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Walls GM, O'Connor J, Harbinson M, Duane F, McCann C, McKavanagh P, Johnston DI, Giacometti V, McAleese J, Hounsell AR, Cole AJ, Butterworth KT, McGarry CK, Hanna GG, Jain S. The Association of Incidental Radiation Dose to the Heart Base with Overall Survival and Cardiac Events after Curative-intent Radiotherapy for Non-small Cell Lung Cancer: Results from the NI-HEART Study. Clin Oncol (R Coll Radiol) 2024; 36:119-127. [PMID: 38042669 DOI: 10.1016/j.clon.2023.11.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/10/2023] [Accepted: 11/06/2023] [Indexed: 12/04/2023]
Abstract
AIMS Cardiac disease is a dose-limiting toxicity in non-small cell lung cancer radiotherapy. The dose to the heart base has been associated with poor survival in multiple institutional and clinical trial datasets using unsupervised, voxel-based analysis. Validation has not been undertaken in a cohort with individual patient delineations of the cardiac base or for the endpoint of cardiac events. The purpose of this study was to assess the association of heart base radiation dose with overall survival and the risk of cardiac events with individual heart base contours. MATERIALS AND METHODS Patients treated between 2015 and 2020 were reviewed for baseline patient, tumour and cardiac details and both cancer and cardiac outcomes as part of the NI-HEART study. Three cardiologists verified cardiac events including atrial fibrillation, heart failure and acute coronary syndrome. Cardiac substructure delineations were completed using a validated deep learning-based autosegmentation tool and a composite cardiac base structure was generated. Cox and Fine-Gray regressions were undertaken for the risk of death and cardiac events. RESULTS Of 478 eligible patients, most received 55 Gy/20 fractions (96%) without chemotherapy (58%), planned with intensity-modulated radiotherapy (71%). Pre-existing cardiovascular morbidity was common (78% two or more risk factors, 46% one or more established disease). The median follow-up was 21.1 months. Dichotomised at the median, a higher heart base Dmax was associated with poorer survival on Kaplan-Meier analysis (20.2 months versus 28.3 months; hazard ratio 1.40, 95% confidence interval 1.14-1.75, P = 0.0017) and statistical significance was retained in multivariate analyses. Furthermore, heart base Dmax was associated with pooled cardiac events in a multivariate analysis (hazard ratio 1.75, 95% confidence interval 1.03-2.97, P = 0.04). CONCLUSIONS Heart base Dmax was associated with the rate of death and cardiac events after adjusting for patient, tumour and cardiovascular factors in the NI-HEART study. This validates the findings from previous unsupervised analytical approaches. The heart base could be considered as a potential sub-organ at risk towards reducing radiation cardiotoxicity.
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Affiliation(s)
- G M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK.
| | - J O'Connor
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - M Harbinson
- Department of Cardiology, Belfast Health & Social Care Trust, Belfast, UK; Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - F Duane
- St. Luke's Radiation Oncology Network, St. Luke's Hospital, Dublin, Ireland; Trinity St James's Cancer Institute, St. James's Hospital, Dublin, Ireland
| | - C McCann
- Department of Cardiology, Belfast Health & Social Care Trust, Belfast, UK
| | - P McKavanagh
- Department of Cardiology, Ulster Hospital, South Eastern Health & Social Care Trust, Dundonald, UK
| | - D I Johnston
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - V Giacometti
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - J McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - A R Hounsell
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - A J Cole
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - K T Butterworth
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - C K McGarry
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - G G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - S Jain
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
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Walls G, Johnston D, Harbsinson M, McCann C, McKavanagh P, Giacometti V, McAleese J, Cole A, Butterworth K, McGarry C, Jain S, Hanna GG. Simulation CT Features and Radiation Cardiotoxicity in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e69. [PMID: 37786027 DOI: 10.1016/j.ijrobp.2023.06.799] [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) Radiation cardiotoxicity is a significant clinical dilemma in non-small cell lung cancer (NSCLC) radiation therapy (RT). Baseline cardiovascular (CV) status may influence the risk of cardiotoxicity, and may be ascertainable from the appearance of the heart on simulation computed tomography (CT). We examined the association of CT features with incidental heart dose and risk of cardiac events in NSCLC. MATERIALS/METHODS Patients treated with curative-intent RT between 2015 and 2020 at a regional center were identified. Clinical notes were interrogated for baseline patient and CV health details, and follow-up CV events. Cardiac events were verified by a cardiologist. A deep learning-based auto-segmentation tool was applied, allowing extraction of a pre-specified list of volume parameters in a programming environment. CAC was graded as none, mild, moderate and severe in patients with a non-contrast scan. The craniocaudal relationship of the PTV and heart (Feng atlas) were annotated. RESULTS A total of 478 patients were included, with a median age of 70 and Charlson Index of 5. The median mean heart dose was 6.3 Gy (IQR 2.7-11.4). The median lung V20 was 20.0% (IQR 14.8-27.1). Cardiovascular risk factors were common, with most patients having 2 (39%) or 3 (31%). A history of previous cardiac events was common, including myocardial infarction (14%), arrhythmia (11%) or heart failure (9%). A total of 6.9% and 7.1% patients developed a new atrial arrhythmia (AA) or heart failure (HF) after completing RT. The volume metrics with the highest AUC for AA and HF events were the left atrium (LA) (AUC 0.67, p = 0.0002) and left ventricle:right ventricle (LV:RV) ratio (AUC 0.66, p = 0.0021). Kaplan-Meier analysis for cardiac events dichotomizing at the optimal cut-point for maximum sensitivity and specificity demonstrated significantly different rates for both AA (LA 109cc, HR 3.35, 95% CI 1.64-6.83, p = 0.0009) and HF (LV:RV ratio 1.61, HR 2.37, 95% CI 1.19-4.74, p = 0.0143). Only 2 patients with non-contrast scans developed a myocardial infarction, both had mild CAC. The incidence of pooled cardiac events was not significantly different between patients with no (n = 2/21, 9.5%), mild (n = 10/38, 26.3%), moderate (n = 8/53, 15.1%) and severe (n = 7/24, 29.2%) CAC (p = 0.3916). Where the inferior border of the PTV was above the superior border of the heart, mean heart dose was significantly lower than compared with overlap of levels (1.9 Gy v 9.7 Gy, p<0.0001), and this was true for 3DCRT (n = 139, p<0.001), IMRT (n = 94, p<0.001) and VMAT (n = 145, p<0.001) patients. CONCLUSION LA volume and LV:RV volume ratio are predictive for the development of AA and HF respectively. CAC grade did not differentiate patients by risk of cardiac events. Where the craniocaudal level of the PTV doesn't overlap with the level of the heart, the cardiac dose is likely to be very low. Several simulation CT features are associated with cardiac events following treatment for NSCLC and prospective evidence of cardiac risk could enable medical optimization prior to RT.
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Affiliation(s)
- G Walls
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - D Johnston
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - M Harbsinson
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - C McCann
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - P McKavanagh
- South Eastern Health & Social Care Trust, Belfast, United Kingdom
| | - V Giacometti
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J McAleese
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - A Cole
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - K Butterworth
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - C McGarry
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - S Jain
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - G G Hanna
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
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Walls G, O'Connor J, Harbsinson M, Duane FK, McCann C, McKavanagh P, Johnston D, Giacometti V, McAleese J, Hounsell A, Cole A, Butterworth K, McGarry C, Hanna GG, Jain S. Patient-Level and Endpoint-Specific Clinico-Dosimetric Analysis of the Cardiac Base as a Mediator of Radiation Cardiotoxicity in Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e69-e70. [PMID: 37786026 DOI: 10.1016/j.ijrobp.2023.06.800] [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) Cardiac disease is a dose-limiting toxicity in non-small cell lung cancer (NSCLC) radiation therapy. Radiation dose to the cardiac base is associated with poor overall survival in several clinical studies, but has not been validated in a non-dose escalated cohort, or with individual patient delineations. In this study we examined the impact of cardiac base dose on overall survival (OS) and cardiac events (CEs), and interrogated the relationships of the substructures comprising the heart base with OS and CEs. MATERIALS/METHODS Patients with stage I-III NSCLC treated with curative-intent radiation therapy between 2015 and 2020 at a regional cancer center were identified. Clinical notes were examined for baseline patient, tumor and cardiac details, and both cancer and cardiac outcomes. Three cardiologists verified CEs. Cardiac delineations were completed using a validated deep learning-based autosegmentation tool. Cox and Fine and Gray regressions were undertaken for the risk of death and CEs respectively, accounting for pre-specified evidence-based dose metrics and clinically relevant cardiac covariates. RESULTS Most patients received 55 Gy/20# (n = 461/478, 96%) without chemotherapy (58%), planned with VMAT (51%) or IMRT (20%). Pre-existing cardiovascular morbidity was common, with 78% having ≥2 risk factors, and 46% having >1 established cardiac disease. The median follow-up was 21.1 months. Dichotomized at the median, higher heart base Dmax was associated with poorer survival on Kaplan-Meier analysis (21.6 months (95% CI 19.3-24.9) versus 29.4 months (95% CI 21.6-36.6), p = 0.021), and remained significant when statistically compared in published multivariate models. In a multivariate analysis for pooled acute CEs, heart base Dmax was associated with CEs (HR 1.75, 95% CI 1.01-1.06, p = 0.04), but this was not the case for individual CEs. Using Fine and Gray models to account for the competing risk of death, left main coronary maximum dose was associated with atrial fibrillation (p = 0.024), proximal right coronary artery V15 (p = 0.023) and mean dose (p = 0.032), and the right atrium mean dose (p = 0.029) were associated with heart failure. No dose-volume metrics were significantly associated with acute coronary syndrome. None of the constituent base substructures dose were significantly associated with death. CONCLUSION Dose to the heart base was associated with increased mortality and an increased pooled cardiac event rate. Accounting for endpoint-specific clinical covariates, only select constituent substructures of the heart base were associated with CEs and no substructures were independently associated with survival. Together, these findings are suggestive of possible interplay between the constituent base substructures in their mediation of radiation cardiotoxicity.
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Affiliation(s)
- G Walls
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J O'Connor
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - M Harbsinson
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - F K Duane
- Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland
| | - C McCann
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - P McKavanagh
- South Eastern Health & Social Care Trust, Belfast, United Kingdom
| | - D Johnston
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - V Giacometti
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - J McAleese
- Belfast Health & Social Care Trust, Belfast, United Kingdom
| | - A Hounsell
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - A Cole
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - K Butterworth
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - C McGarry
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - G G Hanna
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
| | - S Jain
- Patrick G Johnston Centre for Cancer Research, Belfast, United Kingdom
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Thippu Jayaprakash K, Hanna GG, Hatton MQ. Lung Cancer in 2022 and Beyond! Clin Oncol (R Coll Radiol) 2022; 34:695-697. [PMID: 36153212 DOI: 10.1016/j.clon.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Affiliation(s)
- K Thippu Jayaprakash
- Oncology Centre, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Department of Oncology, The Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK.
| | - G G Hanna
- Cancer Centre, Belfast City Hospital, Belfast, UK; Queen's University Belfast, Belfast, UK
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Hegi-Johnson F, Akhurst T, Rudd S, Donnelly P, Scott A, Callahan J, Roselt P, John T, Sithara S, Wichmann C, Hanna G, MacManus M. MA09.05 Increased PD-L1 Tracer Uptake in Recently-irradiated Lesions in NSCLC: Preliminary Results of a Phase 0 Trial (ImmunoPET) of a Novel PET Tracer. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Lee K, Le T, Lim R, Hanna G, Gee H, Vinod S, Dammak S, Palma D, Ong A, Yeghiaian-Alvandi R, Buck J, Hau E. PO-1276 A review into the radiological features predicting local recurrence post-SABR in patients with NSCLC. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Diez P, Hanna GG, Aitken KL, van As N, Carver A, Colaco RJ, Conibear J, Dunne EM, Eaton DJ, Franks KN, Good JS, Harrow S, Hatfield P, Hawkins MA, Jain S, McDonald F, Patel R, Rackley T, Sanghera P, Tree A, Murray L. UK 2022 Consensus on Normal Tissue Dose-Volume Constraints for Oligometastatic, Primary Lung and Hepatocellular Carcinoma Stereotactic Ablative Radiotherapy. Clin Oncol (R Coll Radiol) 2022; 34:288-300. [PMID: 35272913 DOI: 10.1016/j.clon.2022.02.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [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: 12/17/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 12/25/2022]
Abstract
The use of stereotactic ablative radiotherapy (SABR) in the UK has expanded over the past decade, in part as the result of several UK clinical trials and a recent NHS England Commissioning through Evaluation programme. A UK SABR Consortium consensus for normal tissue constraints for SABR was published in 2017, based on the existing literature at the time. The published literature regarding SABR has increased in volume over the past 5 years and multiple UK centres are currently working to develop new SABR services. A review and update of the previous consensus is therefore appropriate and timely. It is hoped that this document will provide a useful resource to facilitate safe and consistent SABR practice.
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Affiliation(s)
- P Diez
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
| | - G G Hanna
- Belfast Health and Social Care Trust, Belfast, UK; Queen's University Belfast, Belfast, UK
| | - K L Aitken
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK
| | - N van As
- Institute of Cancer Research, London, UK; Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - A Carver
- Department of Medical Physics, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Medical Centre, Edgbaston, Birmingham, UK
| | - R J Colaco
- Department of Clinical Oncology, The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - J Conibear
- Radiotherapy Department, Barts Cancer Centre, London, UK
| | - E M Dunne
- Department of Clinical Oncology, Guys and St Thomas' NHS Foundation Trust, London, UK
| | - D J Eaton
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK; Department of Medical Physics, Guys and St Thomas' NHS Foundation Trust, London, UK; School of Biomedical Engineering & Imaging Sciences, King's College London, London, UK
| | - K N Franks
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK
| | - J S Good
- Department of Clinical Oncology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - S Harrow
- Department of Clinical Oncology, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - P Hatfield
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK
| | - M A Hawkins
- Department of Medical Physics and Biomechanical Engineering, University College London, London, UK; Department of Clinical Oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Jain
- Belfast Health and Social Care Trust, Belfast, UK; Queen's University Belfast, Belfast, UK
| | - F McDonald
- Institute of Cancer Research, London, UK; Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Chelsea, London, UK
| | - R Patel
- Radiotherapy Physics, National Radiotherapy Trials Quality Assurance Group (RTTQA), Mount Vernon Cancer Centre, Northwood, UK
| | - T Rackley
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
| | - P Sanghera
- Department of Clinical Oncology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK
| | - A Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK; Institute of Cancer Research, London, UK
| | - L Murray
- Department of Clinical Oncology, Leeds Cancer Centre, St James's University Hospitals, Leeds, UK; Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
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Liu K, Milligan M, Schoenfeld J, Tishler R, Ng A, Devlin P, Fite E, Hanna G, Silk A, Yoon C, Thakuria M, Margalit D. MO-0151 Outcomes after hypofractionated radiotherapy for non-metastatic Merkel cell carcinoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02311-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hanna G, Munairji M. 1542P Kaposi sarcoma: A population-based study of secondary primary neoplasms. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.872] [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] Open
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Fennell D, Ottensmeier C, Califano R, Hanna G, Ewings S, Hill K, Wilding S, Danson S, Nye M, Steele N, Johnson L, Lord J, Middleton C, Marwood E, Szlosarek P, Chan S, Gaba A, Darlison L, Wells-Jordan P, Richards C, Poile C, Lester J. PS01.11 Nivolumab Versus Placebo in Relapsed Malignant Mesothelioma: The CONFIRM Phase 3 Trial. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.323] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Newman S, Bucknell N, Bressel M, Tran P, Campbell BA, David S, Haghighi N, Hanna GG, Kok D, MacManus M, Phillips C, Plumridge N, Shaw M, Wirth A, Wheeler G, Ball D, Siva S. Long-term Survival with 18-Fluorodeoxyglucose Positron Emission Tomography-directed Therapy in Non-small Cell Lung Cancer with Synchronous Solitary Brain Metastasis. Clin Oncol (R Coll Radiol) 2020; 33:163-171. [PMID: 33129655 DOI: 10.1016/j.clon.2020.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/28/2020] [Accepted: 10/13/2020] [Indexed: 11/27/2022]
Abstract
AIMS At diagnosis, <1% of patients with non-small cell lung cancer (NSCLC) have synchronous solitary brain metastasis (SSBM). In prior cohorts without 18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) staging, definitive treatment to intracranial and intrathoracic disease showed a 5-year overall survival (OS) of 11-21%. We investigated the long-term survival outcomes for patients with SSBM NSCLC, diagnosed in the FDG-PET/CT era and treated definitively with local therapies to both intracranial and intrathoracic sites of disease. MATERIALS AND METHODS This retrospective study assessed patients staged with FDG-PET/CT who received definitive lung and SSBM treatment from February 1999 to December 2017. A lung-molecular graded prognostic assessment (lung-molGPA) score was assigned for each patient using age, performance status score, and, where carried out, molecular status. Overall survival and progression-free survival (PFS) were calculated using Kaplan-Meier methods. Cox proportional hazard models determined OS and PFS prognostic factors. RESULTS Forty-nine patients newly diagnosed with NSCLC and SSBM had a median age of 63 years (range 34-76). The median follow-up of all patients was 3.9 years. Thirty-three patients (67%) had ≥T2 disease, 23 (47%) had ≥N2. At 2 years, 45% of first failures were intracranial only (95% confidence interval 30-59). At 3 and 5 years, OS was 45% (95% confidence interval 32-63) and 30% (95% confidence interval 18-51), respectively. In ≥N1 disease, 5-year OS was 34% (95% confidence interval 18-63). The 3- and 5-year PFS was 8% (95% confidence interval 3-22) and 0%, respectively. Higher lung-molGPA was associated with longer OS (hazard ratio 0.26, 95% confidence interval 0.11-0.61, P = 0.002). Higher lung-molGPA (hazard ratio 0.33, 95% confidence interval 0.15-0.71, P = 0.005) and lower N-stage (hazard ratio 1.56, 95% confidence interval 1.13-2.15, P = 0.007) were associated with longer PFS. CONCLUSIONS Definitive treatment of patients with NSCLC and SSBM staged with FDG-PET/CT can result in 5-year survivors, including those with ≥N1 disease.
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Affiliation(s)
- S Newman
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - N Bucknell
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - M Bressel
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - P Tran
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - B A Campbell
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - S David
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - N Haghighi
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - G G Hanna
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - D Kok
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - M MacManus
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - C Phillips
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - N Plumridge
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - M Shaw
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - A Wirth
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - G Wheeler
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia
| | - D Ball
- Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia
| | - S Siva
- Peter MacCallum Cancer Centre, Radiation Oncology, Parkville, Victoria, Australia; Sir Peter MacCallum Department of Oncology, Melbourne University, Parkville, Victoria, Australia.
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Chipidza F, Thakuria M, Schoenfeld J, Silk A, Catalano P, Yoon C, Hanna G, DeCaprio J, Tishler R, Margalit D. Effect of Treatment Center Experience on Survival after Diagnosis of Stage I-III Merkel Cell Carcinoma Treated with Surgery with or without Postoperative Radiation Therapy. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1012] [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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13
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Walls GM, O'Hare J, Hanna GG, Eakin RL, McAleese J. Re: Lewis et al. Palliative Lung Radiotherapy: Higher Dose Leads to Improved Survival? Clin Oncol (R Coll Radiol) 2020; 33:e100. [PMID: 33087297 DOI: 10.1016/j.clon.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Affiliation(s)
- G M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Patrick G. Johnston Centre for Cancer Research, Queen's University of Belfast, Belfast, UK
| | - J O'Hare
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - G G Hanna
- Patrick G. Johnston Centre for Cancer Research, Queen's University of Belfast, Belfast, UK; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - R L Eakin
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - J McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
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Coles CE, Aristei C, Bliss J, Boersma L, Brunt AM, Chatterjee S, Hanna G, Jagsi R, Kaidar Person O, Kirby A, Mjaaland I, Meattini I, Luis AM, Marta GN, Offersen B, Poortmans P, Rivera S. International Guidelines on Radiation Therapy for Breast Cancer During the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 32:279-281. [PMID: 32241520 PMCID: PMC7270774 DOI: 10.1016/j.clon.2020.03.006] [Citation(s) in RCA: 167] [Impact Index Per Article: 41.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- C E Coles
- Oncology Department, University of Cambridge, UK.
| | - C Aristei
- University of Perugia, Italy; Perugia General Hospital Sant'Andrea delle Fratte, Italy
| | - J Bliss
- The Institute of Cancer Research Clinical Trials and Statistics Unit, London, UK
| | - L Boersma
- Department of Radiation Oncology (Maastro), GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - A M Brunt
- University Hospitals of North Midlands & Keele University, Stoke-on-Trent, UK
| | | | - G Hanna
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - R Jagsi
- Department of Radiation Oncology, Center for Bioethics and Social Sciences in Medicine, University of Michigan, USA
| | - O Kaidar Person
- Breast Radiation Unit, Sheba Tel Ha'shomer, Ramat Gan, Israel
| | - A Kirby
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, UK
| | - I Mjaaland
- Department of Hematology and Oncology, Stavanger University Hospital, Norway
| | - I Meattini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy; Radiation Oncology Unit - Oncology Department, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - A M Luis
- University Hospital HM Sanchinarro, Madrid, Spain
| | - G N Marta
- Department of Radiation Oncology, Hospital Sírio-Libanês, São Paulo, Brazil; Division of Radiation Oncology, Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - B Offersen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Denmark
| | - P Poortmans
- Paris Sciences et Lettres University, Paris, France
| | - S Rivera
- Department of Radiation Oncology, Gustave Roussy Cancer Campus, Villejuif, France; Molecular Radiotherapy and Innovative Therapeutics, Gustave Roussy Cancer Campus, Université Paris Saclay, Villejuif, France
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Hanna CR, Lynskey DM, Wadsley J, Appleyard SE, Anwar S, Miles E, Gower J, Hall E, Coles CE, Hanna GG. Radiotherapy Trial Set-up in the UK: Identifying Inefficiencies and Potential Solutions. Clin Oncol (R Coll Radiol) 2020; 32:266-275. [PMID: 31685377 DOI: 10.1016/j.clon.2019.10.004] [Citation(s) in RCA: 2] [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: 05/27/2019] [Revised: 09/04/2019] [Accepted: 09/26/2019] [Indexed: 11/17/2022]
Abstract
AIMS Radiotherapy clinical trials are integral to the development of new treatments to improve the outcomes of patients with cancer. A collaborative study by the National Cancer Research Institute Clinical and Translational Radiotherapy Research Working Group and the National Institute for Health Research was carried out to understand better if and why inefficiencies occur in the set-up of radiotherapy trials in the UK. MATERIALS AND METHODS Two online surveys collected information on the time taken for UK radiotherapy trials to reach key milestones during set-up and the research support currently being provided to radiotherapy centres to enable efficient clinical trial set-up. Semi-structured interviews with project managers and chief investigators identified better ways of working to improve trial set-up in the future. RESULTS The timelines for the set-up of 39 UK radiotherapy trials were captured in an online survey showing that the median time from grant approval to trial opening was 600 days (range 169-1172). There were 38 responses from radiotherapy centres to a survey asking about the current support provided for radiotherapy research. Most of these centres have more than one type of staff member dedicated to supporting radiotherapy research. The most frequent barrier to radiotherapy trial set-up identified was lack of physicists' time and lack of time for clinical oncologists to carry out research activities. Four main themes around trial set-up were identified from semi-structured interviews: the importance of communication and building relationships, the previous experience of the chief investigator and clinical trials units, a lack of resources and having the time and personnel required to produce trial documentation and to process trial approval requests. CONCLUSIONS This unique, collaborative project has provided up to date information about the current landscape of trial set-up and research support in the UK and identified several avenues on which to focus future efforts in order to support the excellent radiotherapy trial work carried out across the UK.
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Affiliation(s)
- C R Hanna
- CRUK Clinical Trials Unit, University of Glasgow, Glasgow, UK.
| | - D M Lynskey
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J Wadsley
- Weston Park Cancer Centre, Sheffield, UK
| | | | - S Anwar
- National Institute for Health Research, Leeds, UK
| | - E Miles
- RTTQA Group, Mount Vernon Cancer Centre, Northwood, UK
| | - J Gower
- National Institute for Health Research, Leeds, UK
| | - E Hall
- The Institute of Cancer Research, London, UK
| | - C E Coles
- University of Cambridge, Cambridge, UK
| | - G G Hanna
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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McDonald F, Mak K, Teague J, Landau D, Hanna G, Farrelly L, Counsell N. SARON: Stereotactic Ablative Radiotherapy for Oligometastatic Non-small cell lung cancer (NSCLC): a randomised phase III trial. Lung Cancer 2020. [DOI: 10.1016/s0169-5002(20)30243-9] [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: 10/25/2022]
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17
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Arhi CS, Markar S, Burns EM, Bouras G, Bottle A, Hanna G, Aylin P, Ziprin P, Darzi A. Delays in referral from primary care are associated with a worse survival in patients with esophagogastric cancer. Dis Esophagus 2019; 32:1-11. [PMID: 30820525 DOI: 10.1093/dote/doy132] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/27/2018] [Accepted: 12/20/2018] [Indexed: 12/11/2022]
Abstract
NICE referral guidelines for suspected cancer were introduced to improve prognosis by reducing referral delays. However, over 20% of patients with esophagogastric cancer experience three or more consultations before referral. In this retrospective cohort study, we hypothesize that such a delay is associated with a worse survival compared with patients referred earlier. By utilizing Clinical Practice Research Datalink, a national primary care linked database, the first presentation, referral date, a number of consultations before referral and stage for esophagogastric cancer patients were determined. The risk of a referral after one or two consultations compared with three or more consultations was calculated for age and the presence of symptom fulfilling the NICE criteria. The risk of death according to the number of consultations before referral was determined, while accounting for stage and surgical management. 1307 patients were included. Patients referred after one (HR 0.80 95% CI 0.68-0.93 p = 0.005) or two consultations (HR 0.81 95% CI 0.67-0.98 p = 0.034) demonstrated significantly improved prognosis compared with those referred later. The risk of death was also lower for patients who underwent a resection, were younger or had an earlier stage at diagnosis. Those presenting with a symptom fulfilling the NICE criteria (OR 0.27 95% CI 0.21-0.35 p < 0.0001) were more likely to be referred earlier. This is the first study to demonstrate an association between a delay in referral and worse prognosis in esophagogastric patients. These findings should prompt further research to reduce primary care delays.
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Affiliation(s)
| | - S Markar
- Department of Surgery and Cancer, St Mary's Hospital Campus
| | - E M Burns
- Department of Surgery and Cancer, St Mary's Hospital Campus
| | - G Bouras
- Department of Surgery and Cancer, St Mary's Hospital Campus
| | - A Bottle
- School of Public Health, Imperial College London, Dorset Rise, London, UK
| | - G Hanna
- Department of Surgery and Cancer, St Mary's Hospital Campus
| | - P Aylin
- School of Public Health, Imperial College London, Dorset Rise, London, UK
| | - P Ziprin
- Department of Surgery and Cancer, St Mary's Hospital Campus
| | - A Darzi
- Department of Surgery and Cancer, St Mary's Hospital Campus
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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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19
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McAleese J, Rooney CM, Baluch S, Drinkwater KJ, Hanna GG. Curative Radiotherapy for Lung Cancer in the UK: International Benchmarking. Clin Oncol (R Coll Radiol) 2019; 31:731. [PMID: 31466843 DOI: 10.1016/j.clon.2019.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022]
Affiliation(s)
- J McAleese
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - C M Rooney
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - S Baluch
- Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | | | - G G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, UK
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20
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Konert T, Vogel WV, Paez D, Polo A, Fidarova E, Carvalho H, Duarte PS, Zuliani AC, Santos AO, Altuhhova D, Karusoo L, Kapoor R, Sood A, Khader J, Al-Ibraheem A, Numair Y, Abubaker S, Soydal C, Kütük T, Le TA, Canh NX, Bieu BQ, Ha LN, Belderbos JSA, MacManus MP, Thorwarth D, Hanna GG. Introducing FDG PET/CT-guided chemoradiotherapy for stage III NSCLC in low- and middle-income countries: preliminary results from the IAEA PERTAIN trial. Eur J Nucl Med Mol Imaging 2019; 46:2235-2243. [PMID: 31367906 PMCID: PMC6717604 DOI: 10.1007/s00259-019-04421-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 06/30/2019] [Indexed: 12/24/2022]
Abstract
Purpose Patients with stage III non-small-cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT) in low- and middle-income countries (LMIC) continue to have a poor prognosis. It is known that FDG PET/CT improves staging, treatment selection and target volume delineation (TVD), and although its use has grown rapidly, it is still not widely available in LMIC. CRT is often used as sequential treatment, but is known to be more effective when given concurrently. The aim of the PERTAIN study was to assess the impact of introducing FDG PET/CT-guided concurrent CRT, supported by training and quality control (QC), on the overall survival (OS) and progression-free survival (PFS) of patients with stage III NSCLC. Methods The study included patients with stage III NSCLC from nine medical centres in seven countries. A retrospective cohort was managed according to local practices between January 2010 and July 2014, which involved only optional diagnostic FDG PET/CT for staging (not for TVD), followed by sequential or concurrent CRT. A prospective cohort between August 2015 and October 2018 was treated according to the study protocol including FDG PET/CT in treatment position for staging and multimodal TVD followed by concurrent CRT by specialists trained in protocol-specific TVD and with TVD QC. Kaplan–Meier analysis was used to assess OS and PFS in the retrospective and prospective cohorts. Results Guidelines for FDG PET/CT image acquisition and TVD were developed and published. All specialists involved in the PERTAIN study received training between June 2014 and May 2016. The PET/CT scanners used received EARL accreditation. In November 2018 a planned interim analysis was performed including 230 patients in the retrospective cohort with a median follow-up of 14 months and 128 patients in the prospective cohort, of whom 69 had a follow-up of at least 1 year. Using the Kaplan–Meier method, OS was significantly longer in the prospective cohort than in the retrospective cohort (23 vs. 14 months, p = 0.012). In addition, median PFS was significantly longer in the prospective cohort than in the retrospective cohort (17 vs. 11 months, p = 0.012). Conclusion In the PERTAIN study, the preliminary results indicate that introducing FDG PET/CT-guided concurrent CRT for patients with stage III NSCLC in LMIC resulted in a significant improvement in OS and PFS. The final study results based on complete data are expected in 2020. Electronic supplementary material The online version of this article (10.1007/s00259-019-04421-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- T Konert
- Nuclear Medicine Department, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - W V Vogel
- Nuclear Medicine Department, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D Paez
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - A Polo
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - E Fidarova
- Division of Human Health, Department of Nuclear Sciences and Applications, International Atomic Energy Agency, Vienna, Austria
| | - H Carvalho
- Department of Radiology and Oncology, Faculty of Medicine, University of São Paulo - Institute of Cancer of Sao Paulo State, São Paulo, Brazil
| | - P S Duarte
- Department of Radiology and Oncology, Faculty of Medicine, University of São Paulo - Institute of Cancer of Sao Paulo State, São Paulo, Brazil
| | - A C Zuliani
- Department of Radiation Oncology and Nuclear Medicine Department, Hospital das Clínicas, Campinas University, Campinas, Brazil
| | - A O Santos
- Department of Radiation Oncology and Nuclear Medicine Department, Hospital das Clínicas, Campinas University, Campinas, Brazil
| | - D Altuhhova
- Department of Radiation Oncology and Radiology Department, North Estonia Medical Center, Tallinn, Estonia
| | - L Karusoo
- Department of Radiation Oncology and Radiology Department, North Estonia Medical Center, Tallinn, Estonia
| | - R Kapoor
- Department of Radiation Oncology and Nuclear Medicine Department, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - A Sood
- Department of Radiation Oncology and Nuclear Medicine Department, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - J Khader
- Department of Radiation Oncology and Nuclear Medicine Department, King Hussein Cancer Center, Amman, Jordan
| | - A Al-Ibraheem
- Department of Radiation Oncology and Nuclear Medicine Department, King Hussein Cancer Center, Amman, Jordan
| | - Y Numair
- Department of Radiation Oncology and Nuclear Medicine Department, Institute of Nuclear Medicine and Oncology, Lahore, Pakistan
| | - S Abubaker
- Department of Radiation Oncology and Nuclear Medicine Department, Institute of Nuclear Medicine and Oncology, Lahore, Pakistan
| | - C Soydal
- Department of Radiation Oncology and Nuclear Medicine Department, Ankara University School of Medicine, Mamak/Ankara, Turkey
| | - T Kütük
- Department of Radiation Oncology and Nuclear Medicine Department, Ankara University School of Medicine, Mamak/Ankara, Turkey
| | - T A Le
- Department of Radiation Oncology and Nuclear Medicine Department, Cho Ray Hospital, University of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - N X Canh
- Department of Radiation Oncology and Nuclear Medicine Department, Cho Ray Hospital, University of Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - B Q Bieu
- Department of Radiation Oncology and Radiosurgery, Tran Hung Dao Hospital, Hanoi, Vietnam
| | - L N Ha
- Department of Radiation Oncology and Radiosurgery, Tran Hung Dao Hospital, Hanoi, Vietnam
| | - J S A Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M P MacManus
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - D Thorwarth
- Section for Biomedical Physics, Department of Radiation Oncology, University Hospital Tübingen, Tübingen, Germany
| | - G G Hanna
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
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McAleese J, Taylor A, Walls GM, Hanna GG. Differential Relapse Patterns for Non-small Cell Lung Cancer Subtypes Adenocarcinoma and Squamous Cell Carcinoma: Implications for Radiation Oncology. Clin Oncol (R Coll Radiol) 2019; 31:711-719. [PMID: 31351746 DOI: 10.1016/j.clon.2019.07.008] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Revised: 05/17/2019] [Accepted: 06/07/2019] [Indexed: 12/25/2022]
Abstract
AIMS Curative-intent (radical) radiotherapy aims to control local disease and cure non-small cell lung cancer (NSCLC). The predominant subtypes of NSCLC are adenocarcinoma and squamous cell carcinoma (SCC). The radiotherapy paradigm offered to patients does not differ according to these two subtypes. Relapse patterns and disease control rates for adenocarcinoma and SCC treated with radical radiotherapy were determined. MATERIALS AND METHODS A radical radiotherapy database covering the period from 2004 to June 2016 was examined to determine the first sites of relapse and the actuarial local and distant control rates. RESULTS In total, 537 patients with known pathological subtype were treated over the period. In 39 (7%), the site of first relapse was uncertain. Of the remainder, 203 (41%) had adenocarcinoma and 295 (59%) had SCC. At a median follow-up of 16.4 months, 58% had relapsed. There was a difference in relapse patterns (chi-squared test P < 0.0005), with a higher rate of first relapse locally in SCC (42% of all patients versus 24%) and a higher rate of first relapse in the brain for adenocarcinoma (14% versus 3%). The actuarial local control rate was worse for SCC (hazard ratio 0.6, 95% confidence interval 0.5-0.9, P = 0.002). The brain metastasis-free survival was worse for adenocarcinoma (hazard ratio 4.1, 95% confidence interval 2.2-7.5, P < 0.0001). CONCLUSION There is a difference in relapse patterns between NSCLC histological subtypes, indicating that these are distinct entities. This may have implications for follow-up policy and strategies to improve disease control.
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Affiliation(s)
- J McAleese
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - A Taylor
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK
| | - G M Walls
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Centre for Cancer Research & Cell Biology, Queen's University of Belfast, Belfast, UK.
| | - G G Hanna
- Cancer Centre Belfast City Hospital, Belfast Health & Social Care Trust, Belfast, UK; Centre for Cancer Research & Cell Biology, Queen's University of Belfast, Belfast, UK
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Xing D, Siva S, Hanna GG. The Abscopal Effect of Stereotactic Radiotherapy and Immunotherapy: Fool's Gold or El Dorado? Clin Oncol (R Coll Radiol) 2019; 31:432-443. [PMID: 31005381 DOI: 10.1016/j.clon.2019.04.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 02/25/2019] [Accepted: 03/16/2019] [Indexed: 12/26/2022]
Abstract
An 'abscopal' effect if often used to refer to distant tumour regression after localised irradiation. Since the first report of the abscopal effect in the 1950s, well-documented cases with radiotherapy alone are very rare. It is widely accepted that the immune response plays an important role in the abscopal effect, although the mechanism is still unclear. With the recent success of cancer immunotherapy, there is growing interest in combining immunotherapy with radiotherapy to boost abscopal response rates. Compared with conventional radiotherapy, stereotactic ablative radiotherapy (SABR) not only delivers ablative dose to the tumour, but may also induce robust immune responses. In this review we examine studies that combine SABR and immunotherapy. We review the preclinical rationale for SABR and immunotherapy combinations, the case for and against abscopal effects, and the current landscape of clinical trials.
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Affiliation(s)
- D Xing
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - S Siva
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - G G Hanna
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
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Walls G, McAleer S, Hanna G. EP-1681 Modern radiotherapy learning: a quantitative study of trainer and trainee views. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32101-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hanna G. SP-0225 Blood biomarkers to predict radiotherapy response. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30645-0] [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: 11/24/2022]
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Crowther K, Osman S, O'Hare S, Gray S, Holland D, Vennard H, Hanna G. OC-0098 Gated vs coached DIBH treatment in left sided breast cancer radiotherapy: a single centre study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30518-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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26
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Walls G, Hanna G, Young L, Kearney B, Harney J, Eakin R, Mcaleese J. Survival following radical radiotherapy for satellite or synchronous ipsilateral nodules. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30239-9] [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: 11/28/2022]
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27
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Smith E, Greystoke A, Iqbal M, Hanna G. Is tissue from stage 3 NSCLC suitable for biomarker evaluation? Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30105-9] [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: 10/27/2022]
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Mcaleese J, Tumelty K, Gillott C, Eakin R, Harney J, Young L, Walls G, Hanna G. Radical radiotherapy alone versus chemoradiotherapy for the treatment of stage III (N2) non-small cell lung cancer. Lung Cancer 2019. [DOI: 10.1016/s0169-5002(19)30243-0] [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: 11/28/2022]
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Rooney C, Mcaleese J, Young L, Walls G, Eakin R, Harney J, Hanna G. P1.17-12 Colleague Peer Review of Radical Lung Radiotherapy Treatment Plans: The Impact on Interval from Decision to Treat to Treatment Delivery. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1045] [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: 11/25/2022]
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30
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Harris A, Kneebone R, Bello F, Hanna G. Surgical expertise. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cobb L, Rickard A, Herbert J, Hanna G, Palmer G, Siamakpour-Reihani S, Huang Z, Peters K, Kontos C, Berchuck A, Secord A. Targeting the TIE2 pathway with a novel small molecule vascular endothelial protein tyrosine phosphatase (VE-PTP) inhibitor in high-grade serous ovarian cancer. Gynecol Oncol 2018. [DOI: 10.1016/j.ygyno.2018.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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32
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McDonald F, Guckenberger M, Popat S, Faivre-Finn C, Andratschke N, Ridell A, Hanna G, Franks K, Miles E, Patell R, Bliss J. Targeted Therapy With or Without Dose-intensified Radiotherapy in Oligoprogressive Disease in Oncogene Addicted Lung Tumours. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.062] [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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Chia B, Landau D, Hanna G, Conibear J. Thoracic intervention and surgery to cure lung cancer: an overview of stereotactic ablative radiotherapy in early and oligometastatic lung cancer. J R Soc Med 2018; 112:334-340. [PMID: 29672204 DOI: 10.1177/0141076818763334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Bsh Chia
- 1 Division of Radiation Oncology, National Cancer Centre Singapore, Singapore 169610, Singapore
| | - D Landau
- 2 Department of Clinical Oncology, Guy's and St Thomas' Hospital, London SE1 7EH, UK
| | - G Hanna
- 3 Department of Clinical Oncology, Belfast City Hospital, Belfast BT9 7AB, UK
| | - J Conibear
- 4 Department of Clinical Oncology, St. Bartholomew's Hospital, London EC1A 7BE, UK
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Hanna G. SP-0110: Combining systemic therapy with hypofractionation in locally dvanced NSCLC: Best of both worlds, or double-trouble? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30420-1] [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: 10/14/2022]
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McCauley S, Tumelty K, Eakin R, Harney J, Young L, McAleese J, Hanna G. EP-1398: Isolated Nodal Failure rates following curative intent radiotherapy in a modern cohort. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31707-9] [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: 11/28/2022]
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Haslett K, Ashcroft L, Bayman N, Franks K, Groom N, Hanna G, Harden S, Harris C, Harrow S, Hatton M, McCloskey P, McDonald F, Ryder D, Faivre-Finn C. PO-0752: Isotoxic Intensity Modulated Radiotherapy in stage III NSCLC – A feasibility study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31062-4] [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: 10/14/2022]
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Walls GM, McAleese J, Hanna GG. Referrals Patterns to an Oncology Clinical Advice Service. Clin Oncol (R Coll Radiol) 2018; 30:395-396. [PMID: 29548616 DOI: 10.1016/j.clon.2018.02.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 02/26/2018] [Indexed: 11/18/2022]
Affiliation(s)
- G M Walls
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK; Cancer Centre, Belfast City Hospital, Belfast, UK.
| | - J McAleese
- Cancer Centre, Belfast City Hospital, Belfast, UK
| | - G G Hanna
- Centre for Cancer Research & Cell Biology, Queen's University Belfast, Belfast, UK; Cancer Centre, Belfast City Hospital, Belfast, UK
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Murray AC, Markar S, Mackenzie H, Baser O, Wiggins T, Askari A, Hanna G, Faiz O, Mayer E, Bicknell C, Darzi A, Kiran RP. An observational study of the timing of surgery, use of laparoscopy and outcomes for acute cholecystitis in the USA and UK. Surg Endosc 2018; 32:3055-3063. [PMID: 29313126 DOI: 10.1007/s00464-017-6016-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 12/19/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evidence supports early laparoscopic cholecystectomy for acute cholecystitis. Differences in treatment patterns between the USA and UK, associated outcomes and resource utilization are not well understood. METHODS In this retrospective, observational study using national administrative data, emergency patients admitted with acute cholecystitis were identified in England (Hospital Episode Statistics 1998-2012) and USA (National Inpatient Sample 1998-2011). Proportions of patients who underwent emergency cholecystectomy, utilization of laparoscopy and associated outcomes including length of stay (LOS) and complications were compared. The effect of delayed treatment on subsequent readmissions was evaluated for England. RESULTS Patients with a diagnosis of acute cholecystitis totaled 1,191,331 in the USA vs. 288 907 in England. Emergency cholecystectomy was performed in 628,395 (52.7% USA) and 45,299 (15.7% England) over the time period. Laparoscopy was more common in the USA (82.8 vs. 37.9%; p < 0.001). Pre-treatment (1 vs. 2 days; p < 0.001) and total ( 4 vs. 7 days; p < 0.001) LOS was lower in the USA. Overall incidence of bile duct injury was higher in England than the USA (0.83 vs. 0.43%; p < 0.001), but was no different following laparoscopic surgery (0.1%). In England, 40.5% of patients without an immediate cholecystectomy were subsequently readmitted with cholecystitis. An additional 14.5% were admitted for other biliary complications, amounting to 2.7 readmissions per patient in the year following primary admission. CONCLUSION This study highlights management practices for acute cholecystitis in the USA and England. Despite best evidence, index admission laparoscopic cholecystectomy is performed less in England, which significantly impacts subsequent healthcare utilization.
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Affiliation(s)
- A C Murray
- Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - S Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - H Mackenzie
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - O Baser
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - T Wiggins
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Askari
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - G Hanna
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - O Faiz
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - E Mayer
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - C Bicknell
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - R P Kiran
- Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, Herbert Irving Pavilion, 161 Fort Washington Avenue, Floor: 8, New York, NY, 10032, USA. .,Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA.
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McDonald F, Hanna GG. Oligoprogressive Oncogene-addicted Lung Tumours: Does Stereotactic Body Radiotherapy Have a Role? Introducing the HALT Trial. Clin Oncol (R Coll Radiol) 2018; 30:1-4. [PMID: 29153859 DOI: 10.1016/j.clon.2017.10.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 10/01/2017] [Accepted: 10/09/2017] [Indexed: 11/19/2022]
Affiliation(s)
| | - G G Hanna
- The Royal Marsden Hospital, London, UK
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McCauley S, Tumelty K, Hanna G, Eakin R, Harney J, Johnston R, McAleese J. Rate of marginal relapse following curative intent radiotherapy in a modern cohort. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30181-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Hanna GG, Murray L, Patel R, Jain S, Aitken KL, Franks KN, van As N, Tree A, Hatfield P, Harrow S, McDonald F, Ahmed M, Saran FH, Webster GJ, Khoo V, Landau D, Eaton DJ, Hawkins MA. UK Consensus on Normal Tissue Dose Constraints for Stereotactic Radiotherapy. Clin Oncol (R Coll Radiol) 2018; 30:5-14. [PMID: 29033164 DOI: 10.1016/j.clon.2017.09.007] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 09/07/2017] [Accepted: 09/18/2017] [Indexed: 01/19/2023]
Abstract
Six UK studies investigating stereotactic ablative radiotherapy (SABR) are currently open. Many of these involve the treatment of oligometastatic disease at different locations in the body. Members of all the trial management groups collaborated to generate a consensus document on appropriate organ at risk dose constraints. Values from existing but older reviews were updated using data from current studies. It is hoped that this unified approach will facilitate standardised implementation of SABR across the UK and will allow meaningful toxicity comparisons between SABR studies and internationally.
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Affiliation(s)
- G G Hanna
- Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK.
| | - L Murray
- Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds, UK
| | - R Patel
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, UK
| | - S Jain
- Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK
| | - K L Aitken
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - K N Franks
- Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds, UK
| | - N van As
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - A Tree
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - P Hatfield
- Department of Clinical Oncology, St James's Institute of Oncology, Leeds Cancer Centre, Leeds, UK
| | - S Harrow
- Department of Radiotherapy, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - F McDonald
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - M Ahmed
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - F H Saran
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - G J Webster
- Department of Radiotherapy, Worcester Oncology Centre, Worcester, UK
| | - V Khoo
- Department of Radiotherapy, Royal Marsden NHS Foundation Trust & Institute of Cancer Research, London, UK
| | - D Landau
- Department of Oncology, Guy's and St Thomas' Hospital, London, UK
| | - D J Eaton
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, Northwood, UK
| | - M A Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
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Hanna G, Griffiths G, Kirkpatrick E, Cozens K, Kalevras M, Maishman T, Danson S, Lester J, Ottensmeier C, Steele N, Szlosarek P, Lord J, Nye M, Fennell D. CONFIRM: a phase III randomised trial to evaluate the efficacy of nivolumab versus placebo in relapsed mesothelioma. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fennell D, Kirkpatrick E, Cozens K, Danson S, Hanna G, Lester J, Lord J, Nye M, Ottensmeier C, Szlosarek P, Steele N, Kalevras M, Maishman T, Griffiths G. PUB035 CONFIRM: A Phase III Randomized Trial to Evaluate the Efficacy of Nivolumab versus Placebo in Relapsed Mesothelioma. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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McAleese J, Baluch S, Drinkwater K, Bassett P, Hanna GG. The Elderly are Less Likely to Receive Recommended Radical Radiotherapy for Non-small Cell Lung Cancer. Clin Oncol (R Coll Radiol) 2017; 29:593-600. [PMID: 28735769 DOI: 10.1016/j.clon.2017.06.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 06/12/2017] [Accepted: 06/15/2017] [Indexed: 12/25/2022]
Affiliation(s)
- J McAleese
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK.
| | - S Baluch
- Queen Alexandra Hospital, Cosham, Portsmouth, UK
| | | | - P Bassett
- Royal College of Radiologists, London, UK
| | - G G Hanna
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK; Centre for Cancer Research and Cell Biology, Queen's University of Belfast, Belfast, UK
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Walls GM, Hanna GG. IMMUNOTHERAPY FOR LUNG CANCER - A GAME CHANGER! Ulster Med J 2017; 86:213-214. [PMID: 29581646 PMCID: PMC5849993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- GM Walls
- Department of Oncology, North West Cancer Centre, Altnagelvin and Belfast City Hospital
| | - GG Hanna
- Department of Oncology, North West Cancer Centre, Altnagelvin and Belfast City Hospital
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Reynolds JV, Preston SR, O’Neill B, Baeksgaard L, Griffin SM, Mariette C, Cuffe S, Cunningham M, Crosby T, Parker I, Hofland K, Hanna G, Svendsen LB, Donohoe CL, Muldoon C, O’Toole D, Johnson C, Ravi N, Jones G, Corkhill AK, Illsley M, Mellor J, Lee K, Dib M, Marchesin V, Cunnane M, Scott K, Lawner P, Warren S, O’Reilly S, O’Dowd G, Leonard G, Hennessy B, Dermott RM. ICORG 10-14: NEOadjuvant trial in Adenocarcinoma of the oEsophagus and oesophagoGastric junction International Study (Neo-AEGIS). BMC Cancer 2017; 17:401. [PMID: 28578652 PMCID: PMC5457631 DOI: 10.1186/s12885-017-3386-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [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: 04/07/2016] [Accepted: 05/25/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Neoadjuvant therapy is increasingly the standard of care in the management of locally advanced adenocarcinoma of the oesophagus and junction (AEG). In randomised controlled trials (RCTs), the MAGIC regimen of pre- and postoperative chemotherapy, and the CROSS regimen of preoperative chemotherapy combined with radiation, were superior to surgery only in RCTs that included AEG but were not powered on this cohort. No completed RCT has directly compared neoadjuvant or perioperative chemotherapy and neoadjuvant chemoradiation. The Neo-AEGIS trial, uniquely powered on AEG, and including comprehensive modern staging, compares both these regimens. METHODS This open label, multicentre, phase III RCT randomises patients (cT2-3, N0-3, M0) in a 1:1 fashion to receive CROSS protocol (Carboplatin and Paclitaxel with concurrent radiotherapy, 41.4Gy/23Fr, over 5 weeks). The power calculation is a 10% difference in favour of CROSS, powered at 80%, two-sided alpha level of 0.05, requiring 540 patients to be evaluable, 594 to be recruited if a 10% dropout is included (297 in each group). The primary endpoint is overall survival, with a minimum 3-year follow up. Secondary endpoints include: disease free survival, recurrence rates, clinical and pathological response rates, toxicities of induction regimens, post-operative pathology and tumour regression grade, operative in-hospital complications, and health-related quality of life. The trial also affords opportunities for establishing a bio-resource of pre-treatment and resected tumour, and translational research. DISCUSSION This RCT directly compares two established treatment regimens, and addresses whether radiation therapy positively impacts on overall survival compared with a standard perioperative chemotherapy regimen Sponsor: Irish Clinical Research Group (ICORG). TRIAL REGISTRATION NCT01726452 . Protocol 10-14. Date of registration 06/11/2012.
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Affiliation(s)
- JV Reynolds
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - SR Preston
- Royal Surrey County Hospital, Guildford, UK
| | | | | | | | - C Mariette
- University Hospital C. Huriez Place de Verdun, Lille, France
| | - S Cuffe
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - M Cunningham
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - T Crosby
- Velindre Cancer Centre, Cardiff, Wales UK
| | - I Parker
- St Mary’s Hospital and Imperial College London, London, UK
| | | | - G Hanna
- St Mary’s Hospital and Imperial College London, London, UK
| | | | - CL Donohoe
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - C Muldoon
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - D O’Toole
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - C Johnson
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - N Ravi
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - G Jones
- Velindre Cancer Centre, Cardiff, Wales UK
| | - AK Corkhill
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - M Illsley
- Royal Surrey County Hospital, Guildford, UK
| | - J Mellor
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - K Lee
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - M Dib
- University Hospital C. Huriez Place de Verdun, Lille, France
| | - V Marchesin
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - M Cunnane
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - K Scott
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - P Lawner
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - S Warren
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - S O’Reilly
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - G O’Dowd
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - G Leonard
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - B Hennessy
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - R Mc Dermott
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
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McAleese J, Hanna G, Thompson C, Eakin R. Consultant-led peer review for lung cancer; system-based or individual-based variances? Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.04.029] [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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Wilson R, McAleese J, Lynch T, Hanna G. Staging for limited disease SCLC; no impact of PET/CT. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.04.014] [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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Markar S, Wiggins T, Antonowicz S, Lagergren J, Mughal M, Hanna G. Breath volatile organic compound analysis for the diagnosis of oesophago-gastric cancer; multi-centre blinded validation clinical trial. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30095-3] [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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McAleese J, Culleton G, Henry A, Agerback E, Johnston R, Hanna G. 129: Survival for patients following radical radiotherapy in the Northern Ireland cancer network in comparison to a large European cohort. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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