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Hudson EM, Slevin F, Biscombe K, Brown SR, Haviland JS, Murray L, Kirby AM, Thomson DJ, Sebag-Montefiore D, Hall E. Hitting the Target: Developing High-quality Evidence for Proton Beam Therapy Through Randomised Controlled Trials. Clin Oncol (R Coll Radiol) 2024; 36:70-79. [PMID: 38042671 DOI: 10.1016/j.clon.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/03/2023] [Indexed: 12/04/2023]
Abstract
The National Health Service strategy for the delivery of proton beam therapy (PBT) in the UK provides a unique opportunity to deliver high-quality evidence for PBT through randomised controlled trials (RCTs). We present a summary of three UK PBT RCTs in progress, including consideration of their key design characteristics and outcome assessments, to inform and support future PBT trial development. The first three UK multicentre phase III PBT RCTs (TORPEdO, PARABLE and APPROACH), will compare PBT with photon radiotherapy for oropharyngeal squamous cell carcinoma, breast cancer and oligodendroglioma, respectively. All three studies were designed by multidisciplinary teams, which combined expertise from clinicians, clinical trialists and scientists with strong patient advocacy and guidance from national radiotherapy research networks and international collaborators. Consistent across all three studies is a focus on the reduction of long-term radiotherapy-related toxicities and an evaluation of patient-reported outcomes and health-related quality of life, which will address key uncertainties regarding the clinical benefits of PBT. Innovative translational components will provide insights into mechanisms of toxicity and help to frame the key future research questions regarding PBT. The UK radiotherapy research community is developing and delivering an internationally impactful PBT research portfolio. The combination of data from RCTs with prospectively collected data from a national PBT outcomes registry will provide an innovative, high-quality repository for PBT research and the platform to design and deliver future trials of PBT.
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Affiliation(s)
- E M Hudson
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - F Slevin
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - K Biscombe
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - S R Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - J S Haviland
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - L Murray
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - A M Kirby
- The Royal Marsden NHS Foundation Trust & The Institute of Cancer Research, Sutton, UK
| | - D J Thomson
- The Christie NHS Foundation Trust, Manchester, UK
| | - D Sebag-Montefiore
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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Shen Z, Brand D, Zhang Y, Simard M, Lopes A, Miles E, Gilbert A, West N, Blake A, Royle G, Appelt A, Maughan TS, Sebag-Montefiore D, Collins-Fekete CA, Hawkins MA. Modeling Acute Chemoradiotherapy (CRT) Diarrhea Severity Using Automatically Contoured Small Bowel. Int J Radiat Oncol Biol Phys 2023; 117:e338. [PMID: 37785184 DOI: 10.1016/j.ijrobp.2023.06.2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Acute severe diarrhea is a common toxicity in rectal cancer patients receiving CRT. A better understanding of the radiation tolerance of the small bowel is needed especially for novel radiation drug combinations. We investigate the dose impact by providing auto-contoured small bowel, using data from the ARISTOTLE phase III trial ISRCTN: 09351447. MATERIALS/METHODS A subset of participants (n = 93/564) with locally advanced rectal cancer in the ARISTOTLE trial testing the addition of concurrent irinotecan (n = 48) to neoadjuvant capecitabine (n = 45) CRT (45/25 Gy/fx), in an MRI defined high risk of loco-regional failure. CRT was delivered with conformal techniques. Diarrhea was measured using CTCAE v4.0 weekly. We applied an AI-based auto-contouring model to segment the small bowel on planning CT. The small-bowel DVH parameters were combined with the treatment arm, age, sex and MRI-defined tumor stage in a linear regression (LR) model to predict acute diarrhea severity. Explainable Shapley values (conditional marginalized expectation of a machine learning model per feature) were used to quantify the independent and normalized impact of radiation dose vs Irinotecan on the likelihood of severe diarrhea. RESULTS The auto-contouring model accuracy was consistent with clinical practice (mean dice coefficient = 0.739) and clinically acceptable when reviewed by clinicians. The treatment arm, MRI-defined T stage and small-bowel mean dose were found to be independently correlated to the diarrhea severity (p<0.001). V30Gy showed the strongest correlation to diarrhea severity in all the DVH parameters. The LR using the three variables yielded mean AUC scores of 0.898 (95% CI: [0.831,0.958]) on predicting Grade 2 and higher diarrhea, and 0.774 (95% CI: [0.678,0.869]) on predicting Grade 3 diarrhea based on 10-fold cross-validation. Shapley values showed that V30Gy>30.56 cm3 increases the likelihood of more severe diarrhea against the average (grade = 1.03) in the cohort. The impact of irradiation will be larger than the usage of Irinotecan within the patients with V30Gy >160.93 cm3. CONCLUSION We accurately modelled acute diarrhea (AUC = 0.90) for rectal cancer patients receiving CRT using AI-contoured small-bowel structures. The treatment arm and small-bowel dose were independently correlated to the diarrhea severity. The explainable model allowed us to quantify the impact of radiation dose, usage of irinotecan, and its combination, with a threshold of V30Gy = 160.93 cm3 yielding an equivalent impact. We will be extending the analysis to the whole trial cohort to improve the statistical power.
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Affiliation(s)
- Z Shen
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - D Brand
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom; Department of Radiotherapy, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Y Zhang
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - M Simard
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - A Lopes
- University College London, London, United Kingdom
| | - E Miles
- National Radiotherapy Trials QA Group, Mount Vernon Hospital, Northwood, United Kingdom
| | - A Gilbert
- University of Leeds, Leeds, United Kingdom
| | - N West
- University of Leeds, Leeds, United Kingdom
| | - A Blake
- MRC Oxford institute for Radiation Biology, Department of Oncology, Medical Sciences Division, University of Oxford, Oxford, United Kingdom
| | - G Royle
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - A Appelt
- St. James's University Hospital, Leeds, United Kingdom
| | - T S Maughan
- MRC Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Oxford, United Kingdom
| | | | - C A Collins-Fekete
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - M A Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
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Slevin F, Hanna CR, Appelt A, Cunningham C, Marijnen CAM, Sebag-Montefiore D, Muirhead R. The Long and the Short of it: the Role of Short-course Radiotherapy in the Neoadjuvant Management of Rectal Cancer. Clin Oncol (R Coll Radiol) 2022; 34:e210-e217. [PMID: 34955376 DOI: 10.1016/j.clon.2021.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/05/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
Total mesorectal excision is the cornerstone of treatment for rectal cancer. Multiple randomised trials have shown a reduction in local recurrence rates with the addition of preoperative radiotherapy, either as a 1-week hypofractionated short-course (SCRT) or a conventionally fractionated long-course (LCRT) schedule with concurrent chemotherapy. There is also increasing interest in the addition of neoadjuvant chemotherapy to radiotherapy with the aim of improving disease-free survival. The relative use of SCRT and LCRT varies considerably across the world. This is reflected in, and is probably driven in part by, disparity between international guideline recommendations. In addition, different approaches to treatment may exist both between and within countries, with variation related to patient, disease and treatment centre and financial factors. In this review, we will specifically focus on the use of SCRT for the treatment of rectal cancer. We will discuss the literature base and current guidelines, highlighting the challenges and controversies in clinical application of this evidence. We will also discuss potential future applications of SCRT, including its role in optimisation and intensification of treatment for rectal cancer.
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Affiliation(s)
- F Slevin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - C R Hanna
- Beatson West of Scotland Cancer Centre, Glasgow, UK; CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - A Appelt
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - C Cunningham
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C A M Marijnen
- Netherlands Cancer Institute, Amsterdam, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - D Sebag-Montefiore
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - R Muirhead
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
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Wakeham K, Murray L, Muirhead R, Hawkins MA, Sebag-Montefiore D, Brown S, Murphy L, Thomas G, Bell S, Whibley M, Morgan C, Sleigh K, Gilbert DC. Multicentre Investigation of Prognostic Factors Incorporating p16 and Tumour Infiltrating Lymphocytes for Anal Cancer After Chemoradiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:638-649. [PMID: 34024700 DOI: 10.1016/j.clon.2021.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/09/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022]
Abstract
AIMS Anal squamous cell carcinomas (ASCC) are strongly associated with human papillomaviruses. Standard of care is chemoradiotherapy at uniform doses with no treatment stratification. Immunohistochemical staining for p16INK4A (p16), a surrogate for human papillomaviruses, is prognostic for outcomes. We investigated this alongside clinical-pathological factors, including tumour infiltrating lymphocyte (TIL) scores. MATERIALS AND METHODS Using an independent, multicentre cohort of 257 ASCC treated with chemoradiotherapy, pretreatment biopsies were stained and scored for p16 and TIL. Kaplan-Meier curves were derived for outcomes (disease-free survival [DFS], overall survival and cancer-specific survival), by stage, p16 and TIL scores and Log-rank tests were carried out to investigate prognostic effect. A multivariate analysis was carried out using Cox regression. RESULTS Stage, sex, p16 and TILs were independently prognostic. Hazard ratios for death (overall survival) were 2.51 (95% confidence interval 1.36-4.63) for p16 negative versus p16 positive, 2.17 (1.34-3.5) for T3/4 versus T1/2, 2.42 (1.52-3.8) for males versus females and 3.30 (1.52-7.14) for TIL1 versus TIL3 (all P < 0.05). CONCLUSIONS We have refined prognostic factors in ASCC. p16 adds to stratification by stage with respect to DFS in early disease and overall survival/DFS in locally advanced cancers. Our data support the role of the host immune response in mediating outcomes. These factors will be prospectively evaluated in PLATO (ISRCTN88455282).
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Affiliation(s)
- K Wakeham
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - L Murray
- Leeds Institute of Medical Research, University of Leeds, Leeds Cancer Centre, Leeds, UK
| | - R Muirhead
- Oxford University Hospitals NHS Trust, Department of Oncology, Churchill Hospital, Oxford, UK
| | - M A Hawkins
- University College London, Medical Physics and Biomedical Engineering, London, UK
| | - D Sebag-Montefiore
- Leeds Institute of Medical Research, University of Leeds, Leeds Cancer Centre, Leeds, UK
| | - S Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - L Murphy
- MRC Clinical Trials Unit at UCL, London, UK
| | - G Thomas
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK; Cancer Sciences Unit, University of Southampton, Southampton, UK
| | - S Bell
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - M Whibley
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - C Morgan
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - K Sleigh
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - D C Gilbert
- MRC Clinical Trials Unit at UCL, London, UK.
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Hanna CR, Slevin F, Appelt A, Beavon M, Adams R, Arthur C, Beasley M, Duffton A, Gilbert A, Gollins S, Harrison M, Hawkins MA, Laws K, O'Cathail S, Porcu P, Robinson M, Sebag-Montefiore D, Teo M, Teoh S, Muirhead R. Intensity-modulated Radiotherapy for Rectal Cancer in the UK in 2020. Clin Oncol (R Coll Radiol) 2021; 33:214-223. [PMID: 33423883 PMCID: PMC7985673 DOI: 10.1016/j.clon.2020.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/13/2020] [Accepted: 12/11/2020] [Indexed: 12/15/2022]
Abstract
AIMS Preoperative (chemo)radiotherapy followed by total mesorectal excision is the current standard of care for patients with locally advanced rectal cancer. The use of intensity-modulated radiotherapy (IMRT) for rectal cancer is increasing in the UK. However, the extent of IMRT implementation and current practice was not previously known. A national survey was commissioned to investigate the landscape of IMRT use for rectal cancer and to inform the development of national rectal cancer IMRT guidance. MATERIALS AND METHODS A web-based survey was developed by the National Rectal Cancer IMRT Guidance working group in collaboration with the Royal College of Radiologists and disseminated to all UK radiotherapy centres. The survey enquired about the implementation of IMRT with a focus on the following aspects of the workflow: dose fractionation schedules and use of a boost; pre-treatment preparation and simulation; target volume/organ at risk definition; treatment planning and treatment verification. A descriptive statistical analysis was carried out. RESULTS In total, 44 of 63 centres (70%) responded to the survey; 30/44 (68%) and 36/44 (82%) centres currently use IMRT to treat all patients and selected patients with rectal cancer, respectively. There was general agreement concerning several aspects of the IMRT workflow, including patient positioning, use of intravenous contrast and bladder protocols. Greater variation in practice was identified regarding rectal protocols; use of a boost to primary/nodal disease; target volume delineation; organ at risk delineation and dose constraints and treatment verification. Delineation of individual small bowel loops and daily volumetric treatment verification were considered potentially feasible by most centres. CONCLUSION This survey identified that IMRT is already used to treat rectal cancer in many UK radiotherapy centres, but there is heterogeneity between centres in its implementation and practice. These results have been a valuable aid in framing the recommendations within the new National Rectal Cancer IMRT Guidance.
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Affiliation(s)
- C R Hanna
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - F Slevin
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Appelt
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Beavon
- Royal College of Radiologists, London, UK
| | - R Adams
- Velindre Cancer Centre, Cardiff, UK
| | - C Arthur
- The Christie NHS Foundation Trust, Manchester, UK
| | - M Beasley
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Duffton
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Gilbert
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Rhyl, UK
| | - M Harrison
- Mount Vernon Cancer Centre, Northwood, UK
| | - M A Hawkins
- Medical Physics and Biochemical Engineering, University College London, London, UK
| | - K Laws
- Aberdeen Cancer Centre, Aberdeen Royal Infirmary, Aberdeen, UK
| | - S O'Cathail
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - P Porcu
- Royal Free London NHS Foundation Trust, London, UK
| | - M Robinson
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - D Sebag-Montefiore
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Teo
- University of Leeds, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - S Teoh
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Muirhead
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Lewis PJ, Morris EJA, Chan CSK, Darley K, Sebag-Montefiore D, Evans M. COVID RT - Assessing the Impact of COVID-19 on Radiotherapy in the UK. A National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group Initiative in Partnership with the Royal College of Radiologists, the Society of Radiographers and the Institute of Physics and Engineering in Medicine. Clin Oncol (R Coll Radiol) 2021; 33:e69-e72. [PMID: 32950351 PMCID: PMC7467021 DOI: 10.1016/j.clon.2020.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/13/2020] [Accepted: 08/25/2020] [Indexed: 11/20/2022]
Affiliation(s)
- P J Lewis
- NHS England; Royal College of Radiologists, London, UK.
| | - E J A Morris
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - C S K Chan
- National Cancer Research Institute, London, UK
| | - K Darley
- Royal College of Radiologists, London, UK
| | | | - M Evans
- Velindre University NHS Trust, Cardiff, UK
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Gilbert A, Sebag-Montefiore D, Brown J, Brown S. PO-1303: Radiotherapy platform trials: accelerating our ability to answer important scientific questions. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01321-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Appelt A, Beasley M, Teo M, Slevin F, Muirhead R, Sebag-Montefiore D. PO-1638: Treatment delivery uncertainties in rectal cancer radiotherapy – evidence-based margin estimates. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01656-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sebag-Montefiore D. SP-0490: The treatment of anal cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00512-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bird D, Teo M, Casanova N, Cooper R, Gilbert A, Mccallum H, Sebag-Montefiore D, Henry A, Speight R, Al-Qaisieh B, Nix M. PH-0410: Multi-centre, deep learning, sCT generation for anorectal cancers with AI robustness assessment. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00432-1] [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: 10/22/2022]
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O'Cathail S, Muirhead R, Sebag-Montefiore D, Hawkins M. PH-0161: Elective clinical target volumes for rectal IMRT delivery – moving towards a UK wide consensus. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Glynne-Jones R, Meadows HM, Lopes A, Muirhead R, Sebag-Montefiore D, Adams R. Reply to the letter to the editor: DPD testing in radical chemoradiation for anal squamous cell carcinoma? by R. Muirhead, H. Jones, D. Gilbert, A. Gilbert & C. Jacobs. Ann Oncol 2020; 31:1587-1588. [PMID: 32822831 DOI: 10.1016/j.annonc.2020.08.2097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 12/24/2022] Open
Affiliation(s)
- R Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK.
| | - H M Meadows
- Cancer Research UK & University College London Cancer Trials Centre, UCL, London, UK
| | - A Lopes
- Cancer Research UK & University College London Cancer Trials Centre, UCL, London, UK
| | - R Muirhead
- Oxford Cancer & Haematology Centre, Oxford University Hospitals, Oxford, UK
| | | | - R Adams
- School of Medicine, Cardiff University, Cardiff, UK
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13
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Glynne-Jones R, Meadows HM, Lopes A, Muirhead R, Sebag-Montefiore D, Adams R. Impact of compliance to chemoradiation on long-term outcomes in squamous cell carcinoma of the anus: results of a post hoc analysis from the randomised phase III ACT II trial. Ann Oncol 2020; 31:1376-1385. [PMID: 32619648 DOI: 10.1016/j.annonc.2020.06.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 03/05/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Concurrent chemoradiation is standard-of-care for patients with squamous cell carcinoma of the anus. Poor compliance to chemotherapy, radiotherapy treatment interruptions and unplanned breaks may impact adversely on long-term outcomes. METHODS The ACT II trial recruited 940 patients with localised squamous cell carcinoma of the anus, and assigned patients to mitomycin (week 1) or cisplatin (weeks 1 and 5), with fluorouracil (weeks 1 and 5) and radiotherapy (50.4 Gy in 28 fractions over 38 days). This post hoc analysis examined the association between baseline factors (age, gender, site, T stage and N stage), and compliance to treatment (radiotherapy and chemotherapy), and their effects on locoregional failure-free survival, progression-free survival (PFS) and overall survival (OS). Compliance was categorised into groups. Radiotherapy: six groups according to total dose and overall treatment time (OTT). Chemotherapy: three groups (A = per-protocol; B = dose reduction or delay; C = omitted). RESULTS A total of 931/940 patients were assessable for radiotherapy and 936 for chemotherapy compliance. Baseline glomerular filtration rate <60 ml/min and cisplatin were significantly associated with poor week 5 compliance to chemotherapy (P = 0.003 and 0.02, respectively). Omission of week 5 chemotherapy was associated with significantly worse locoregional failure-free survival [hazard ratio (HR) 2.53 (1.33-4.82) P = 0.005]. Dose reductions/delays or omission of week 5 chemotherapy were associated with significantly worse PFS {HR: 1.56 [95% confidence interval (CI): 1.18-2.06], P = 0.002 and HR: 2.39 (95% CI: 1.44-3.98), P = 0.001, respectively} and OS [HR: 1.92 (95% CI: 1.41-2.63), P < 0.001 and HR: 2.88 (95% CI: 1.63-5.08), P < 0.001, respectively]. Receiving the target radiotherapy dose in >42 days is associated with worse PFS and OS [HR: 1.72 (95% CI: 1.17-2.54), P =0.006]. CONCLUSION Poor compliance to chemotherapy and radiotherapy were associated with worse locoregional failure-free survival, PFS and OS. Treatment interruptions should be minimised, and OTT and total dose maintained. CLINICAL TRIAL NUMBER ISRCTN 26715889.
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Affiliation(s)
- R Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK.
| | - H M Meadows
- Cancer Research UK & University College London Cancer Trials Centre, UCL, London, UK
| | - A Lopes
- Cancer Research UK & University College London Cancer Trials Centre, UCL, London, UK
| | - R Muirhead
- Oxford Cancer & Haematology Centre, Oxford University Hospitals, Oxford, UK
| | | | - R Adams
- School of Medicine, Cardiff University, Cardiff, UK
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14
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Marijnen CAM, Peters FP, Rödel C, Bujko K, Haustermans K, Fokas E, Glynne-Jones R, Valentini V, Spindler KLG, Guren MG, Maingon P, Calvo FA, Pares O, Glimelius B, Sebag-Montefiore D. International expert consensus statement regarding radiotherapy treatment options for rectal cancer during the COVID 19 pandemic. Radiother Oncol 2020; 148:213-215. [PMID: 32342861 PMCID: PMC7194592 DOI: 10.1016/j.radonc.2020.03.039] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 03/30/2020] [Accepted: 03/30/2020] [Indexed: 01/04/2023]
Affiliation(s)
- C A M Marijnen
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | - F P Peters
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands; Department of Radiation Oncology, Leiden University Medical Center, the Netherlands
| | - C Rödel
- Department of Radiotherapy and Oncology, University of Frankfurt, Germany
| | - K Bujko
- Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - K Haustermans
- Department of Radiation Oncology, University Hospitals Leuven, Belgium
| | - E Fokas
- Department of Radiotherapy and Oncology, University of Frankfurt, Germany
| | - R Glynne-Jones
- Department of Radiotherapy, Mount Vernon Centre for Cancer Treatment, Northwood, London, United Kingdom
| | - V Valentini
- Department of Radiology, Radiation Oncology and Hematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica S. Cuore, Rome, Italy
| | - K-L G Spindler
- Department of Oncology, Aarhus University Hospital, Denmark
| | - M G Guren
- Department of Oncology, Oslo University Hospital, Norway
| | | | - F A Calvo
- Department of Radiotherapy, Universidad de Navarra, Madrid, Spain
| | - O Pares
- Department of Radiotherapy, Champalimaud Foundation, Lisbon, Portugal
| | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Sweden
| | - D Sebag-Montefiore
- Department of Radiotherapy, Leeds Cancer Centre, University of Leeds, UK
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O'Cathail SM, Gilbert DC, Sebag-Montefiore D, Muirhead R. Challenges and Consequences of COVID-19 in the Management of Anorectal Cancer: Coming Together Through Social Distancing. Clin Oncol (R Coll Radiol) 2020; 32:413-416. [PMID: 32359847 PMCID: PMC7184022 DOI: 10.1016/j.clon.2020.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/23/2022]
Affiliation(s)
- S M O'Cathail
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - D C Gilbert
- Sussex Cancer Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - D Sebag-Montefiore
- University of Leeds and Leeds Cancer Centre, Faculty of Medicine & Health, University of Leeds, UK
| | - R Muirhead
- Oxford University NHS Foundation Trust, Oxford, UK.
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16
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Gilbert A, Drinkwater K, McParland L, Adams R, Glynne-Jones R, Harrison M, Hawkins MA, Sebag-Montefiore D, Gilbert DC, Muirhead R. UK national cohort of anal cancer treated with intensity-modulated radiotherapy: One-year oncological and patient-reported outcomes. Eur J Cancer 2020; 128:7-16. [PMID: 32109852 DOI: 10.1016/j.ejca.2019.12.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/28/2019] [Revised: 12/13/2019] [Accepted: 12/26/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Concurrent chemoradiotherapy is the standard treatment for anal cancer. Following national UK implementation of intensity-modulated radiotherapy (IMRT), this prospective, national cohort evaluates the one-year oncological outcomes and patient-reported toxicity outcomes (PRO) after treatment. MATERIALS AND METHODS A national cohort of UK cancer centers implementing IMRT was carried out between February to July 2015. Cancer centers provided data on oncological outcomes, including survival, and disease and colostomy status at one-year. EORTC-QLQ core (C30) and colorectal (CR29) questionnaires were completed at baseline and one-year followup. The PRO scores at baseline and one year were compared. RESULTS 40 UK Cancer Centers returned data with a total of 187 patients included in the analysis. 92% received mitomycin with 5-fluorouracil or capecitabine. One-year overall survival was 94%; 84% were disease-free and 86% colostomy-free at one-year followup. At one year, PRO results found significant improvements in buttock pain, blood and mucus in stools, pain, constipation, appetite loss, and health anxiety compared to baseline. No significant deteriorations were reported in diarrhea, bowel frequency, and flatulence. Urinary symptom scores were low at one year. Moderate impotence symptoms at baseline remained at one year, and a moderate deterioration in dyspareunia reported. CONCLUSIONS With national anal cancer IMRT implementation, at this early pre-defined time point, one-year oncological outcomes were reassuring and resulted in good disease-related symptom control. one-year symptomatic complications following CRT for anal cancer using IMRT techniques appear to be relatively mild. These PRO results provide a basis to benchmark future studies.
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Affiliation(s)
- A Gilbert
- University of Leeds, Leeds Cancer Centre, St. James's University Hospital, Leeds, UK.
| | | | - L McParland
- Leeds Clinical Trials Research Unit, Worsley Building, University of Leeds, Leeds, UK
| | - R Adams
- Cardiff University - Centre for Trials Research and Velindre Cancer Centre, Cardiff, UK
| | - R Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Rickmansworth Road, Northwood, UK
| | - M Harrison
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Rickmansworth Road, Northwood, UK
| | - M A Hawkins
- CRUK MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - D Sebag-Montefiore
- University of Leeds, Leeds Cancer Centre, St. James's University Hospital, Leeds, UK
| | - D C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Eastern Road, Brighton, UK
| | - R Muirhead
- Oxford University Hospitals NHS Trust, Department of Oncology, Churchill Hospital, Oxford, UK
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17
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Chalmers AJ, Chan C, Sebag-Montefiore D. CTRad 10 Years On: From 10-point Plan to Top 10 Achievements. Clin Oncol (R Coll Radiol) 2020; 32:9-12. [PMID: 31543302 DOI: 10.1016/j.clon.2019.09.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 11/30/2022]
Affiliation(s)
- A J Chalmers
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
| | - C Chan
- National Cancer Research Institute, London, UK
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18
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Brown PJ, Zhong J, Frood R, Currie S, Gilbert A, Appelt AL, Sebag-Montefiore D, Scarsbrook A. Prediction of outcome in anal squamous cell carcinoma using radiomic feature analysis of pre-treatment FDG PET-CT. Eur J Nucl Med Mol Imaging 2019; 46:2790-2799. [PMID: 31482428 PMCID: PMC6879433 DOI: 10.1007/s00259-019-04495-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/20/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Incidence of anal squamous cell carcinoma (ASCC) is increasing, with curative chemoradiotherapy (CRT) as the primary treatment of non-metastatic disease. A significant proportion of patients have locoregional treatment failure (LRF), but distant relapse is uncommon. Accurate prognostication of progression-free survival (PFS) would help personalisation of CRT regimens. The study aim was to evaluate novel imaging pre-treatment features, to prognosticate for PFS in ASCC. METHODS Consecutive patients with ASCC treated with curative intent at a large tertiary referral centre who underwent pre-treatment FDG-PET/CT were included. Radiomic feature extraction was performed using LIFEx software on baseline FDG-PET/CT. Outcome data (PFS) was collated from electronic patient records. Elastic net regularisation and feature selection were used for logistic regression model generation on a randomly selected training cohort and applied to a validation cohort using TRIPOD guidelines. ROC-AUC analysis was used to compare performance of a regression model encompassing standard clinical prognostic factors (age, sex, tumour and nodal stage-model A), a radiomic feature model (model B) and a combined radiomic/clinical model (model C). RESULTS A total of 189 patients were included in the study, with 145 in the training cohort and 44 in the validation cohort. Median follow-up was 35.1 and 37. 9 months, respectively for each cohort, with 70.3% and 68.2% reaching this time-point with PFS. GLCM entropy (a measure of randomness of distribution of co-occurring pixel grey-levels), NGLDM busyness (a measure of spatial frequency of changes in intensity between nearby voxels of different grey-level), minimum CT value (lowest HU within the lesion) and SMTV (a standardized version of MTV) were selected for inclusion in the prognostic model, alongside tumour and nodal stage. AUCs for performance of model A (clinical), B (radiomic) and C (radiomic/clinical) were 0.6355, 0.7403, 0.7412 in the training cohort and 0.6024, 0.6595, 0.7381 in the validation cohort. CONCLUSION Radiomic features extracted from pre-treatment FDG-PET/CT in patients with ASCC may provide better PFS prognosis than conventional staging parameters. With external validation, this might be useful to help personalise CRT regimens in the future.
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Affiliation(s)
- P J Brown
- Department of Clinical Radiology, Lincoln Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK.
| | - J Zhong
- Department of Clinical Radiology, Lincoln Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - R Frood
- Department of Clinical Radiology, Lincoln Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - S Currie
- Department of Clinical Radiology, Lincoln Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - A Gilbert
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Bexley Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - A L Appelt
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Bexley Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - D Sebag-Montefiore
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Bexley Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
| | - A Scarsbrook
- Department of Clinical Radiology, Lincoln Wing, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, UK
- Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
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19
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Gilbert A, McParland L, Webster J, Bell S, Copeland J, Adams R, Harrison M, Muirhead R, Renehan A, Sebag-Montefiore D, Hawkins M. Pre-specified pilot analysis of a randomised pilot/phase II/III trial comparing standard dose vs dose-escalated concurrent chemoradiotherapy (CRT) in anal cancer (PLATO-ACT5). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.013] [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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20
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Hudson A, Brown S, Chalmers A, Dive C, Franks K, Hanna G, Hannaway N, Harrow S, Haswell T, Hiley C, Hinsley S, Krebs M, Murden G, Reed S, Ryan A, Sebag-Montefiore D, Shaw P, Smith A, Walls G, Young R, Faivre-Finn C, Greystoke A. P2.01-08 Clinical Trial in Progress: CONCORDE - A Phase 1B Study of Novel Agents in Combination with Conventional Radiotherapy in NSCLC. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1352] [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: 10/25/2022]
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21
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Brown PJ, Hyland R, Quyn AJ, West NP, Sebag-Montefiore D, Jayne D, Sagar P, Tolan DJ. Current concepts in imaging for local staging of advanced rectal cancer. Clin Radiol 2019; 74:623-636. [PMID: 31036310 DOI: 10.1016/j.crad.2019.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/22/2019] [Indexed: 12/20/2022]
Abstract
Imaging of rectal cancer has an increasingly pivotal role in the diagnosis, staging, and treatment stratification of patients with the disease. This is particularly true for advanced rectal cancers where magnetic resonance imaging (MRI) findings provide essential information that can change treatment. In this review we describe the rationale for the current imaging standards in advanced rectal cancer for both morphological and functional imaging on the baseline staging and reassessment studies. In addition the clinical implications and future methods by which radiologists may improve these are outlined relative to TNM8.
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Affiliation(s)
- P J Brown
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - R Hyland
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - A J Quyn
- Department of General Surgery, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - N P West
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Welcome Trust Brenner Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - D Sebag-Montefiore
- Department of Clinical Oncology, Bexley Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - D Jayne
- Department of General Surgery, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - P Sagar
- Department of General Surgery, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - D J Tolan
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
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22
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Shakir R, Adams R, Cooper R, Downing A, Geh I, Gilbert D, Jacobs C, Jones C, Lorimer C, Namelo W, Sebag-Montefiore D, Shaw P, Muirhead R. Patterns and predictors of relapse following radical chemoradiotherapy delivered using intensity-modulated radiotherapy with a simultaneous integrated boost in anal squamous cell carcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.158] [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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23
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Jones CM, Spencer K, Hitchen C, Pelly T, Wood B, Hatfield P, Crellin A, Sebag-Montefiore D, Goody R, Crosby T, Radhakrishna G. Hypofractionated Radiotherapy in Oesophageal Cancer for Patients Unfit for Systemic Therapy: A Retrospective Single-Centre Analysis. Clin Oncol (R Coll Radiol) 2019; 31:356-364. [PMID: 30737068 DOI: 10.1016/j.clon.2019.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 11/24/2018] [Accepted: 12/06/2018] [Indexed: 02/06/2023]
Abstract
AIMS Chemoradiotherapy (CRT) is established as a superior treatment option to definitive radiotherapy in the non-surgical management of oesophageal cancer. For patients precluded from CRT through choice or comorbidity there is little evidence to guide delivery of single-modality radiotherapy. In this study we outline outcomes for patients unfit for CRT who received a hypofractionated radiotherapy (HRT) regimen. MATERIALS AND METHODS A retrospective UK single-centre analysis of 61 consecutive patients with lower- or middle-third adenocarcinoma (OAC; 61%) or squamous cell carcinoma of the oesophagus managed using HRT with radical intent between April 2009 and 2014. Treatment consisted of 50 Gy in 16 fractions (n = 49, 80.3%) or 50-52.5 Gy in 20 fractions (n = 12, 19.7%). Outcomes were referenced against a contemporaneous comparator cohort of 80 (54% OAC) consecutive patients managed with conventionally fractionated CRT within the same centre. RESULTS Three-year and median overall survival were, respectively, 56.9% and 29 months with HRT compared with 55.5% and 26 months for CRT; adjusted hazard ratio 0.79 (95% confidence interval 0.48-1.28). Grade 3 and 4 toxicity rates were low at 16.4% (n = 10) for those receiving HRT and 40.2% (n = 32) for the CRT group. In patients with OAC, CRT delivered superior overall survival (hazard ratio 0.46; 95% confidence interval 0.25-0.85) and progression-free survival (hazard ratio 0.45; 95% confidence interval 0.23-0.88) when compared with HRT. CONCLUSIONS The HRT regimen described here was safe and tolerable in patients unable to receive CRT, and delivered promising survival outcomes. The use of HRT for the treatment of oesophageal cancer, both alone and as a sequential or concurrent treatment with chemotherapy, requires further study. New precision radiotherapy technologies may provide additional scope for improving outcomes in oesophageal cancer using HRT-based approaches and should be evaluated.
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Affiliation(s)
- C M Jones
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - K Spencer
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Institute of Health Sciences, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - C Hitchen
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - T Pelly
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - B Wood
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - P Hatfield
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Crellin
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Sebag-Montefiore
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - R Goody
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
| | - G Radhakrishna
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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24
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Renehan AG, Muirhead R, Berkman L, McParland L, Sebag-Montefiore D. Early stage anal margin cancer: towards evidence-based management. Colorectal Dis 2019; 21:387-391. [PMID: 30687991 DOI: 10.1111/codi.14571] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 01/12/2019] [Indexed: 02/08/2023]
Affiliation(s)
- A G Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Manchester Cancer Research Centre, NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - R Muirhead
- Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - L Berkman
- Patient and Public Involvement Trial Representative, London, UK
| | - L McParland
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - D Sebag-Montefiore
- Leeds Cancer Centre, St James University Hospital, University of Leeds, Leeds, UK
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25
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Franks K, Mcparland L, Webster J, Baldwin D, Sebag-Montefiore D, Evison M, Booton R, Faivre-Finn C, Naidu B, Ferguson J, Peedell C, Callister M, Kennedy M, Gregory W, Hewison J, Bestall J, Bell S, Hall P, Snee M. P2.16-16 SABRTOOTH: A Fasibility Study of SABR Versus Surgery in Patients with Peripheral Stage I NSCLC Considered to be at Higher Risk for Surgery. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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Mukherjee S, Virdee P, Shaw R, Bridgewater J, Radhakrishna G, Falk S, Scott-Brown M, Strauss V, Brooks C, Gillmore R, Patel N, Tranter B, Parsons P, Sebag-Montefiore D, Hawkins M, Corrie P, Maughan T. SCALOP-2: A multi-centre randomised trial of induction chemotherapy followed by capecitabine +/-nelfinavir with high or standard dose radiotherapy for locally advanced pancreatic cancer (LAPC): Results of stage 1 - the non-randomised dose-finding component. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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27
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Rao S, Sclafani F, Eng C, Grønlie Guren M, Adams R, Benson A, Sebag-Montefiore D, Segelov E, Bryant A, Peckitt C, Roy A, Seymour M, Welch J, Saunders M, Muirhead R, Bridgewater J, Falk S, Glynne-Jones R, Arnold D, Cunningham D. InterAACT: A multicentre open label randomised phase II advanced anal cancer trial of cisplatin (CDDP) plus 5-fluorouracil (5-FU) vs carboplatin (C) plus weekly paclitaxel (P) in patients (pts) with inoperable locally recurrent (ILR) or metastatic treatment naïve disease - An International Rare Cancers Initiative (IRCI) trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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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28
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Janjua T, Hingorani M, Cooper R, Hatfield P, Casanova N, Williams M, Teo M, Sebag-Montefiore D. The role of palliative re-irradiation in management of rectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy151.314] [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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29
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Holyoake D, Robinson M, Grose D, McIntosh D, Radhakrishna G, Sebag-Montefiore D, Hawkins M. Analysis of On-trial Quality Assurance for the SPARC Clinical Trial using Novel Peer-review Methodology. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Amos R, Bulbeck H, Burnet N, Crellin A, Eaton D, Evans P, Hall E, Hawkins M, Kirkby K, Mackay R, Sebag-Montefiore D, Sharma R. Proton Beam Therapy - the Challenges of Delivering High-quality Evidence of Clinical Benefit. Clin Oncol (R Coll Radiol) 2018; 30:280-284. [PMID: 29551566 DOI: 10.1016/j.clon.2018.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 12/11/2022]
Abstract
The use of proton beam therapy (PBT) offers the opportunity to improve greater conformality of radiotherapy treatment delivery in some patients. However, it is associated with a high capital cost and the need to build new dedicated facilities. We discuss how the global radiotherapy community can respond to the challenge of producing high-quality evidence of clinical benefit from PBT in adult patients. In the UK, the National Cancer Research Institute-funded Clinical and Radiotherapy Translational group has established the PBT Clinical Trial Strategy Group. An eight-point framework is described that can assist the development and delivery of high-quality clinical trials.
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31
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Wale A, Wexner SD, Saur NM, Massarotti H, Laurberg S, Kennedy E, Rockall A, Sebag-Montefiore D, Brown G. Session 1: The evolution and development of the multidisciplinary team approach: USA, European and UK experiences - what can we do better? Colorectal Dis 2018; 20 Suppl 1:17-27. [PMID: 29878684 DOI: 10.1111/codi.14073] [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: 02/08/2023]
Abstract
The process of determining the best treatments that should be offered to patients with newly diagnosed colon and rectal cancer remains highly variable around the world. The aim of this expert review was to agree the key elements of good quality preoperative treatment decision making.
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Affiliation(s)
- A Wale
- Royal Marsden NHS Foundation Trust, London, UK
| | - S D Wexner
- Digestive Disease Center, Cleveland Clinic, Weston, Florida, USA.,Department of Colorectal Surgery, Cleveland Clinic, Weston, Florida, USA
| | - N M Saur
- Division of Colon and Rectal Surgery, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - H Massarotti
- Department of Colorectal Surgery, Cleveland Clinic, Weston, Florida, USA
| | - S Laurberg
- Aarhus University Hospital, Aarhus, Denmark
| | - E Kennedy
- General Surgery and Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - A Rockall
- Royal Marsden NHS Foundation Trust, London, UK
| | | | - G Brown
- Royal Marsden NHS Foundation Trust, London, UK.,Imperial College London, London, UK
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32
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Christophides D, Gilbert A, Appelt A, Lilley J, Sebag-Montefiore D. PO-0905: Data mining for pre-plan evaluation of organ at risk priority. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31215-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Johnstone E, Wyatt J, Henry A, Broadbent D, Short S, Sebag-Montefiore D, Kelly C, Al-Qaisieh B, Murray L, McCallum H, Speight R. EP-2136: Assessing the stability of MRI geometric distortions on multiple scanners. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32445-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Brown S, Van Herk M, Chuter R, Falk S, Kirkby K, Mackay R, Harrington K, Cosgrove V, Gray A, Hall E, Hawkins M, Hawkes D, Henry A, Maughan T, Nutting C, Oelfke U, Royle G, Sebag-Montefiore D, Sharma R, Van Den Heuvel F, Faivre-Finn C. Advanced Radiotherapy Technologies Network in the UK (ART-NET) – focus on lung cancer. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30166-1] [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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Harrington K, Hall E, Hawkins M, Henry A, MacKay R, Maughan T, McDonald A, Nutting C, Oelfke U, Sebag-Montefiore D, Sharma RA, van Herk M, Faivre-Finn C. Introducing the Cancer Research UK Advanced Radiotherapy Technologies Network (ART-NET). Clin Oncol (R Coll Radiol) 2017; 29:707-710. [PMID: 28807360 PMCID: PMC6155492 DOI: 10.1016/j.clon.2017.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 06/30/2017] [Accepted: 07/08/2017] [Indexed: 12/25/2022]
Affiliation(s)
| | - E Hall
- Institute of Cancer Research, London, UK
| | - M Hawkins
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - A Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; University of Leeds, Leeds, UK
| | - R MacKay
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | | | - A McDonald
- Institute of Cancer Research, London, UK
| | - C Nutting
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U Oelfke
- Institute of Cancer Research, London, UK
| | - D Sebag-Montefiore
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; University of Leeds, Leeds, UK
| | - R A Sharma
- University College London, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - M van Herk
- University of Manchester, Manchester, UK
| | - C Faivre-Finn
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
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Fish R, Sebag-Montefiore D, Sanders C, Williamson P, Renehan A. Core outcome research measures in anal cancer. Colorectal Dis 2017; 19:782-783. [PMID: 28621457 DOI: 10.1111/codi.13776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 05/08/2017] [Indexed: 02/08/2023]
Affiliation(s)
- R Fish
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - D Sebag-Montefiore
- Radiotherapy Research Group, Leeds Institute of Cancer and Pathology, University of Leeds, St James's University Hospital, Leeds, UK
| | - C Sanders
- Centre for Primary Care, University of Manchester, Manchester, UK
| | - P Williamson
- Department of Biostatistics, Block F Waterhouse Building, University of Liverpool, Liverpool, UK
| | - A Renehan
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Peritoneal and Colorectal Oncology Centre, Christie NHS Foundation Trust, Manchester, UK
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Christophides D, Gilbert A, Appelt A, Fenwick J, Lilley J, Sebag-Montefiore D. OC-0255: Practical use of principal component analysis in radiotherapy planning. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30698-9] [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: 11/16/2022]
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38
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Appelt A, Teo M, Christophides D, Peters F, Lilley J, Spindler K, Marijnen C, Sebag-Montefiore D. EP-1748: Mesorectal-only irradiation for early stage rectal cancer: Target volumes and dose to organs at risk. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32111-4] [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: 11/30/2022]
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39
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Wyatt J, Hedley S, Johnstone E, Speight R, Kelly C, Henry A, Short S, Murray L, Sebag-Montefiore D, McCallum H. EP-1708: Investigating the reproducibility of geometric distortion measurements for MR-only radiotherapy. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32240-5] [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: 10/19/2022]
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40
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Gilbert A, Davidson S, Velikova G, Sebag-Montefiore D. SP-0519: Collecting PROs in clinical practice to assess radiotherapy toxicity and develop normal tissue complication probability models. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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41
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Muirhead R, Drinkwater K, O'Cathail SM, Adams R, Glynne-Jones R, Harrison M, Hawkins MA, Sebag-Montefiore D, Gilbert DC. Initial Results from the Royal College of Radiologists' UK National Audit of Anal Cancer Radiotherapy 2015. Clin Oncol (R Coll Radiol) 2017; 29:188-197. [PMID: 27810119 PMCID: PMC5304408 DOI: 10.1016/j.clon.2016.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/08/2016] [Accepted: 08/15/2016] [Indexed: 11/22/2022]
Abstract
AIMS UK guidance was recently developed for the treatment of anal cancer using intensity-modulated radiotherapy (IMRT). We audited the current use of radiotherapy in UK cancer centres for the treatment of anal cancer against such guidance. We describe the acute toxicity of IMRT in comparison with patient population in the audit treated with two-phase conformal radiotherapy and the previous published data from two-phase conformal radiotherapy, in the UK ACT2 trial. MATERIALS AND METHODS A Royal College of Radiologists' prospective national audit of patients treated with radiotherapy in UK cancer centres was carried out over a 6 month period between February and July 2015. RESULTS Two hundred and forty-two cases were received from 40/56 cancer centres (71%). In total, 231 (95%) underwent full dose radiotherapy with prophylactic nodal irradiation. Of these, 180 (78%) received IMRT or equivalent, 52 (22%) two-phase conformal (ACT2) technique. The number of interruptions in radiotherapy treatment in the ACT2 trial was 15%. Interruptions were noted in 7% (95% confidence interval 0-14%) of courses receiving two-phase conformal and 4% (95% confidence interval 1-7%) of those receiving IMRT. The percentage of patients completing the planned radiotherapy dose, irrelevant of gaps, was 90% (95% confidence interval 82-98%) and 96% (95% confidence interval 93-99%), in two-phase conformal and IMRT respectively. The toxicity reported in the ACT2 trial, in patients receiving two-phase conformal in the audit and in patients receiving IMRT in the audit was: any toxic effect 71%, 54%, 48%, non-haematological 62%, 49%, 40% and haematological 26%, 13%, 18%, respectively. CONCLUSIONS IMRT implementation for anal cancer is well underway in the UK with most patients receiving IMRT delivery, although its usage is not yet universal. This audit confirms that IMRT results in reduced acute toxicity and minimised treatment interruptions in comparison with previous two-phase conformal techniques.
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Affiliation(s)
- R Muirhead
- CRUK MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK.
| | | | - S M O'Cathail
- Oxford University Hospitals NHS Trust, Department of Oncology, Churchill Hospital, Oxford, UK
| | - R Adams
- Cardiff University Department of Cancer and Genetics and Velindre Hospital, Cardiff, UK
| | - R Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - M Harrison
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, UK
| | - M A Hawkins
- CRUK MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - D Sebag-Montefiore
- University of Leeds, Cancer Research UK Leeds Centre, St. James's University Hospital, Leeds, UK
| | - D C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
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42
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Snee MP, McParland L, Collinson F, Lowe CM, Striha A, Baldwin DR, Naidu B, Sebag-Montefiore D, Gregory WM, Bestall J, Hewison J, Hinsley S, Franks KN. Erratum to: The SABRTooth feasibility trial protocol: a study to determine the feasibility and acceptability of conducting a phase III randomised controlled trial comparing stereotactic ablative radiotherapy (SABR) with surgery in patients with peripheral stage I non-small cell lung cancer (NSCLC) considered to be at higher risk of complications from surgical resection. Pilot Feasibility Stud 2016; 2:55. [PMID: 27976752 PMCID: PMC5154043 DOI: 10.1186/s40814-016-0095-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- M P Snee
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF UK
| | - L McParland
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, 71-75 Clarendon Road, Leeds, LS2 9PH UK
| | - F Collinson
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, 71-75 Clarendon Road, Leeds, LS2 9PH UK
| | - C M Lowe
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, 71-75 Clarendon Road, Leeds, LS2 9PH UK
| | - A Striha
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, 71-75 Clarendon Road, Leeds, LS2 9PH UK
| | - D R Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals and University of Nottingham, Hucknall Rd, Nottingham, NG5 1PB UK
| | - B Naidu
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, Edgbaston B15 2TT, UK
| | - D Sebag-Montefiore
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF UK ; Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Beckett Street, Leeds, LS9 7TF UK
| | - W M Gregory
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, 71-75 Clarendon Road, Leeds, LS2 9PH UK
| | - J Bestall
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, 101 Clarendon Rd, Leeds, LS2 9LJ UK
| | - J Hewison
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, 101 Clarendon Rd, Leeds, LS2 9LJ UK
| | - S Hinsley
- Clinical Trials Research Unit (CTRU), Leeds Institute of Clinical Trials Research, University of Leeds, 71-75 Clarendon Road, Leeds, LS2 9PH UK
| | - K N Franks
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF UK
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43
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Sebag-Montefiore D, Adams R, Bell S, Berkman L, Gilbert D, Glynne-Jones R, Goh V, Gregory W, Harrison M, Kachnic L, Lee M, McParland L, Muirhead R, O'Neill B, Hutchins G, Rao S, Renehan A, Smith A, Velikova G, Hawkins M. The Development of an Umbrella Trial (PLATO) to Address Radiation Therapy Dose Questions in the Locoregional Management of Squamous Cell Carcinoma of the Anus. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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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44
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Robinson M, Christophides D, Cooper R, Murray P, Lilley J, Muirhead R, Sebag-Montefiore D, Hawkins M. Personalized Dose Escalation in Anal Cancer. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1089] [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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45
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Gilbert D, Drinkwater K, O'Cathail S, Adams R, Glynne-Jones R, Harrison M, Hawkins M, Sebag-Montefiore D, Muirhead R. Stepwise Multicenter Introduction of Intensity Modulated Radiation Therapy for Anal Cancer in the United Kingdom: From Consensus Guidance to Large-Scale Prospective Audit, Prior to Future Clinical Trials. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.260] [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: 10/20/2022]
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46
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Downing A, Finan PJ, Sebag-Montefiore D, Wright P, Thomas JD, Gilbert A, Corner J, Richards M, Morris EJA, Glaser AW. P77 Health-related quality of life and functional outcomes following curative treatments for rectal cancer: A population-level study in England. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.176] [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: 11/04/2022]
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47
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Morris EJA, Finan PJ, Spencer K, Geh I, Crellin A, Quirke P, Thomas JD, Lawton S, Adams R, Sebag-Montefiore D. Wide Variation in the Use of Radiotherapy in the Management of Surgically Treated Rectal Cancer Across the English National Health Service. Clin Oncol (R Coll Radiol) 2016; 28:522-531. [PMID: 26936609 PMCID: PMC4944647 DOI: 10.1016/j.clon.2016.02.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/12/2016] [Accepted: 02/04/2016] [Indexed: 12/16/2022]
Abstract
AIMS Radiotherapy is an important treatment modality in the multidisciplinary management of rectal cancer. It is delivered both in the neoadjuvant setting and postoperatively, but, although it reduces local recurrence, it does not influence overall survival and increases the risk of long-term complications. This has led to a variety of international practice patterns. These variations can have a significant effect on commissioning, but also future clinical research. This study explores its use within the large English National Health Service (NHS). MATERIALS AND METHODS Information on all individuals diagnosed with a surgically treated rectal cancer between April 2009 and December 2010 were extracted from the Radiotherapy Dataset linked to the National Cancer Data Repository. Individuals were grouped into those receiving no radiotherapy, short-course radiotherapy with immediate surgery (SCRT-I), short-course radiotherapy with delayed surgery (SCRT-D), long-course chemoradiotherapy (LCCRT), other radiotherapy (ORT) and postoperative radiotherapy (PORT). Patterns of use were then investigated. RESULTS The study consisted of 9201 individuals; 4585 (49.3%) received some form of radiotherapy. SCRT-I was used in 12.1%, SCRT-D in 1.2%, LCCRT in 29.5%, ORT in 4.7% and PORT in 2.3%. Radiotherapy was used more commonly in men and in those receiving an abdominoperineal excision and less commonly in the elderly and those with comorbidity. Significant and substantial variations were also seen in its use across all the multidisciplinary teams managing this disease. CONCLUSION Despite the same evidence base, wide variation exists in both the use of and type of radiotherapy delivered in the management of rectal cancer across the English NHS. Prospective population-based collection of local recurrence and patient-reported early and late toxicity information is required to further improve patient selection for preoperative radiotherapy.
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Affiliation(s)
- E J A Morris
- Cancer Epidemiology Group, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK.
| | - P J Finan
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, UK; National Cancer Intelligence Network, London, UK
| | - K Spencer
- Cancer Epidemiology Group, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK; Non-Surgical Oncology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - I Geh
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Birmingham, UK
| | - A Crellin
- Non-Surgical Oncology, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - P Quirke
- Section of Pathology and Tumour Biology, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK
| | - J D Thomas
- National Cancer Registration Service, Northern and Yorkshire Office, St James's Institute of Oncology, St James's University Hospital, Leeds, UK; Knowledge and Intelligence Team (Northern and Yorkshire), St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - S Lawton
- Knowledge and Intelligence Team (Northern and Yorkshire), St James's Institute of Oncology, St James's University Hospital, Leeds, UK
| | - R Adams
- Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - D Sebag-Montefiore
- Section of Clinical Oncology, Leeds Institute of Cancer & Pathology, University of Leeds, St James's University Hospital, Leeds, UK
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48
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Ward G, Ramasamy S, Sykes JR, Prestwich R, Chowdhury F, Scarsbrook A, Murray P, Harris K, Crellin A, Hatfield P, Sebag-Montefiore D, Spezi E, Crosby T, Radhakrishna G. Superiority of Deformable Image Co-registration in the Integration of Diagnostic Positron Emission Tomography-Computed Tomography to the Radiotherapy Treatment Planning Pathway for Oesophageal Carcinoma. Clin Oncol (R Coll Radiol) 2016; 28:655-62. [PMID: 27266819 DOI: 10.1016/j.clon.2016.05.009] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 11/26/2022]
Abstract
AIMS To investigate the use of image co-registration in incorporating diagnostic positron emission tomography-computed tomography (PET-CT) directly into the radiotherapy treatment planning pathway, and to describe the pattern of local recurrence relative to the PET-avid volume. MATERIALS AND METHODS Fourteen patients were retrospectively identified, six of whom had local recurrence. The accuracy of deformable image registration (DIR) and rigid registration of the diagnostic PET-CT and recurrence CT, to the planning CT, were quantitatively assessed by comparing co-registration of oesophagus, trachea and aorta contours. DIR was used to examine the correlation between PET-avid volumes, dosimetry and site of recurrence. RESULTS Positional metrics including the dice similarity coefficient (DSC) and conformity index (CI), showed DIR to be superior to rigid registration in the co-registration of diagnostic and recurrence imaging to the planning CT. For diagnostic PET-CT, DIR was superior to rigid registration in the transfer of oesophagus (DSC=0.75 versus 0.65, P<0.009 and CI=0.59 versus 0.48, P<0.003), trachea (DSC=0.88 versus 0.65, P<0.004 and CI=0.78 versus 0.51, P<0.0001) and aorta structures (DSC=0.93 versus 0.86, P<0.006 and CI=0.86 versus 0.76, P<0.006). For recurrence imaging, DIR was superior to rigid registration in the transfer of trachea (DSC=0.91 versus 0.66, P<0.03 and CI=0.83 versus 0.51, P<0.02) and oesophagus structures (DSC=0.74 versus 0.51, P<0.004 and CI=0.61 versus 0.37, P<0.006) with a non-significant trend for the aorta (DSC=0.91 versus 0.75, P<0.08 and CI=0.83 versus 0.63, P<0.06) structure. A mean inclusivity index of 0.93 (range 0.79-1) showed that the relapse volume was within the planning target volume (PTVPET-CT); all relapses occurred within the high dose region. CONCLUSION DIR is superior to rigid registration in the co-registration of PET-CT and recurrence CT to the planning CT, and can be considered in the direct integration of PET-CT to the treatment planning process. Local recurrences occur within the PTVPET-CT, suggesting that this is a suitable target for dose-escalation strategies.
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Affiliation(s)
- G Ward
- Medical Physics and Engineering, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - S Ramasamy
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J R Sykes
- Radiation Oncology and Medical Physics, Blacktown Hospital, Blacktown, Australia
| | - R Prestwich
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - F Chowdhury
- Clinical Radiology and Nuclear Medicine, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Scarsbrook
- Clinical Radiology and Nuclear Medicine, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Murray
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Harris
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Crellin
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Hatfield
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Sebag-Montefiore
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Spezi
- Biomedical Engineering Research Group, School of Engineering, Cardiff University, Cardiff, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
| | - G Radhakrishna
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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49
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Smart CJ, Korsgen S, Hill J, Speake D, Levy B, Steward M, Geh JI, Robinson J, Sebag-Montefiore D, Bach SP. Multicentre study of short-course radiotherapy and transanal endoscopic microsurgery for early rectal cancer. Br J Surg 2016; 103:1069-75. [DOI: 10.1002/bjs.10171] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Revised: 02/17/2016] [Accepted: 02/18/2016] [Indexed: 12/13/2022]
Abstract
Abstract
Background
Organ-preserving treatment for early-stage rectal cancer may avoid the substantial perioperative morbidity and functional sequelae associated with total mesorectal excision (TME). The initial results of an organ-preserving approach using preoperative short-course radiotherapy (SCRT) and transanal endoscopic microsurgery (TEMS) are presented.
Methods
Patients with cT1–2N0 rectal cancers staged using high-quality MRI and endorectal ultrasonography received SCRT, with TEMS 8–10 weeks later, at four regional referral centres between 2007 and 2013. Patients were generally considered high risk for TME surgery (a small number refused TME).
Results
Following SCRT and TEMS, 60 (97 per cent) of 62 patients had an R0 resection. Histopathological staging identified 20 ypT0 tumours, 23 ypT1, 18 ypT2 and one ypT3. Preoperative uT category was significantly associated with a complete pathological response, which was achieved in 13 of 27 patients with uT0/uT1 disease and in five of 29 with uT2 (P = 0·010). Acute complications affected 19 patients, the majority following TEMS. No fistulas occurred and no stomas were formed. Surveillance detected four intraluminal local recurrences at a median follow-up of 13 months, all in patients with tumours staged as ypT2. Salvage TME achieved R0 resection in three patients and a stent was placed in one patient owing to co-morbidities.
Conclusion
SCRT with TEMS was effective in the majority of patients considered high risk for (or who refused) TME surgery.
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Affiliation(s)
- C J Smart
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK
| | - S Korsgen
- Department of Surgery, Good Hope Hospital, Sutton Coldfield, UK
| | - J Hill
- Department of Surgery, Manchester Royal Infirmary, Manchester, UK
| | - D Speake
- Department of Surgery, Western General Hospital, Edinburgh, UK
| | - B Levy
- Department of Surgery, St Richard's Hospital, Chichester, UK
| | - M Steward
- Department of Surgery, Bradford Royal Infirmary, Bradford, UK
| | - J I Geh
- Department of Clinical Oncology, Queen Elizabeth Hospital, Birmingham, UK
| | - J Robinson
- Department of Surgery, Bradford Royal Infirmary, Bradford, UK
| | | | - S P Bach
- Department of Surgery, Queen Elizabeth Hospital, Birmingham, UK
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50
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Holyoake D, Robinson M, Grose D, Mcintosh D, Sebag-Montefiore D, Radhakrishna G, Patel N, Mukherjee S, Hawkins M. PO-0713: Conformity analysis of target-volume definition for margin-directed boost in pancreatic cancer SBRT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31963-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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