & Northern Ireland
| | - R Clements
- NHS North East London Clinical Commissioning Group , London , United Kingdom of Great Britain & Northern Ireland
| | - A Theodoulou
- Barts Health NHS Trust, Haematology , London , United Kingdom of Great Britain & Northern Ireland
| | - P Wright
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom of Great Britain & Northern Ireland
| | - M Kearney
- UCLPartners , London , United Kingdom of Great Britain & Northern Ireland
| | - R Patel
- Barts Heart Centre, Cardiology , London , United Kingdom of Great Britain & Northern Ireland
| | - A Sohaib
- Barking Havering and Redbridge Hospitals NHS trust, Cardiology , London , United Kingdom of Great Britain & Northern Ireland
| | - S Antoniou
- Barts Heart Centre, Pharmacy , Greater London , United Kingdom of Great Britain & Northern Ireland
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8
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Gawalko M, Hermans ANL, Van Der Velden RMJ, Betz K, Verhaert DVM, Pluymaekers NAHA, Vernooy K, Sultan A, Pison L, Manninger M, Duncker D, Evans S, Sohaib A, Linz D, Hendriks JM. Patient motivation and adherence to an on-demand app-based heart rate and rhythm monitoring infrastructure for atrial fibrillation management through teleconsultation. TeleCheck-AF project results. Europace 2022. [DOI: 10.1093/europace/euac053.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
TeleCheck-AF is a mobile health (mHealth) infrastructure developed to provide remote management and comprehensive care to patients with atrial fibrillation (AF) during the Covid disease-19 pandemic lockdown within cardiology centers in Europe. TeleCheck-AF integrates an on-demand photoplethysmography-based heart rate/rhythm monitoring application supported a scheduled teleconsultation.
Purpose
The current sub-study of the TeleCheck-AF project aimed to provide the first real-world dataset on patient adherence and motivation to a standardized mHealth application integrated in remote AF management.
Methods
Patients were instructed to perform 60-second app-based heart rate/rhythm recordings three times daily and in case of symptoms for seven consecutive days prior to teleconsultation. Motivation was defined as number of days in which the expected number of measurements (≥three/day) were performed per number of days over the entire prescription period. Adherence was defined as number of performed measurements per number of expected measurements over the entire prescription period.
Results
Data from 990 consecutive patients with diagnosed AF (median age 64 [57-71] years, 39% female) from 10 centers that included the highest number of patients (≥25) were analyzed. Patients with both optimal motivation (100%) and adherence (≥100%) constituted 28% of the study population and had a lower percentage of recordings in sinus rhythm (90 [53-100%] vs 100 [64-100%], P<0.001) compared to others. Age and diabetes were predictors of both optimal motivation and adherence (odds ratio [OR] 1.02, 95% coincidence interval [95% CI] 1.01-1.04, P<0.001 and OR, 0.49, 95% CI 0.28-0.86, P=0.013, respectively). Patients with 100% motivation also had ≥100% adherence. Independent predictors for optimal adherence alone were age (OR 1.02, 95% CI 1.00-1.04, P=0.014), female sex (OR 1.70, 95% CI 1.29-2.23, P<0.001), previous AF ablation (OR 1.35, 95%CI 1.03-1.07, P=0.028).
Conclusion
In the TeleCheck-AF project, older age and diabetes were predictors of optimal patient motivation and adherence to app-based heart rate/rhythm monitoring. Therefore, physicians, nurses and allied health specialists involved in the management and care for patients with AF should not be discouraged to provide a mHealth infrastructure to elderly patients. Patient engagement improves mHealth adherence/motivation, hence, it is crucial to tailor the mHelath intervention to the needs and preferences of the patient.
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Affiliation(s)
- M Gawalko
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - ANL Hermans
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - RMJ Van Der Velden
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - K Betz
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - DVM Verhaert
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - NAHA Pluymaekers
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - K Vernooy
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - A Sultan
- Heart Center at the University of Cologne, Department of Electrophysiology, Cologne, Germany
| | - L Pison
- Hospital Oost-Limburg (ZOL), Department of Cardiology, Genk, Belgium
| | - M Manninger
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - D Duncker
- Hannover Medical School, Department of Cardiology and Angiology, Hannover, Germany
| | - S Evans
- Qompium NV, Hasselt, Belgium
| | - A Sohaib
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - D Linz
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
| | - JM Hendriks
- Maastricht University Medical Centre (MUMC), Department of Cardiology, Maastricht, Netherlands (The)
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9
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Sritharan K, Akhiat H, Cahill D, Choi S, Choudhury A, Chung P, Diaz J, Dysager L, Hall W, Kerkmeijer L, Lawton C, Murray J, Nyborg C, Pos F, Rigo M, Schytte T, Sidhom M, Sohaib A, Tan A, van der Voort van Zyp J, Vesprini D, Zelefsky M, Tree A. PD-0571 Determining interobserver variability in prostate bed CTV target delineation using MRI. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02886-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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10
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Murray J, Tree A, Potts L, Gunapala R, Greenlay E, Alexander E, Gao A, McNair H, Blasiak-Wal I, Sohaib A, Parker C, deSouza N, Dearnaley D. OC-0106 Late Toxicity and Efficacy of Hypofractionated Prostate RT with Focal Boost in the DELINEATE trial. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02482-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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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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12
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Oldenburg J, Berney DM, Bokemeyer C, Climent MA, Daugaard G, Gietema JA, De Giorgi U, Haugnes HS, Huddart RA, Leão R, Sohaib A, Gillessen S, Powles T. Testicular seminoma and non-seminoma: ESMO-EURACAN Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:362-375. [PMID: 35065204 DOI: 10.1016/j.annonc.2022.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 12/17/2021] [Accepted: 01/05/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - D M Berney
- Department of Cellular Pathology, Barts Cancer Institute, Queen Mary University of London, London; Barts Health NHS Trust, London, UK
| | - C Bokemeyer
- Department of Oncology, Hematology, Bone Marrow Transplantation with section Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M A Climent
- Fundacion Instituto Valenciano de Oncología, València, Spain
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - U De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST),'Dino Amadori', Meldola, Italy
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway and UiT-The Arctic University, Tromsoe, Norway
| | - R A Huddart
- Institute of Cancer Research and Royal Marsden Foundation Trust, London, UK
| | - R Leão
- Department of Urology, Hospital de Braga, Hospital CUF Coimbra, Faculty of Medicine University of Coimbra, Coimbra, Portugal
| | - A Sohaib
- Department of Diagnostic Radiology, Royal Marsden Hospital, Sutton, Surrey, UK
| | - S Gillessen
- Oncology Institute of Southern Switzerland, EOC, Bellinzona; Faculty of Biomedical Sciences, USI, Lugano, Switzerland; Division of Cancer Medicine, University of Manchester, Manchester
| | - T Powles
- Barts Health NHS Trust, London, UK
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13
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Dearnaley D, Hinder V, Hijab A, Horan G, Srihari N, Rich P, Houston JG, Henry AM, Gibbs S, Venkitaraman R, Cruickshank C, Hassan S, Miners A, Mason M, Pedley I, Payne H, Brock S, Wade R, Robinson A, Din O, Lees K, Graham J, Worlding J, Murray J, Parker C, Griffin C, Sohaib A, Hall E. Observation versus screening spinal MRI and pre-emptive treatment for spinal cord compression in patients with castration-resistant prostate cancer and spinal metastases in the UK (PROMPTS): an open-label, randomised, controlled, phase 3 trial. Lancet Oncol 2022; 23:501-513. [PMID: 35279270 PMCID: PMC8960282 DOI: 10.1016/s1470-2045(22)00092-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/10/2022] [Accepted: 02/10/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Early diagnosis of malignant spinal cord compression (SCC) is crucial because pretreatment neurological status is the major determinant of outcome. In metastatic castration-resistant prostate cancer, SCC is a clinically significant cause of disease-related morbidity and mortality. We investigated whether screening for SCC with spinal MRI, and pre-emptive treatment if radiological SCC (rSCC) was detected, reduced the incidence of clinical SCC (cSCC) in asymptomatic patients with metastatic castration-resistant prostate cancer and spinal metastasis. METHODS We did a parallel-group, open-label, randomised, controlled, phase 3, superiority trial. Patients with metastatic castration-resistant prostate cancer were recruited from 45 National Health Service hospitals in the UK. Eligible patients were aged at least 18 years, with an Eastern Co-operative Oncology Group performance status of 0-2, asymptomatic spinal metastasis, no previous SCC, and no spinal MRI in the past 12 months. Participants were randomly assigned (1:1), using a minimisation algorithm with a random element (balancing factors were treatment centre, alkaline phosphatase [normal vs raised, with the upper limit of normal being defined at each participating laboratory], number of previous systemic treatments [first-line vs second-line or later], previous spinal treatment, and imaging of thorax and abdomen), to no MRI (control group) or screening spinal MRI (intervention group). Serious adverse events were monitored in the 24 h after screening MRI in the intervention group. Participants with screen-detected rSCC were offered pre-emptive treatment (radiotherapy or surgical decompression was recommended per treating physician's recommendation) and 6-monthly spinal MRI. All patients were followed up every 3 months, and then at month 30 and 36. The primary endpoint was time to and incidence of confirmed cSCC in the intention-to-treat population (defined as all patients randomly assigned), with the primary timepoint of interest being 1 year after randomisation. The study is registered with ISRCTN, ISRCTN74112318, and is now complete. FINDINGS Between Feb 26, 2013, and April 25, 2017, 420 patients were randomly assigned to the control (n=210) or screening MRI (n=210) groups. Median age was 74 years (IQR 68 to 79), 222 (53%) of 420 patients had normal alkaline phosphatase, and median prostate-specific antigen concentration was 48 ng/mL (IQR 17 to 162). Screening MRI detected rSCC in 61 (31%) of 200 patients with assessable scans in the intervention group. As of data cutoff (April 23, 2020), at a median follow-up of 22 months (IQR 13 to 31), time to cSCC was not significantly improved with screening (hazard ratio 0·64 [95% CI 0·37 to 1·11]; Gray's test p=0·12). 1-year cSCC rates were 6·7% (95% CI 3·8-10·6; 14 of 210 patients) for the control group and 4·3% (2·1-7·7; nine of 210 patients) for the intervention group (difference -2·4% [95% CI -4·2 to 0·1]). Median time to cSCC was not reached in either group. No serious adverse events were reported within 24 h of screening. INTERPRETATION Despite the substantial incidence of rSCC detected in the intervention group, the rate of cSCC in both groups was low at a median of 22 months of follow-up. Routine use of screening MRI and pre-emptive treatment to prevent cSCC is not warranted in patients with asymptomatic castration-resistant prostate cancer with spinal metastasis. FUNDING Cancer Research UK.
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Affiliation(s)
- David Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Victoria Hinder
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Adham Hijab
- Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Gail Horan
- Clinical Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Narayanan Srihari
- Clinical Oncology, The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, UK
| | - Philip Rich
- Radiology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - J Graeme Houston
- Imaging Science and Technology, University of Dundee, Dundee, UK
| | - Ann M Henry
- Clinical Oncology, University of Leeds, Leeds, UK
| | - Stephanie Gibbs
- Clinical Oncology, Barking, Havering and Redbridge University Hospitals NHS Trust, London, UK
| | - Ram Venkitaraman
- Clinical Oncology, East Suffolk and North Essex NHS Foundation Trust, Ipswich, UK
| | - Clare Cruickshank
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Shama Hassan
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Alec Miners
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ian Pedley
- Clinical Oncology, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Heather Payne
- Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Susannah Brock
- Clinical Oncology, University Hospitals Dorset NHS Foundation Trust, Poole, UK
| | - Robert Wade
- Clinical Oncology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Angus Robinson
- Clinical Oncology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Omar Din
- Clinical Oncology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Kathryn Lees
- Clinical Oncology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - John Graham
- Clinical Oncology, Somerset NHS Foundation Trust, Taunton, UK
| | - Jane Worlding
- Oncology, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Julia Murray
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Chris Parker
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Clare Griffin
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Aslam Sohaib
- Urology Unit, Royal Marsden NHS Foundation Trust, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK.
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14
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Rockall AG, Barwick TD, Wilson W, Singh N, Bharwani N, Sohaib A, Nobbenhuis M, Warbey V, Miquel M, Koh DM, De Paepe KN, Martin-Hirsch P, Ghaem-Maghami S, Fotopoulou C, Stringfellow H, Sundar S, Manchanda R, Sahdev A, Hackshaw A, Cook GJ. Diagnostic Accuracy of FEC-PET/CT, FDG-PET/CT, and Diffusion-Weighted MRI in Detection of Nodal Metastases in Surgically Treated Endometrial and Cervical Carcinoma. Clin Cancer Res 2021; 27:6457-6466. [PMID: 34526364 PMCID: PMC9401562 DOI: 10.1158/1078-0432.ccr-21-1834] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/14/2021] [Accepted: 09/13/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Preoperative nodal staging is important for planning treatment in cervical cancer and endometrial cancer, but remains challenging. We compare nodal staging accuracy of 18F-ethyl-choline-(FEC)-PET/CT, 18F-fluoro-deoxy-glucose-(FDG)-PET/CT, and diffusion-weighted-MRI (DW-MRI) with conventional morphologic MRI. EXPERIMENTAL DESIGN A prospective, multicenter observational study of diagnostic accuracy for nodal metastases was undertaken in 5 gyne-oncology centers. FEC-PET/CT, FDG-PET/CT, and DW-MRI were compared with nodal size and morphology on MRI. Reference standard was strictly correlated nodal histology. Eligibility included operable cervical cancer stage ≥ 1B1 or endometrial cancer (grade 3 any stage with myometrial invasion or grade 1-2 stage ≥ II). RESULTS Among 162 consenting participants, 136 underwent study DW-MRI and FDG-PET/CT and 60 underwent FEC-PET/CT. In 118 patients, 267 nodal regions were strictly correlated at histology (nodal positivity rate, 25%). Sensitivity per patient (n = 118) for nodal size, morphology, DW-MRI, FDG- and FEC-PET/CT was 40%*, 53%, 53%, 63%*, and 67% for all cases (*, P = 0.016); 10%, 10%, 20%, 30%, and 25% in cervical cancer (n = 40); 65%, 75%, 70%, 80% and 88% in endometrial cancer (n = 78). FDG-PET/CT outperformed nodal size (P = 0.006) and size ratio (P = 0.04) for per-region sensitivity. False positive rates were all <10%. CONCLUSIONS All imaging techniques had low sensitivity for detection of nodal metastases and cannot replace surgical nodal staging. The performance of FEC-PET/CT was not statistically different from other techniques that are more widely available. FDG-PET/CT had higher sensitivity than size in detecting nodal metastases. False positive rates were low across all methods. The low false positive rate demonstrated by FDG-PET/CT may be helpful in arbitration of challenging surgical planning decisions.
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Affiliation(s)
- Andrea G. Rockall
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom.,Corresponding Author: Andrea G. Rockall, Division of Surgery and Cancer, Imperial College London, ICTEM Building, Hammersmith Campus, Du Cane Road, London W12 0NS, United Kingdom. E-mail:
| | - Tara D. Barwick
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - William Wilson
- Cancer Research UK & UCL Cancer Trials Centre, University College London, United Kingdom
| | - Naveena Singh
- Department of Pathology, Barts Health NHS Trust, London, United Kingdom
| | - Nishat Bharwani
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Radiology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Aslam Sohaib
- Department of Radiology, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Marielle Nobbenhuis
- Department of Gynaeoncology, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Victoria Warbey
- Department of Radiology, Guys and St Thomas' NHS Trust, London, United Kingdom
| | - Marc Miquel
- Clinical Physics, Barts Health NHS Trust, London, United Kingdom.,William Harvey Research Institute, Digital Environment Research Institute, Queen Mary University of London, London, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Katja N. De Paepe
- Department of Radiology, Royal Marsden Hospital NHS Foundation Trust, London, United Kingdom
| | - Pierre Martin-Hirsch
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Sadaf Ghaem-Maghami
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Gynaeoncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Christina Fotopoulou
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom.,Department of Gynaeoncology, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Helen Stringfellow
- Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
| | - Sudha Sundar
- Pan Birmingham Gynaecological Cancer Centre, City Hospital and Insitute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ranjit Manchanda
- Wolfson Institute of Preventive Medicine QMUL, London, United Kingdom.,Department of Gynaecological Oncology, Barts Health NHS Trust, London, United Kingdom.,Department of Health Services Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Anju Sahdev
- Department of Radiology, St Bartholomews Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, University College London, United Kingdom
| | - Gary J. Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom
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15
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Castelletti S, Kosiuk J, Ladeiras Lopes R, Sohaib A, Bohm A. The experience of cardiovascular professional training across europe: preliminary results from the ESC young cardiovascular professionals survey. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aim
There are differences in the training programs among European Countries and some sub-specialities are not even recognized in all the training programs. However, discrepancies amongst the Countries and the needs of the trainees are not well known. As such, a survey on the experience of Cardiovascular Professional Training across Europe was created by the ESC Board Committee for Young Cardiovascular professionals to provide a detailed picture of the training programs in the European Countries with deep insights into the needs and expectations of trainees
Methods
Between February and April 2021 a survey with 35 questions on the structure of the training program and on the expectations and needs of the young professionals was launched and advertised through all the official ESC social media and communications channels.
Results
643 under 40-year-old young professionals participated to the survey, 72% cardiologists, 14% other professionals, 3% nurses. The majority of the participants were in practice (59%) and male (57%), mean age was 33 year-old. The current working environment was university hospital (52%), local hospitals (18%), other tertiary locations (13%) and private sector (12%). The majority (54%) of the participants declared not being satisfied with the structure of their training programme and almost all would like a standardised European training programme (94%). The feeling was that more time should be allocated to active participation in interventions (currently 30%, suggested 46%) and that they do not have easy access to all subspecialities (52%). Only 39% of the participants were aware that a 2020 ESC Core curriculum exists and 36% declared that it used in their own Country. Nevertheless, the majority consult the ESC's online education contents (33%, 25% and 17% once per week, per month and per day respectively) and attend Congresses regularly (41% both national and international, 33% only national). Although the majority feel sufficiently recognized for their work by patients, supervisors and society (84%, 65% and 60% respectively), they are unsatisfied from a financial point of view (71%).
Conclusions
The majority of the young cardiovascular professionals feel that their training programme is not satisfactory and a standardised European programme should be implemented. However the ESC Core Curriculum is not well known among the young and not widely used in European Countries. These findings suggest more efforts will be needed to implement a standardized training programme by the ESC and national cardiac societies.
Funding Acknowledgement
Type of funding sources: None. Interventional training needsRecognition feelings of the participants
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Affiliation(s)
| | - J Kosiuk
- Helios Clinic Kothen, Kothen, Germany
| | - R Ladeiras Lopes
- Faculty of Medicine University of Porto, Cardiovascular R&D Unit, Porto, Portugal
| | - A Sohaib
- St Bartholomew's Hospital, Barts Heart Centre, London, United Kingdom
| | - A Bohm
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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16
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Curcean A, Curcean S, Rescigno P, Dafydd DA, Tree A, Reid A, Koh DM, Sohaib A, Tunariu N, Shur J. Imaging features of the evolving patterns of metastatic prostate cancer. Clin Radiol 2021; 77:88-95. [PMID: 34598790 DOI: 10.1016/j.crad.2021.09.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 09/02/2021] [Indexed: 12/28/2022]
Abstract
The pattern of metastases in prostate cancer (PC) is evolving. Increased use of imaging, newer imaging techniques with higher sensitivity for disease detection and patients receiving multiple lines of novel therapies with increased life expectancy are likely to be contributory. Awareness of metastatic disease patterns improves early diagnosis, accurate staging, and initiation of appropriate therapy, and can inform prognostic information and anticipate potential disease complications. The aim of this review is to document the spectrum of metastases in PC including emerging and unusual patterns, and to highlight the role of novel imaging including prostate-specific membrane antigen (PSMA)-positron-emission tomography (PET) and whole-body magnetic resonance imaging (WB-MRI) to improve diagnostic and response assessment accuracy.
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Affiliation(s)
- A Curcean
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, Sutton, Surrey, UK
| | - S Curcean
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK
| | - P Rescigno
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK
| | - D Ap Dafydd
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK
| | - A Tree
- Institute of Cancer Research, Sutton, Surrey, UK; Academic Uro-oncology Unit, The Royal Marsden NHS Foundation Trust, UK
| | - A Reid
- Institute of Cancer Research, Sutton, Surrey, UK; Academic Uro-oncology Unit, The Royal Marsden NHS Foundation Trust, UK
| | - D-M Koh
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, Sutton, Surrey, UK
| | - A Sohaib
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK
| | - N Tunariu
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK; Institute of Cancer Research, Sutton, Surrey, UK
| | - J Shur
- Department of Radiology, The Royal Marsden NHS Foundation Trust, UK.
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17
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Kalantar R, Messiou C, Winfield JM, Renn A, Latifoltojar A, Downey K, Sohaib A, Lalondrelle S, Koh DM, Blackledge MD. CT-Based Pelvic T 1-Weighted MR Image Synthesis Using UNet, UNet++ and Cycle-Consistent Generative Adversarial Network (Cycle-GAN). Front Oncol 2021; 11:665807. [PMID: 34395244 PMCID: PMC8363308 DOI: 10.3389/fonc.2021.665807] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Computed tomography (CT) and magnetic resonance imaging (MRI) are the mainstay imaging modalities in radiotherapy planning. In MR-Linac treatment, manual annotation of organs-at-risk (OARs) and clinical volumes requires a significant clinician interaction and is a major challenge. Currently, there is a lack of available pre-annotated MRI data for training supervised segmentation algorithms. This study aimed to develop a deep learning (DL)-based framework to synthesize pelvic T1-weighted MRI from a pre-existing repository of clinical planning CTs. METHODS MRI synthesis was performed using UNet++ and cycle-consistent generative adversarial network (Cycle-GAN), and the predictions were compared qualitatively and quantitatively against a baseline UNet model using pixel-wise and perceptual loss functions. Additionally, the Cycle-GAN predictions were evaluated through qualitative expert testing (4 radiologists), and a pelvic bone segmentation routine based on a UNet architecture was trained on synthetic MRI using CT-propagated contours and subsequently tested on real pelvic T1 weighted MRI scans. RESULTS In our experiments, Cycle-GAN generated sharp images for all pelvic slices whilst UNet and UNet++ predictions suffered from poorer spatial resolution within deformable soft-tissues (e.g. bladder, bowel). Qualitative radiologist assessment showed inter-expert variabilities in the test scores; each of the four radiologists correctly identified images as acquired/synthetic with 67%, 100%, 86% and 94% accuracy. Unsupervised segmentation of pelvic bone on T1-weighted images was successful in a number of test cases. CONCLUSION Pelvic MRI synthesis is a challenging task due to the absence of soft-tissue contrast on CT. Our study showed the potential of deep learning models for synthesizing realistic MR images from CT, and transferring cross-domain knowledge which may help to expand training datasets for 21 development of MR-only segmentation models.
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Affiliation(s)
- Reza Kalantar
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Christina Messiou
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Jessica M. Winfield
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Alexandra Renn
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Arash Latifoltojar
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Kate Downey
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Aslam Sohaib
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Susan Lalondrelle
- Gynaecological Unit, The Royal Marsden Hospital, London, United Kingdom
| | - Dow-Mu Koh
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
- Department of Radiology, The Royal Marsden Hospital, London, United Kingdom
| | - Matthew D. Blackledge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
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18
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Linz D, Pluymaekers N, Duncker D, Manninger M, Van Der Velden R, Hermans A, Verhaert D, Hemels M, Sultan A, Gupta D, Heidbuchel H, Sohaib A, Svennberg E, Crijns H, Hendriks J. The TeleCheck-AF project on remote app-based management of atrial fibrillation during the COVID-19 pandemic: Patient experiences. Europace 2021. [PMCID: PMC8194565 DOI: 10.1093/europace/euab116.521] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Funding Acknowledgements OnBehalf Aims Methods Results Conclusions
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Affiliation(s)
- D Linz
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - N Pluymaekers
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - D Duncker
- Hannover Medical School, Cardiology, Hannover, Germany
| | - M Manninger
- Medical University of Graz, Cardiology, Graz, Austria
| | - R Van Der Velden
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - A Hermans
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - D Verhaert
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - M Hemels
- Rijnstate Hospital, Arnhem, Netherlands (The)
| | - A Sultan
- Cologne University Hospital - Heart Center, Cologne, Germany
| | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | | | - A Sohaib
- Barts Heart Centre, London, United Kingdom of Great Britain & Northern Ireland
| | - E Svennberg
- Karolinska University Hospital, Stockholm, Sweden
| | - H Crijns
- Maastricht University Medical Centre (MUMC), Maastricht, Netherlands (The)
| | - J Hendriks
- Flinders Medical Centre and Flinders University, Adelaide, Australia
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19
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Heath OM, Bryan SJ, Sohaib A, Barton DPJ. Laparoscopic assessment improves case selection for exenterative surgery in recurrent cervical and endometrial cancer. J OBSTET GYNAECOL 2021; 41:1252-1256. [PMID: 33646894 DOI: 10.1080/01443615.2020.1867963] [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] [Indexed: 10/22/2022]
Abstract
The objective of this study is to evaluate the role of laparoscopy in the case selection of patients for pelvic exenteration to treat recurrent cervical or endometrial cancer. Pelvic exenteration is a rare surgical procedure performed by specialised multidisciplinary surgical teams. We performed a review of 55 consecutive laparoscopies for patients being evaluated for possible exenterative surgery for recurrent cervical or endometrial cancer at a single centre in the UK with a significant exenterative surgical practice. All patients had no evidence of metastatic disease on imaging prior to the laparoscopy. Despite thorough radiological assessment laparoscopy detected peritoneal, nodal or extrapelvic metastases in 20.8% of cases. 5.6% of the patients who underwent exenterative surgery were found to have unresectable pelvic disease intraoperatively. In these cases, the extent of disease was not determined radiologically or during the initial exploratory laparotomy. In our view, laparoscopic assessment is an essential component of the pre-operative work up of patients with recurrent cervical or endometrial cancer being considered for exenterative surgery.Impact statementWhat is already known on this subject? Pelvic exenteration is potentially curative in cases of recurrent pelvic malignancy. Case selection is essential to determine those patients without metastases and with resectable pelvic disease - this will improve patient outcomes, avoid the unnecessary morbidity of major surgery, as well as the psychological consequences of abandoned procedures. The only two previous studies, published in 1998 (Plante and Roy 1998) and 2002 (Köhler et al. 2002) have shown laparoscopic assessment to be safe and improve case selection.What do the results of this study add? This study provides evidence that in the context of modern imaging modalities, including PET-CT scans, laparoscopic assessment continues to improve case selection for exenterative surgery.What are the implications of these findings for clinical practice and/or further research? This study provides further evidence of the benefit of laparoscopy in the assessment of patients being considered for exenterative surgery for recurrent pelvic cancer. Routine laparoscopy improves case selection and will enhance patient experiences and outcomes.
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Affiliation(s)
| | - Stacey J Bryan
- Gynaeoncology Department, Royal Marsden Hospital, London, UK
| | - Aslam Sohaib
- Gynaeoncology Department, Royal Marsden Hospital, London, UK
| | - Desmond P J Barton
- Gynaeoncology Department, Royal Marsden Hospital, London, UK.,Gynaeoncology Department, St. George's Hospital, London, UK
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20
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Nicholls L, Suh YE, Chapman E, Henderson D, Jones C, Morrison K, Sohaib A, Taylor H, Tree A, van As N. Stereotactic radiotherapy with focal boost for intermediate and high-risk prostate cancer: Initial results of the SPARC trial. Clin Transl Radiat Oncol 2020; 25:88-93. [PMID: 33145444 PMCID: PMC7591551 DOI: 10.1016/j.ctro.2020.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Dose escalation to dominant intraprostatic lesions (DILs) is a novel method to increase the therapeutic ratio in localised prostate cancer. The Stereotactic Prostate Augmented Radiotherapy with Cyberknife (SPARC) trial was designed to determine the feasibility of a focal boost defined with multiparametric magnetic resonance imaging (mpMRI) using stereotactic ablative body radiotherapy (SABR). MATERIALS AND METHODS Patients were included with newly diagnosed intermediate to high risk prostate cancer with at least one of: Gleason score 4 + 3, stage T3a, or PSA > 20 ng/ml. Visible disease on mpMRI was mandatory and up to 2 separate nodules were allowed. All patients received androgen deprivation. Patients received 36.25 Gy in 5 fractions using CyberKnife® and the DIL received a simultaneous boost to a maximum of 47.5 Gy, as allowed by OAR constraints. Genitourinary (GU) and gastrointestinal (GI) toxicity was reported using the RTOG scoring criteria. International Index of Erectile Function (IIEF) and EQ-5D global health scores were regularly captured. RESULTS An interim safety analysis was performed on the first 8 patients, recruited between July 2013 and December 2015. Median follow up was 56 months (range 50-74). Median D95 values for the prostate PTV and boost volume were 36.55 Gy (range 35.87-36.99) and 46.62 Gy (range 44.85-48.25) respectively. Of the dose constraints, 10/80 were not achieved but all were minor dose variations. Grade 2+ acute GU and GI toxicities were 37.5% respectively while grade 2+ late GU and GI toxicities were 12.5% and 0% respectively. IIEF and quality of life scores recovered over time and all patients remain in biochemical remission. CONCLUSION The first patients have been successfully treated with prostate SABR and focal boost on the SPARC trial, with excellent adherence to the planning protocol. Toxicity and efficacy results are promising and further recruitment is underway.
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Affiliation(s)
- Luke Nicholls
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Yae-eun Suh
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Ewan Chapman
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 237 Fulham Road, Chelsea, London SW3 6JJ, UK
| | - Daniel Henderson
- University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Edgbaston, Birmingham, West Midlands B15 2GW, UK
| | - Caroline Jones
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Kirsty Morrison
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Aslam Sohaib
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Helen Taylor
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Alison Tree
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 237 Fulham Road, Chelsea, London SW3 6JJ, UK
| | - Nicholas van As
- Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 237 Fulham Road, Chelsea, London SW3 6JJ, UK
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21
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Hanson H, Brady AF, Crawford G, Eeles RA, Gibson S, Jorgensen M, Izatt L, Sohaib A, Tischkowitz M, Evans DG. UKCGG Consensus Group guidelines for the management of patients with constitutional TP53 pathogenic variants. J Med Genet 2020; 58:jmedgenet-2020-106876. [PMID: 32571901 PMCID: PMC7848057 DOI: 10.1136/jmedgenet-2020-106876] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 12/29/2022]
Abstract
Constitutional pathogenic variants in TP53 are associated with Li-Fraumeni syndrome or the more recently described heritable TP53-related cancer syndrome and are associated with increased lifetime risks of a wide spectrum of cancers. Due to the broad tumour spectrum, surveillance for this patient group has been limited. To date, the only recommendation in the UK has been for annual breast MRI in women; however, more recently, a more intensive surveillance protocol including whole-body MRI (WB-MRI) has been recommended by International Expert Groups. To address the gap in surveillance for this patient group in the UK, the UK Cancer Genetics Group facilitated a 1-day consensus meeting to discuss a protocol for the UK. Using a preworkshop survey followed by structured discussion on the day, we achieved consensus for a UK surveillance protocol for TP53 carriers to be adopted by UK Clinical Genetics services. The key recommendations are for annual WB-MRI and dedicated brain MRI from birth, annual breast MRI from 20 years in women and three-four monthly abdominal ultrasound in children along with review in a dedicated clinic.
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Affiliation(s)
- Helen Hanson
- St George's Hospital NHS Foundation Trust, South West Thames Regional Genetic Services, London, UK
| | - Angela F Brady
- North West Thames Regional Genetics Service, Kennedy-Galton Centre, London North West University Healthcare NHS Trust, Harrow, UK
| | - Gillian Crawford
- Clinical Genetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rosalind A Eeles
- Oncogenetics Team, The Institute of Cancer Research, Sutton, Surrey, UK
- Clinical Oncology and Oncogenetics, Royal Marsden NHS Foundation Trust, London, London, UK
| | - Sarah Gibson
- Peninsula Clinical Genetics, Royal Devon & Exeter Hospital, Exeter, UK
| | - Mette Jorgensen
- Paediatric Oncology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Louise Izatt
- Clinical Genetics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Aslam Sohaib
- Radiology, Royal Marsden Hospital NHS FoundationTrust, London, UK
| | - Marc Tischkowitz
- Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK
| | - D Gareth Evans
- Genetic Medicine, Central Manchester University Hospitals NHS FoundationTrust, Manchester, UK
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22
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Talibova N, Sohaib A, Gouda M, Gunaldi M. Incidence and Survival Rates of Gynecological Malignancies in The United States Before and After the HPV Vaccine. Tumori 2020. [DOI: 10.1177/0300891620914152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intoduction: Gynecological malignancies are one of the most common cancers in women and have high mortality rates in the United States. In this study, we aimed to analyze the incidence and mortality rates of gynecological malignancies in 2011-2015 and compare these data with the corresponding parameters of 2001-2005. We chose these intervals of years for contrasting, as HPV vaccines have been actively used since 2006. HPV vaccine is known to prevent cervical cancer but has unknown impact on other gynecological malignancies. The aim of the is study is to check if incidence and survival of gynecological malignancies has changed before and after application of HPV vaccine Material and Methods: The Surveillance, Epidemiology and End Results (SEER) cancer registry 2005-2011 and 2011-2015 database was investigated and patients with gynecological malignancy were identified. Data were obtained using SEER*Stat version 8.3.5. A statistical analysis on the incidence rate and mortality rate was performed. Data were exported using case-listing session in SEER*Stat and were analyzed using SPSS version 25. Results: Overall 125,357 cases with a gynecological malignancy were identified in 2011-2015 in comparison with 102,534 cases in the period of 2001-2005. The incidence of cervical cancer decreased in the period of 2011-2015 compared with the period from 2001 to 2005 (median incidence rates 3.9 and 4.3 per 100.000 persons, respectively, p < 0.05), while incidence of uterine (15.3 and 12.0 per 100.000 persons persons, respectively) and vulvar (1.55 and 1.86 per 100.000 persons, respectively) has increased ( p < 0.05). There was no change in the incidence rate of ovarian cancer (7.28 and 7.19 per 100.000 persons). Survival rates for cervix, uterine, ovarian and vulva cancer have increased. However, zero time error couldn’t be avoided in statistical analysis. Conclusion: As a result of widespread screening with Pap smear test and availability of human papilloma virus vaccine the incidence of cervix cancer has declined. Increase in vulvar and uterine cancer incidence may be attributed to lack of effective screening program for early detection of these type of cancers and most probably HPV vaccine has no effect on their incidence. Survival of gynecological malignancies has increased over years which may be explained by better treatment options or earlier detection.
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Affiliation(s)
- N Talibova
- Chemotherapy Department, National Center of Oncology, Baku, Azerbaijan
| | - A Sohaib
- Clinical oncology department, Menoufia University, Al Minufya Egypt
| | - M Gouda
- Clinical oncology department, Menoufia University, Al Minufya Egypt
| | - M Gunaldi
- Istanbul Aydin University Medical Faculty, Department of Medical Oncology, Istanbul, Turkey
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23
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Murray JR, Tree AC, Alexander EJ, Sohaib A, Hazell S, Thomas K, Gunapala R, Parker CC, Huddart RA, Gao A, Truelove L, McNair HA, Blasiak-Wal I, deSouza NM, Dearnaley D. Standard and Hypofractionated Dose Escalation to Intraprostatic Tumor Nodules in Localized Prostate Cancer: Efficacy and Toxicity in the DELINEATE Trial. Int J Radiat Oncol Biol Phys 2020; 106:715-724. [PMID: 31812718 DOI: 10.1016/j.ijrobp.2019.11.402] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [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: 07/18/2019] [Revised: 11/11/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To report a planned analysis of the efficacy and toxicity of dose escalation to the intraprostatic dominant nodule identified on multiparametric magnetic resonance imaging using standard and hypofractionated external beam radiation therapy. METHODS AND MATERIALS DELINEATE is a single centre prospective phase 2 multicohort study including standard (cohort A: 74 Gy in 37 fractions) and moderately hypofractionated (cohort B: 60 Gy in 20 fractions) prostate image guided intensity modulated radiation therapy in patients with National Comprehensive Cancer Network intermediate- and high-risk disease. Patients received an integrated boost of 82 Gy (cohort A) and 67 Gy (cohort B) to lesions visible on multiparametric magnetic resonance imaging. Fifty-five patients were treated in cohort A, and 158 patients were treated in cohort B; the first 50 sequentially treated patients in cohort B were included in this planned analysis. The primary endpoint was late Radiation Therapy Oncology Group rectal toxicity at 1 year. Secondary endpoints included acute and late toxicity measured with clinician- and patient-reported outcomes at other time points and biochemical relapse-free survival for cohort A. Median follow-up was 74.5 months for cohort A and 52.0 months for cohort B. RESULTS In cohorts A and B, 27% and 40% of patients, respectively, were classified as having National Comprehensive Cancer Network high-risk disease. The cumulative 1-year incidence of Radiation Therapy Oncology Group grade 2 or worse rectal and urinary toxicity was 3.6% and 0% in cohort A and 8% and 10% in cohort B, respectively. There was no reported late grade 3 rectal toxicity in either cohort. Within cohort A, 4 of 55 (7%) patients had biochemical relapse. CONCLUSIONS Delivery of a simultaneous integrated boost to intraprostatic dominant nodules is feasible in prostate radiation therapy using standard and moderately hypofractionated regimens, with rectal and genitourinary toxicity comparable to contemporary series without an intraprostatic boost.
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Affiliation(s)
- Julia R Murray
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom.
| | - Alison C Tree
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | | | - Aslam Sohaib
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Steve Hazell
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Karen Thomas
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Ranga Gunapala
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Chris C Parker
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - Robert A Huddart
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - Annie Gao
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - Lesley Truelove
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - Helen A McNair
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - Irena Blasiak-Wal
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - Nandita M deSouza
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
| | - David Dearnaley
- The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research, London, United Kingdom
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24
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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White IM, Scurr E, Wetscherek A, Brown G, Sohaib A, Nill S, Oelfke U, Dearnaley D, Lalondrelle S, Bhide S. Realizing the potential of magnetic resonance image guided radiotherapy in gynaecological and rectal cancer. Br J Radiol 2019; 92:20180670. [PMID: 30933550 PMCID: PMC6592079 DOI: 10.1259/bjr.20180670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 07/31/2018] [Revised: 02/24/2019] [Accepted: 03/21/2019] [Indexed: 12/25/2022] Open
Abstract
CT-based radiotherapy workflow is limited by poor soft tissue definition in the pelvis and reliance on rigid registration methods. Current image-guided radiotherapy and adaptive radiotherapy models therefore have limited ability to improve clinical outcomes. The advent of MRI-guided radiotherapy solutions provides the opportunity to overcome these limitations with the potential to deliver online real-time MRI-based plan adaptation on a daily basis, a true "plan of the day." This review describes the application of MRI guided radiotherapy in two pelvic tumour sites likely to benefit from this approach.
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Affiliation(s)
- Ingrid M White
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Erica Scurr
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Andreas Wetscherek
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Gina Brown
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Aslam Sohaib
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Simeon Nill
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Uwe Oelfke
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - David Dearnaley
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Susan Lalondrelle
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
| | - Shreerang Bhide
- Institute of Cancer Research and Royal Marsden National Health Service Foundation Trust, Sutton, Surrey, UK
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Chan K, Warren-Oseni K, Abdel-Aty H, Dunlop A, McQuaid D, Koh M, Sohaib A, Huddart R, Hafeez S. PO-0864 Normal tissue sparing with diffusion weighted MRI informed tumour boost in bladder radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31284-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hunt A, Chan A, Delacroix L, Dysager L, Edwards A, Frew J, Gordon A, Henry A, Huddart R, Koh M, Kong V, Nagar Y, Parikh O, Pearson R, Rimmer Y, Schytte T, Serra M, Sidhom M, Sohaib A, Syndikus I, Tan A, Treece S, Varughese M, Hafeez S. EP-1589 Establishing international variation in target delineation using MRI for bladder radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Arnold AD, Shun-Shin MJ, Sohaib A, Chiew K, Howard JP, Keene D, Leong K, Ahmad Y, Cole G, Lefroy D, Kanagaratnam P, Varnava A, Francis DP, Whinnett ZI. P3553Automated, high-precision echocardiographic and haemodynamic assessment of the effect of atrioventricular interval during right ventricular pacing in obstructed hypertrophic cardiomyopathy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A D Arnold
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - M J Shun-Shin
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Sohaib
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - K Chiew
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - J P Howard
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D Keene
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - K Leong
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Y Ahmad
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - G Cole
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D Lefroy
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - P Kanagaratnam
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Varnava
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D P Francis
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Z I Whinnett
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
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Shun-Shin M, Arnold A, Keene D, Howard J, Sohaib A, Lim PB, Tanner M, Lefroy D, Peters N, Kanagaratnam P, Davies DW, Francis D, Whinnett Z. P1829The magnitude of LV activation time reduction with His bundle pacing over biventricular pacing in LBBB predicts the incremental improvement in acute cardiac function. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M Shun-Shin
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Arnold
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D Keene
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - J Howard
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Sohaib
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - P B Lim
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - M Tanner
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D Lefroy
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - N Peters
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - P Kanagaratnam
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D W Davies
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D Francis
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Z Whinnett
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
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Arnold AD, Howard JP, Ahmad Y, Chiew K, Kerrigan W, De Vere F, Keene D, Shun-Shin MJ, Cole G, Sohaib A, Varnava A, Francis DP, Whinnett ZI. P3551Right ventricular pacing for LVOT gradient reduction in hypertrophic obstructive cardiomyopathy: a meta-analysis and meta-regression of clinical trials. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A D Arnold
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - J P Howard
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Y Ahmad
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - K Chiew
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - W Kerrigan
- Imperial College Healthcare NHS Trust, Cardiology, London, United Kingdom
| | - F De Vere
- Royal Free Hospital, Intensive Care Unit, London, United Kingdom
| | - D Keene
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - M J Shun-Shin
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - G Cole
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Sohaib
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - A Varnava
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - D P Francis
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
| | - Z I Whinnett
- Imperial College London, National Heart and Lung Institute, London, United Kingdom
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Matoori S, Thian Y, Koh DM, Sohaib A, Larkin J, Pickering L, Gutzeit A. Contrast-Enhanced CT Density Predicts Response to Sunitinib Therapy in Metastatic Renal Cell Carcinoma Patients. Transl Oncol 2017; 10:679-685. [PMID: 28672196 PMCID: PMC5496476 DOI: 10.1016/j.tranon.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 06/03/2017] [Accepted: 06/05/2017] [Indexed: 12/27/2022] Open
Abstract
The first-line therapy in metastatic renal cell carcinoma (mRCC), sunitinib, exhibits an objective response rate of approximately 30%. Therapeutic alternatives such as other tyrosine kinase inhibitors, VEGF inhibitors, or mTOR inhibitors emphasize the clinical need to predict the patient's response to sunitinib therapy before treatment initiation. In this study, we evaluated the prognostic value of pretreatment portal venous phase contrast-enhanced computed tomography (CECT) mean tumor density on overall survival (OS), progression-free survival (PFS), and tumor growth in 63 sunitinib-treated mRCC patients. Higher pretreatment CECT tumor density was associated with longer PFS and OS [hazard ratio (HR)=0.968, P=.002, and HR=0.956, P=.001, respectively], and CECT density was inversely correlated with tumor growth (P=.010). Receiver operating characteristic analysis identified two CECT density cut-off values (63.67 HU, sensitivity 0.704, specificity 0.694; and 68.67 HU, sensitivity 0.593, specificity 0.806) which yielded subpopulations with significantly different PFS and OS (P<.001). Pretreatment CECT is therefore a promising noninvasive strategy for response prediction in sunitinib-treated mRCC patients, identifying patients who will derive maximum therapeutic benefit.
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Affiliation(s)
- Simon Matoori
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom; Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093 Zurich, Switzerland; Clinical Research Group, Hirslanden Clinic St. Anna, St. Anna-Strasse 32, 6006 Luzern, Switzerland.
| | - Yeeliang Thian
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Dow-Mu Koh
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Aslam Sohaib
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - James Larkin
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Lisa Pickering
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
| | - Andreas Gutzeit
- Department of Radiology, Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom; Department of Chemistry and Applied Biosciences, ETH Zurich, Vladimir-Prelog-Weg 3, 8093 Zurich, Switzerland; Clinical Research Group, Hirslanden Clinic St. Anna, St. Anna-Strasse 32, 6006 Luzern, Switzerland; Department of Radiology, Paracelsus Medical University Salzburg, Strubergasse 21, 5020 Salzburg, Austria
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Eccles C, McNair H, McQuaid D, Warren-Oseni K, Hansen V, Sohaib A, Koh M, Huddart R, Hafeez S. PV-0461: Integrating diagnostic MRI in radical bladder cancer radiotherapy: Challenges in image registration. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30902-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Seebacher V, Nobbenhuis M, Rockall A, Sohaib A, Shepherd J, Barton D. Präoperative Mangelernährung und Sarkopenie – Risikofaktoren für ein kürzeres Überleben von Patientinnen nach pelviner Exenteration? Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1599179] [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: 10/19/2022] Open
Affiliation(s)
- V Seebacher
- Abteilung für allgemeine Gynäkologie und gynäkologische Onkologie, Universitätsklinik für Frauenheilkunde, Medizinische Universität Wien
| | - M Nobbenhuis
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - A Rockall
- Department for Radiology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - A Sohaib
- Department for Radiology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - J Shepherd
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - D Barton
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, United Kingdom
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Sohaib A. Cost benefit of prophylactic filgrastim in breast cancer patients treated with adjuvant docetaxel. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30468-9] [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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Schmidt MA, Panek R, Colgan R, Hughes J, Sohaib A, Saran F, Murray J, Bernard J, Revell P, Nittka M, Leach MO, Hansen VN. Slice Encoding for Metal Artefact Correction in magnetic resonance imaging examinations for radiotherapy planning. Radiother Oncol 2016; 120:356-62. [PMID: 27222296 PMCID: PMC5013753 DOI: 10.1016/j.radonc.2016.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 11/13/2015] [Revised: 04/27/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Magnetic resonance (MR) and computed tomography (CT) images are degraded in the presence of metallic implants. We investigate whether SEMAC (Slice Encoding for Metal Artifact Correction) MR is advantageous for radiotherapy (RT) planning. METHODS Conventional and SEMAC MR protocols were compared (1.5T). A spine fixation device suspended in gelatine, two patients with spine fixation devices and six patients with bilateral hip replacements were scanned with both conventional and SEMAC protocols. In spine patients the visibility of the spinal canal and spinal cord was assessed; in prostate patients, the visibility of the prostate, pelvic structures and the pelvic girdle. RESULTS The signal loss volume surrounding the spine fixation device was reduced by approximately 20% when the SEMAC protocol was employed, and registration errors were reduced. For spine patients, the spinal canal was completely visible only using the SEMAC protocol. In hip replacement patients, metal artifacts were local; the signal loss extended to the internal surface of the acetabulum in eight implants with conventional protocols, but only in four using SEMAC. CONCLUSIONS SEMAC MR contributes towards correct co-registration of MR and CT images for RT planning, and is particularly relevant when the TV or OARs are close to implants.
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Affiliation(s)
- Maria A Schmidt
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, CR-UK & EPSRC Cancer Imaging Centre, Sutton, United Kingdom.
| | - Rafal Panek
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, CR-UK & EPSRC Cancer Imaging Centre, Sutton, United Kingdom
| | - Ruth Colgan
- Royal Marsden NHS Foundation Trust, Radiotherapy Department, Sutton, United Kingdom
| | - Julie Hughes
- Royal Marsden NHS Foundation Trust, Radiology Department, Sutton, United Kingdom
| | - Aslam Sohaib
- Royal Marsden NHS Foundation Trust, Radiology Department, Sutton, United Kingdom
| | - Frank Saran
- Royal Marsden NHS Foundation Trust, Neuro-Oncology Unit, Sutton, United Kingdom
| | - Julia Murray
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Radiotherapy and Imaging Department, Sutton, United Kingdom
| | - Jason Bernard
- St George's Hospital NHS Trust, Orthopaedic Surgery, London, United Kingdom
| | - Patrick Revell
- Siemens Healthcare GmbH, Diagnostic Imaging, Camberley, United Kingdom
| | - Mathias Nittka
- Siemens Healthcare Limited, Diagnostic Imaging, Erlangen, Germany
| | - Martin O Leach
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, CR-UK & EPSRC Cancer Imaging Centre, Sutton, United Kingdom
| | - Vibeke N Hansen
- Royal Marsden NHS Foundation Trust, Radiotherapy Department, Sutton, United Kingdom
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Schmidt M, Panek R, Colgan R, Hughes J, Sohaib A, Saran F, Murray J, Bernard J, Ravell P, Nittka M, Leach M, Hansen V. EP-1899: Evaluation of SEMAC MRI metal artifact reduction for orthopaedic implants in radiotherapy planning. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33150-4] [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: 10/21/2022]
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Harris VA, Staffurth J, Naismith O, Esmail A, Gulliford S, Khoo V, Lewis R, Littler J, McNair H, Sadoyze A, Scrase C, Sohaib A, Syndikus I, Zarkar A, Hall E, Dearnaley D. Consensus Guidelines and Contouring Atlas for Pelvic Node Delineation in Prostate and Pelvic Node Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2015; 92:874-83. [PMID: 26104940 DOI: 10.1016/j.ijrobp.2015.03.021] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [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: 12/16/2014] [Revised: 03/19/2015] [Accepted: 03/20/2015] [Indexed: 12/29/2022]
Abstract
PURPOSE The purpose of this study was to establish reproducible guidelines for delineating the clinical target volume (CTV) of the pelvic lymph nodes (LN) by combining the freehand Royal Marsden Hospital (RMH) and Radiation Therapy Oncology Group (RTOG) vascular expansion techniques. METHODS AND MATERIALS Seven patients with prostate cancer underwent standard planning computed tomography scanning. Four different CTVs (RMH, RTOG, modified RTOG, and Prostate and pelvIs Versus prOsTate Alone treatment for Locally advanced prostate cancer [PIVOTAL] trial) were created for each patient, and 6 different bowel expansion margins (BEM) were created to assess bowel avoidance by the CTV. The resulting CTVs were compared visually and by using Jaccard conformity indices. The volume of overlap between bowel and planning target volume (PTV) was measured to aid selection of an appropriate BEM to enable maximal LN yet minimal normal tissue coverage. RESULTS In total, 84 nodal contours were evaluated. LN coverage was similar in all groups, with all of the vascular-expansion techniques (RTOG, modified RTOG, and PIVOTAL), resulting in larger CTVs than that of the RMH technique (mean volumes: 287.3 cm(3), 326.7 cm(3), 310.3 cm(3), and 256.7 cm(3), respectively). Mean volumes of bowel within the modified RTOG PTV were 19.5 cm(3) (with 0 mm BEM), 17.4 cm(3) (1-mm BEM), 10.8 cm(3) (2-mm BEM), 6.9 cm(3) (3-mm BEM), 5.0 cm(3) (4-mm BEM), and 1.4 cm(3) (5-mm BEM) in comparison with an overlap of 9.2 cm(3) seen using the RMH technique. Evaluation of conformity between LN-CTVs from each technique revealed similar volumes and coverage. CONCLUSIONS Vascular expansion techniques result in larger LN-CTVs than the freehand RMH technique. Because the RMH technique is supported by phase 1 and 2 trial safety data, we proposed modifications to the RTOG technique, including the addition of a 3-mm BEM, which resulted in LN-CTV coverage similar to that of the RMH technique, with reduction in bowel and planning target volume overlap. On the basis of these findings, recommended guidelines including a detailed pelvic LN contouring atlas have been produced and implemented in the PIVOTAL trial.
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Affiliation(s)
- Victoria A Harris
- Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - John Staffurth
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, Wales, United Kingdom
| | - Olivia Naismith
- Joint Department of Physics, Institute of Cancer Research, and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alikhan Esmail
- Ipswich Hospital NHS Foundation Trust, Ipswich, United Kingdom
| | - Sarah Gulliford
- Joint Department of Physics, Institute of Cancer Research, and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Vincent Khoo
- Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Rebecca Lewis
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, United Kingdom
| | - John Littler
- Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - Helen McNair
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Azmat Sadoyze
- Beatson West of Scotland Cancer Centre, Scotland, Glasgow, United Kingdom
| | | | - Aslam Sohaib
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Anjali Zarkar
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, United Kingdom
| | - David Dearnaley
- Academic Urology Unit, Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, United Kingdom.
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Abstract
OBJECTIVES The aim of this study was to determine the utility of fluorine-18 fluorodeoxyglucose PET/computed tomography ((18)F-FDG PET/CT) in managing testicular cancer. PATIENTS AND METHODS Sixty-two patients (29 seminoma, 28 nonseminoma and five mixed) underwent 75 (18)F-FDG PET/CT scans (16 scans for primary staging, 44 for residual masses and 15 for rising tumour markers). Follow-up histology, clinical scans and tumour marker results were included for retrospective analysis. RESULTS (i) Primary staging: eight of 11 patients with equivocal CT scans had true-negative (18)F-FDG PET/CT scans. Five high-risk patients with normal stage 1 CT scans had negative (18)F-FDG PET/CT scans, but two subsequently relapsed. (ii) Residual masses: of the 20 scans interpreted as showing viable disease, five were false positive. Nineteen scans were negative (18 true negative and one false negative). (iii) Rising tumour markers: of the 15 scans, two were false negative and 13 were true positive. CONCLUSION (18)F-FDG PET/CT is helpful when primary staging CT scans are equivocal but insufficiently sensitive to predict relapse in high-risk patients with normal CT scans. With residual masses, a negative scan is rarely associated with relapse. (18)F-FDG PET/CT is helpful in defining recurrent disease in the majority of patients with rising tumour markers and negative CT scans.
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Affiliation(s)
- Gary J Cook
- aKings College London bRoyal Marsden NHS Foundation Trust, London cInstitute of Cancer Research, Sutton, Surrey, UK
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Andreou A, Sohaib A, Collins DJ, Takahara T, Kwee TC, Leach MO, MacVicar DA, Koh DM. Diffusion-weighted MR neurography for the assessment of brachial plexopathy in oncological practice. Cancer Imaging 2015; 15:6. [PMID: 25934632 PMCID: PMC4417248 DOI: 10.1186/s40644-015-0041-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 09/02/2014] [Accepted: 04/14/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To evaluate diffusion-weighted MR neurography (DW-MRN) for visualizing the brachial plexus and for the assessment of brachial plexopathy. METHODS 40 oncological patients with symptoms of brachial plexopathy underwent 1.5 T MRI using conventional MR sequences and unidirectional DW-MRN. The images were independently reviewed by two radiologists. Anatomic visualization of the brachial plexus was scored using a 5 point scale on conventional MR sequences and then combined with DW-MRN. A brachial plexus abnormality was also scored using a 5 point scale and inter-observer agreement determined by kappa statistics. Diagnostic accuracy for brachial plexopathy assessed by conventional MRI alone versus conventional MRI combined with DW-MRN was compared by ROC analysis using reference standards. RESULTS DW-MRN significantly improved visualization of the brachial plexus compared with conventional MRI alone (P<0.001). When assessing brachial plexopathy, inter-observer agreement was moderate for conventional MRI (kappa=0.48) but good for conventional MRI with DW-MRN (kappa=0.62). DW-MRN combined with conventional MRI significantly improved diagnostic accuracy in one observer (P<0.05) but was similar in the other observer. CONCLUSION DW-MRN improved visualization of the brachial plexus. Combining DW-MRN with conventional MRI can improve inter-observer agreement and detection of brachial plexopathy in symptomatic oncological patients.
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Affiliation(s)
- Adrian Andreou
- Department of Radiology, Royal Marsden, Sutton, Surrey, UK.
| | - Aslam Sohaib
- Department of Radiology, Royal Marsden, Sutton, Surrey, UK.
| | - David J Collins
- CR UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, UK.
| | - Taro Takahara
- Department of Radiology, University Medical Center, Utrecht, Netherlands.
| | - Thomas C Kwee
- Department of Radiology, University Medical Center, Utrecht, Netherlands.
| | - Martin O Leach
- CR UK Clinical Magnetic Resonance Research Group, Institute of Cancer Research, Sutton, Surrey, UK.
| | | | - Dow-Mu Koh
- Department of Radiology, Royal Marsden, Sutton, Surrey, UK.
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Alexander E, DeSouza N, Murray J, Riches S, Hazell S, Livni N, Thomas K, Giles S, Morgan V, Sohaib A, Thompson A, Dearnaley D. The Accuracy of T2- and Diffusion-weighted Magnetic Resonance (T2W/DWI-MR) in the Detection of Intra-prostatic Tumour as Target Volume for Focal Dose-escalation using Intensity-modulated Radiotherapy (IMRT). Clin Oncol (R Coll Radiol) 2015. [DOI: 10.1016/j.clon.2014.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Atri M, Zhang Z, Marques H, Gorelick J, Harisinghani M, Sohaib A, Koh DM, Raman S, Gee M, Choi H, Landrum L, Mannel R, Chuang L, Yu JQM, McCourt CK, Gold M. Utility of preoperative ferumoxtran-10 MRI to evaluate retroperitoneal lymph node metastasis in advanced cervical cancer: Results of ACRIN 6671/GOG 0233. Eur J Radiol Open 2015; 2:11-18. [PMID: 25774381 PMCID: PMC4357172 DOI: 10.1016/j.ejro.2014.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
RATIONALE AND OBJECTIVES To assess if ferumoxtran-10 (f-10) improves accuracy of MRI to detect lymph node (LN) metastasis in advanced cervical cancer. MATERIALS AND METHODS F-10 MRI component of an IRB approved HIPAA compliant ACRIN/GOG trial was analyzed. Patients underwent f-10 MRI followed by extra-peritoneal or laparoscopic pelvic and abdominal lymphadenectomy. F-10-sensitive sequences were T2* GRE sequences with TE of 12 and 21. Seven independent blinded readers reviewed f-10-insensitive sequences and all sequences in different sessions. Region correlations were performed between pathology and MRI for eight abdomen and pelvis regions. Sensitivity and specificity were calculated at participant level. Reference standard is based on pathology result of surgically removed LNs. RESULTS Among 43 women enrolled in the trial between September 2007 and November 2009, 33 women (mean age 49 ±11 years old) with advanced cervical cancer (12 IB2, 3 IIA, 15 IIB and 3 IIIB, 29 squamous cell carcinomas, 32 grade 2 or 3) were evaluable. Based on histopathology, LN metastasis was 39% in abdomen and 70% in pelvis. Sensitivity of all sequence review in pelvis, abdomen, and combined were 83%, 60%, and 86%, compared with 78%, 54%, and 80% for f-10 insensitive sequences (P: 0.24, 0.44 and 0.14, respectively). Mean diameter of the largest positive focus on histopathology was 13.7 mm in abdomen and 18.8 mm in pelvis (P = 0.018). Specificities of all sequence review in pelvis, abdomen, and combined were 48%, 75%, and 43%, compared with 75%, 83%, and 73% (P: 0.003, 0.14, 0.002 respectively) for f-10 insensitive sequences. CONCLUSION Addition of f-10 increased MRI sensitivity to detect LN metastasis in advanced cervical cancer. Increased sensitivity did not reach statistical significance and was at the expense of lower specificity.
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Affiliation(s)
| | | | | | | | | | | | | | - Steven Raman
- University of California at Los Angeles, United States
| | - Michael Gee
- Massachusetts General Hospital, United States
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Thian Y, Gutzeit A, Koh DM, Fisher R, Lote H, Larkin J, Sohaib A. Revised Choi imaging criteria correlate with clinical outcomes in patients with metastatic renal cell carcinoma treated with sunitinib. Radiology 2014; 273:452-61. [PMID: 24869795 DOI: 10.1148/radiol.14132702] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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: 01/01/2023]
Abstract
PURPOSE To compare revised Choi criteria that incorporate concurrent size and attenuation changes at early follow-up imaging with Response Evaluation Criteria in Solid Tumors ( RECIST Response Evaluation Criteria in Solid Tumors ) 1.1 and original Choi criteria in stratification of clinical outcomes in patients with metastatic renal cell carcinoma ( mRCC metastatic renal cell carcinoma ) treated with sunitinib. MATERIALS AND METHODS Institutional review board approved this retrospective study and waived informed consent. Baseline and first follow-up computed tomographic scans in 69 patients (50 men, 19 women; mean age, 60.3 years; range, 19-83 years) with mRCC metastatic renal cell carcinoma treated with sunitinib from October 1, 2008, to March 1, 2013, were evaluated for tumor response by using RECIST Response Evaluation Criteria in Solid Tumors 1.1, original Choi criteria, and revised Choi criteria. Correlations with overall survival ( OS overall survival ) and progression-free survival ( PFS progression-free survival ) were compared and stratified according to each radiologic criteria with Kaplan-Meier and multivariate Cox regression analysis. RESULTS Median follow-up time was 29.7 months (95% confidence interval [ CI confidence interval ]: 18.9, 45.9). Response according to revised Choi criteria was independently correlated with OS overall survival (hazard ratio, 0.47 [95% CI confidence interval : 0.23, 0.99]; P = .046) and PFS progression-free survival (hazard ratio, 0.53 [95% CI confidence interval : 0.29, 0.99]; P = .047). Response according to RECIST Response Evaluation Criteria in Solid Tumors was not significantly correlated with OS overall survival (hazard ratio, 0.65 [95% CI confidence interval : 0.27, 1.58]; P = .344) or PFS progression-free survival (hazard ratio, 0.89 [95% CI confidence interval : 0.42, 1.91]; P = .768). Response according to original Choi criteria was not significantly correlated with OS overall survival (hazard ratio, 0.60 [95% CI confidence interval : 0.32, 1.11]; P = .106) or PFS progression-free survival (hazard ratio, 0.59 [95% CI confidence interval : 0.34, 1.02]; P = .060). Median OS overall survival and PFS progression-free survival in responders according to revised Choi criteria was 39.4 months (95% CI confidence interval : 9.1, upper limit not estimated) and 13.7 months (95% CI confidence interval : 6.4, 24.6), respectively, compared with 12.8 months (95% CI confidence interval : 8.7, 18.0) and 5.3 months (95% CI confidence interval : 3.9, 8.4), respectively, in nonresponders. CONCLUSION Contemporaneous reduction in tumor size and attenuation were correlated with favorable clinical outcomes. Response according to revised Choi criteria showed better correlation with clinical outcomes compared with that according to RECIST Response Evaluation Criteria in Solid Tumors or original Choi criteria in patients with mRCC metastatic renal cell carcinoma treated with sunitinib.
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Affiliation(s)
- Yeeliang Thian
- From the Departments of Radiology (Y.T., A.G., D.M.K., A.S.) and Medical Oncology (R.F., H.L., J.L.), Royal Marsden Hospital, Downs Road, Sutton, Surrey SM2 5PT, England
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Hafeez S, Koh M, Sohaib A, Huddart R. PO-0734: Assessing response to radiotherapy with diffusion weighted MRI (DW-MRI) in muscle invasive bladder cancer (MIBC). Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30852-5] [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: 10/23/2022]
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Lee G, Hunter R, Lovell M, Finlay M, Sawhney V, Ullah W, Diab I, Dhinoja M, Earley M, Sporton S, Schilling RJ, Williams SE, Linton NWF, Harrison J, Wright M, O'Neill M, Jamil-Copley S, Linton N, Koa-Wing M, Lim PB, Hayat S, Qureshi N, Whinnett Z, Davies W, Peters N, Francis D, Kanagaratnam P, Jamil-Copley S, Ryan B, Kojodjojo P, Qureshi N, Koa-Wing M, Hayat S, Kyriacou A, Sandler B, Sohaib A, Wright I, Davies W, Peters N, Whinnett Z, Kanagaratnam P, Lim PB, Qureshi NA, Bai W, Ariff B, Williams A, Monro C, Kim S, Jamil-Copley S, Hayat S, Kao-Wing M, Kyriacou A, Sandler B, Fu NS, Kanagaratnam P, Whinnett Z, Davies DW, Lefroy D, Peters NS, Lim PB, Ryan MJ, Ezzat VA, O'Leary J, Bull C, Chow A, Lambiase P, Lowe MD, Anwar AS, Collitt S, Iddon P, Rice N, Dodd M, Dunsdale A, Petkar S, Mudd J, Linker N, Fitzpatrick AP, Fraser S, Choo WK, Padfield G, Rushworth G, Bloe C, Forsyth P, Cross SJ, Leslie SJ, Phan TT, Dewhurst M, Lee D, Williams D, James S, Thornley A, de Belder M, Linker N, Turley A, Campbell NG, Cantor E, Sawhney V, Duncan ER, Demartini C, Baker V, Diab IG, Dhinoja M, Earley MJ, Sporton S, Davies LC, Schilling RJ, Pettit SJ, Randles DA, Shaw M, Hawkins NM, Wright DJ, Lambiase PD, Barr C, Knops R, Neuzil P, Theuns D, Johansen JB, Hood M, Pederson S, Reeve HL, Boersma L. ABSTRACTS FOR ORAL PRESENTATION, SESSION 3, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut316] [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: 11/14/2022] Open
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Fabritz L, Fortmuller L, Vloumidi E, Yue TY, Syeda F, Kirchhof P, Leube R, Krusche C, Chin SH, Winter J, Brack KE, Ng GA, Ng FS, Holzem KM, Koppel AC, Janks D, Wit AL, Peters NS, Efimov IR, Chowdhury RA, El-Harasis MA, Dupont E, Terracciano CMN, Peters NS, Mellor GJ, Raju H, de Noronha SV, Papadakis M, Sharma S, Behr ER, Sheppard MN, Jamil-Copley S, Bai W, Ariff B, Lim PB, Koa-Wing M, Kyriacou A, Hayat S, Sohaib A, Qureshi N, Sandler B, O'Regan D, Whinnett Z, Davies W, Rueckert D, Kanagaratnam P, Peters N, Lambiase PD, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Sandilands A, Paisey J, Roberts P, Morgan JM, McCready J, Yue A, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley M, Schilling R, Ghosh J, Martin A, Keech A, Chan KH, Gomes S, Singarayar S, McGuire M, Lee G, Hunter R, Berriman T, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Unsworth B, Mayet J, Abrams D, Dhinoja M, Sporton S, Earley M, Schilling RJ, Bowers RW, Mulholland V, Balasubramaniam RN, Paisey JR, Sopher SM, Chu GS, Chin SH, Winter J, Armstrong S, Masca N, Almeida TP, Brown PD, Sandilands AJ, Schlindwein FS, Ng GA. ABSTRACTS FOR ORAL PRESENTATION, SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut315] [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: 11/13/2022] Open
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Tree A, Jones C, Sohaib A, Khoo V, van As N. Prostate stereotactic body radiotherapy with simultaneous integrated boost: which is the best planning method? Radiat Oncol 2013; 8:228. [PMID: 24088319 PMCID: PMC3853231 DOI: 10.1186/1748-717x-8-228] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background The delivery of a simultaneous integrated boost to the intra-prostatic tumour nodule may improve local control. The ability to deliver such treatments with hypofractionated SBRT was attempted using RapidArc (Varian Medical systems, Palo Alto, CA) and Multiplan (Accuray inc, Sunnyvale, CA). Materials and methods 15 patients with dominant prostate nodules had RapidArc and Multiplan plans created using a 5 mm isotropic margin, except 3 mm posteriorly, aiming to deliver 47.5 Gy in 5 fractions to the boost whilst treating the whole prostate to 36.25 Gy in 5 fractions. An additional RapidArc plan was created using an 8 mm isotropic margin, except 5 mm posteriorly, to account for lack of intrafraction tracking. Results Both RapidArc and Multiplan can produce clinically acceptable boost plans to a dose of 47.5 Gy in 5 fractions. The mean rectal doses were lower for RapidArc plans (D50 13.2 Gy vs 15.5 Gy) but the number of missed constraints was the same for both planning methods (11/75). When the margin was increased to 8 mm/5 mm for the RapidArc plans to account for intrafraction motion, 37/75 constraints were missed. Conclusions RapidArc and Multiplan can produce clinically acceptable simultaneous integrated boost plans, but the mean rectal D50 and D20 with RapidArc are lower. If the margins are increased to account for intrafraction motion, the RapidArc plans exceed at least one dose constraint in 13/15 cases. Delivering a simultaneous boost with hypofractionation appears feasible, but requires small margins needing intrafraction motion tracking.
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Affiliation(s)
- Alison Tree
- Royal Marsden NHS Foundation Trust, Fulham Road, London SW3 6JJ, UK.
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Brockbank E, Harry V, Kolomainen D, Mukhopadhyay D, Sohaib A, Bridges J, Nobbenhuis M, Shepherd J, Ind T, Barton D. Laparoscopic staging for apparent early stage ovarian or fallopian tube cancer. First case series from a UK cancer centre and systematic literature review. Eur J Surg Oncol 2013; 39:912-7. [DOI: 10.1016/j.ejso.2013.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 04/30/2013] [Accepted: 05/08/2013] [Indexed: 01/29/2023] Open
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Horwich A, Dearnaley D, Sohaib A, Pennert K, Huddart R. Neoadjuvant carboplatin before radiotherapy in stage IIA and IIB seminoma. Ann Oncol 2013; 24:2104-7. [DOI: 10.1093/annonc/mdt148] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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