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Zallar L, Rivera-Irizarry J, Hamor P, Pigulevskiy I, Liu D, Welday J, Rico Rozo A, Bender R, Asfouri J, Levine O, Skelly M, Hadley C, Fecteau K, Mehanna H, Nelson S, Miller J, Ghazal P, Bellotti P, Singh A, Hollmer L, Erikson D, Geri J, Pleil K. Rapid nongenomic estrogen signaling controls alcohol drinking behavior. bioRxiv 2024:2023.11.02.565358. [PMID: 37961707 PMCID: PMC10635092 DOI: 10.1101/2023.11.02.565358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
The sex steroid hormone estrogen is a key modulator of numerous physiological processes and adaptive behaviors, but it may also be co-opted to drive maladaptive behaviors. While many behavioral roles for estrogen signaling have been shown to occur through canonical genomic signaling mechanisms via nuclear receptors, estrogen can also act in a neurotransmitter-like fashion at membrane-associated estrogen receptors to rapidly regulate neuronal function. Early alcohol drinking confers greater risk for alcohol use disorder in women than men, and binge alcohol drinking is correlated with high circulating estrogen but a causal role for estrogen in alcohol drinking has not been established. Here, we demonstrate that gonadally intact female mice consume more alcohol and display an anxiolytic phenotype when they have elevated levels of ovarian-derived estrogen across the estrous cycle. We found that rapid, nongenomic estrogen signaling at membrane-associated estrogen receptor alpha in the bed nucleus of the stria terminalis (BNST) is necessary and sufficient for the pro-alcohol drinking effects of ovarian estrogen signaling, regardless of the transcriptional program of a high ovarian estrogen state. We further show that a population of corticotropin-releasing factor (CRF) BNST neurons (BNSTCRF) is a critical mediator of these effects, as high estrogen rapidly enhances synaptic excitation of BNSTCRF neurons and promotes their role in driving binge alcohol drinking. These findings show a causal role for endogenous, ovarian-derived estrogen in hormonal modulation of risky alcohol consumption and provide the first demonstration of a purely rapid, nongenomic signaling mechanism of ovarian estrogen in the brain controlling behavior in gonadally intact females.
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Affiliation(s)
- L.J. Zallar
- Pharmacology Graduate Program, Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - J.K. Rivera-Irizarry
- Neuroscience Graduate Program, Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - P.U. Hamor
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - I. Pigulevskiy
- Pharmacology Graduate Program, Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - D. Liu
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - J.P. Welday
- Neuroscience Graduate Program, Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - A.S. Rico Rozo
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - R. Bender
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - J. Asfouri
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - O.B. Levine
- Neuroscience Graduate Program, Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - M.J. Skelly
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - C.K. Hadley
- Weill Cornell/Rockefeller/Sloan Kettering Tri-institutional MD-PhD Program, New York, NY 10065, USA
| | - K.M. Fecteau
- Endocrine Technologies Core, Oregon National Primate Research Center, Beaverton, OR, USA
| | - H. Mehanna
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - S. Nelson
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - J. Miller
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - P. Ghazal
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - P. Bellotti
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - A. Singh
- Neuroscience Graduate Program, Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - L.V. Hollmer
- Pharmacology Graduate Program, Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - D.W. Erikson
- Endocrine Technologies Core, Oregon National Primate Research Center, Beaverton, OR, USA
| | - J. Geri
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - K.E. Pleil
- Pharmacology Graduate Program, Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
- Neuroscience Graduate Program, Weill Cornell Graduate School of Medical Sciences, Weill Cornell Medicine, Cornell University, New York, NY, USA
- Department of Pharmacology, Weill Cornell Medicine, Cornell University, New York, NY, USA
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Cavalieri S, Vener C, LeBlanc M, Lopez Perez L, Fico G, Resteghini C, Monzani D, Marton G, Moreira-Soares M, Filippidou D, Almeida A, Bilbao A, Mehanna H, Singer S, Thomas S, Lacerenza L, Manfuso A, Mercalli F, Martinelli E, Licitra L. 708TiP BD4QoL: A multicenter randomized trial for monitoring quality of life (QoL) by intelligent tools in head and neck cancer (HNC) survivors after curative treatment. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.832] [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: 11/01/2022] Open
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Rischin D, Mehanna H, Young RJ, Bressel M, Dunn J, Corry J, Soni P, Fulton-Lieuw T, Iqbal G, Kenny L, Porceddu S, Wratten C, Robinson M, Solomon BJ. Prognostic stratification of HPV-associated oropharyngeal cancer based on CD103 + immune cell abundance in patients treated on TROG 12.01 and De-ESCALaTE randomized trials. Ann Oncol 2022; 33:804-813. [PMID: 35525376 DOI: 10.1016/j.annonc.2022.04.074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 02/09/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High CD103+ intratumoral immune cell (ITIC) abundance is associated with better prognosis in unselected patients with human papilloma virus-associated oropharyngeal squamous cell carcinoma (HPV-associated OPSCC) treated with cisplatin and radiotherapy (CIS/RT). Substituting cetuximab (CETUX) for CIS with RT in HPV-associated OPSCC resulted in inferior efficacy. Our aim was to determine whether quantification of CD103 ITIC could be used to identify a population of HPV-associated OPSCC with superior prognosis. PATIENTS AND METHODS We pooled data from the TROG 12.01 and De-ESCALaTE randomized trials that compared CETUX/70GyRT with CIS/70GyRT in low-risk HPV-associated OPSCC: American Joint Committee on Cancer 7 stage III (excluding T1-2N1) or stage IV (excluding N2b-c if smoking history >10 pack-years and/or distant metastases), including all patients with available tumor samples. The primary endpoint was failure-free survival (FFS) in patients receiving CETUX/RT comparing CD103+ ITIC high (≥30%) versus low (<30%). High and low CD103 were compared using Cox regression adjusting for age, stage and trial. RESULTS Tumor samples were available in 159/182 patients on TROG 12.01 and 145/334 on De-ESCALaTE. CD103+ ITIC abundance was high in 27% of patients. The median follow-up was 3.2 years. The 3-year FFS in patients treated with CETUX/RT was 93% [95% confidence interval (CI) 79% to 98%] in high CD103 and 74% (95% CI 63% to 81%) in low CD103 [adjusted hazard ratio = 0.22 (95% CI 0.12-0.41), P < 0.001]. The 3-year overall survival in patients treated with CETUX/RT was 100% in high CD103 and 86% (95% CI 76% to 92%) in low CD103, P < 0.001. In patients treated with CIS/RT, there was no significant difference in FFS. CONCLUSIONS CD103+ ITIC expression separates CETUX/RT-treated low-risk HPV-associated OPSCC into excellent and poor prognosis subgroups. The high CD103 population is a rational target for de-intensification trials.
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Affiliation(s)
- D Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
| | - H Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - R J Young
- Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - M Bressel
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Corry
- Genesiscare St Vincent's Hospital, Melbourne, Australia; Department of Medicine, University of Melbourne, Melbourne, Australia
| | - P Soni
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T Fulton-Lieuw
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - G Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - L Kenny
- Department of Radiation Oncology, Royal Brisbane & Women's Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - S Porceddu
- Faculty of Medicine, University of Queensland, Brisbane, Australia; Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - C Wratten
- Department of Radiation Oncology, Calvary Mater Hospital and University of Newcastle, Newcastle, Australia
| | - M Robinson
- Cellular Pathology, Newcastle upon Tyne Hospitals, Newcastle, UK
| | - B J Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia
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Lorenc A, Wells M, Fulton-Lieuw T, Nankivell P, Mehanna H, Jepson M. Clinicians' Views of Patient-initiated Follow-up in Head and Neck Cancer: a Qualitative Study to Inform the PETNECK2 Trial. Clin Oncol (R Coll Radiol) 2022; 34:230-240. [PMID: 34862101 PMCID: PMC8950325 DOI: 10.1016/j.clon.2021.11.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/13/2021] [Accepted: 11/12/2021] [Indexed: 12/23/2022]
Abstract
AIMS Current follow-up for head and neck cancer (HNC) is ineffective, expensive and fails to address patients' needs. The PETNECK2 trial will compare a new model of patient-initiated follow-up (PIFU) with routine scheduled follow-up. This article reports UK clinicians' views about HNC follow-up and PIFU, to inform the trial design. MATERIALS AND METHODS Online focus groups with surgeons (ear, nose and throat/maxillofacial), oncologists, clinical nurse specialists and allied health professionals. Clinicians were recruited from professional bodies, mailing lists and personal contacts. Focus groups explored views on current follow-up and acceptability of the proposed PIFU intervention and randomised controlled trial design (presented by the study co-chief investigator), preferences, margins of equipoise, potential organisational barriers and thoughts about the content and format of PIFU. Data were interpreted using inductive thematic analysis. RESULTS Eight focus groups with 34 clinicians were conducted. Clinicians highlighted already known limitations with HNC follow-up - lack of flexibility to address the wide-ranging needs of HNC patients, expense and lack of evidence - and agreed that follow-up needs to change. They were enthusiastic about the PETNECK2 trial to develop and evaluate PIFU but had concerns that PIFU may not suit disengaged patients and may aggravate patient anxiety/fear of recurrence and delay detection of recurrence. Anticipated issues with implementation included ensuring a reliable route back to clinic and workload burden on nurses and allied health professionals. CONCLUSIONS Clinicians supported the evaluation of PIFU but voiced concerns about barriers to help-seeking. An emphasis on patient engagement, psychosocial issues, symptom reporting and reliable, quick routes back to clinic will be important. Certain patient groups may be less suited to PIFU, which will be evaluated in the trial. Early, meaningful, ongoing engagement with clinical teams and managers around the trial rationale and recruitment process will be important to discourage selective recruitment and address risk-averse behaviour and potential workload burden.
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Affiliation(s)
- A Lorenc
- QuinteT Research Group, Bristol Medical School, University of Bristol, Bristol, UK.
| | - M Wells
- Nursing Directorate, Imperial College Healthcare, NHS Trust / Department of Surgery and Oncology, Imperial College, London, London, UK
| | - T Fulton-Lieuw
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - P Nankivell
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK; University Hospitals, Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Jepson
- QuinteT Research Group, Bristol Medical School, University of Bristol, Bristol, UK
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Vreugdenhil M, Fong C, Iqbal G, Roques T, Evans M, Palaniappan N, Yang H, O'Toole L, Sanghera P, Nutting C, Foran B, Sen M, Al Booz H, Fulton-Lieuw T, Dalby M, Dunn J, Hartley A, Mehanna H. Improvement in Dysphagia Outcomes Following Clinical Target Volume Reduction in the De-ESCALaTE Study. Clin Oncol (R Coll Radiol) 2021; 33:795-803. [PMID: 34340917 DOI: 10.1016/j.clon.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
AIMS The De-ESCALaTE study showed an overall survival advantage for the administration of synchronous cisplatin chemotherapy with radiotherapy in low-risk oropharyngeal cancer when compared with synchronous cetuximab. During the trial, a radiotherapy quality assurance protocol amendment permitted centres to swap from the original radiotherapy contouring protocol (incorporating the whole oropharynx into the high-dose clinical target volume (CTV); anatomical protocol) to a protocol that incorporated the gross tumour volume with a 10 mm margin into the CTV (volumetric protocol). The purpose of this study was to examine both toxicity and tumour control related to this protocol amendment. MATERIALS AND METHODS Overall survival and recurrence at 2 years were used to compare tumour control in the two contouring cohorts. For toxicity, the cohorts were compared by both the number of severe (grades 3-5) and all grades acute and late toxicities. In addition, quality of life and swallowing were compared using EORTC-C30 and MD Anderson Dysphagia Inventory, respectively. RESULTS Of 327 patients included in this study, 185 were contoured according to the anatomical protocol and 142 by the volumetric protocol. The two cohorts were well balanced, with the exception of significantly more patients in the anatomical cohort undergoing prophylactic feeding tube insertion (P < 0.001). With a minimum of 2 years of follow-up there was no significant difference in overall survival or recurrence between the two contouring protocols. Similarly, there was no significant difference in the rate of reported severe or all grades acute or late toxicity and no sustained significant difference in quality of life. However, there was a significant difference in favour of volumetric contouring in several domains of the MD Anderson Dysphagia Inventory questionnaire at 1 year, which persisted to 2 years in the dysphagia functional (P = 0.002), dysphagia physical (P = 0.009) and dysphagia overall function (P = 0.008) domains. CONCLUSION In the context of the unplanned post-hoc analysis of a randomised trial, measurable improvement in long-term dysphagia has been shown following a reduction in the CTV. Further reductions in the CTV should be subject to similar scrutiny within the confines of a prospective study.
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Affiliation(s)
- M Vreugdenhil
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - C Fong
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - G Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - T Roques
- Norfolk and Norwich University Hospitals, Norwich, UK
| | - M Evans
- Velindre University NHS Trust, Cardiff, UK
| | | | - H Yang
- Addenbrooke's Hospital, Cambridge, UK
| | - L O'Toole
- Castle Hill Hospital, Cottingham, UK
| | - P Sanghera
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | | | - B Foran
- Weston Park Hospital, Sheffield, UK
| | - M Sen
- St James' Institute of Oncology, Leeds, UK
| | - H Al Booz
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - T Fulton-Lieuw
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - M Dalby
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - A Hartley
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK.
| | - H Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
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Psyrri A, Mehanna H, Economopoulou P, Porceddu S, Waldron J, Wen Ong E, Chua M, Saba N, Basté N, Cavalieri S, Fountzilas G, Licitra L. 929TiP HERODOTUS: Head and neck cancers international COVID-19 collaboration: An international registry on head and neck cancer with COVID-19. Ann Oncol 2021. [PMCID: PMC8454395 DOI: 10.1016/j.annonc.2021.08.1339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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7
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Fong C, Mistry P, Roques T, Evans M, Yang H, O'Toole L, Sanghera P, Nutting C, Foran B, Sen M, Al Booz H, Fulton-Lieuw T, Dalby M, Dunn J, Hartley A, Mehanna H. OC-0573: Improvement in late dysphagia following clinical target volume reduction in the De-ESCALaTE study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00595-8] [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: 11/16/2022]
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8
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Mehanna H, Taberna Sanz M, Tous S, Brooks J, von Buchwald C, Mena M, Batis N, Brakenhoff R, Baatenburg de Jong R, Klussmann J, Dalianis T, Mirghani H, Schache A, James J, Huang S, Broglie M, Hoffmann M, Alemany L. 911O Performance of dual p16 and HPV testing for determining prognosis in cancer of the oropharynx, the EPIC-OPC Study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Jones D, Mehanna H, Mistry P, Dalby M, Fulton-Lieuw T, Kong A, Dunn J, Gray A. Cisplatin reduces costs and provides more quality adjusted life years (QALYs) than cetuximab in chemoradiotherapy for patients with HPV-positive oropharyngeal cancer (HPV+OPC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz252.003] [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: 11/12/2022] Open
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Wu R, Huang S, Su J, Gregoire V, Lydiatt W, Patel S, Brierley J, Haddad R, Langendijk H, Le Q, Lee A, Leemans C, Licitra L, Mehanna H, Porceddu S, Rocco J, Xu W, O'Sullivan B. Survey of the Adoption of the UICC/AJCC 8th Edition TNM for Head and Neck Cancer: The User’s Initial Experience. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1650] [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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Chatterjee S, Ghosh Laskar S, Mehanna H, Nutting CM, Mallick I. Oropharyngeal Cancers in the East and the West - Implications of Aetiopathogenesis on Prognosis and Research. Clin Oncol (R Coll Radiol) 2019; 31:510-519. [PMID: 31196762 DOI: 10.1016/j.clon.2019.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/12/2019] [Revised: 04/30/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
There has been a surge in human papillomavirus (HPV)-positive oropharyngeal cancers (OPCs) in the West. Although the prognosis of HPV-positive OPC is good, de-escalation strategies have so far not been able to confirm comparable cancer control. We examine the strategies implemented across the globe to safely reduce toxicities in HPV-positive disease. HPV-negative OPC has a poorer prognosis and is more prevalent in Eastern countries. We outline the intensification strategies currently used in HPV-negative cancers, with an aim to better prognosis. With recent improvements in clinical trial frameworks in Eastern countries such as India, we discuss areas where joint collaborative research between Western and Eastern countries could further improve outcomes in OPC.
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Affiliation(s)
- S Chatterjee
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India.
| | - S Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Hospital, Mumbai, India
| | - H Mehanna
- Institute of Head and Neck Studies and Education, Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - C M Nutting
- Department of Clinical Oncology, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | - I Mallick
- Department of Radiation Oncology, Tata Medical Center, Kolkata, India
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Mehanna H, Robinson M, Hartley A, Kong A, Foran B, Fulton-Lieuw T, Dalby M, Mistry P, Sen M, O’Toole L, Dunn J. OC-011 New insights from the De-ESCALate HPV trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30177-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: 11/30/2022]
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13
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Mehanna H, Kong A, Hartley A, Mistry P, Dalby M, Fulton-Lieuw T, Robinson M, Gray A, Foran B, Sen M, O'Toole L, Dyker K, Al Booz H, Moleron R, Brennan S, Aynsley E, Chan A, Srinivasan D, Buter J, Dunn J. Cetuximab versus cisplatin in patients with HPV-positive, low risk oropharyngeal cancer, receiving radical radiotherapy. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Read M, Modasia B, Fletcher A, Thompson R, Baker K, Boelaert K, Turnell A, Smith V, Mehanna H, McCabe C. PO-124 PTTG and PBF functionally interact with P53 and predict overall survival in head and neck cancer. ESMO Open 2018. [DOI: 10.1136/esmoopen-2018-eacr25.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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15
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Meade S, Gaunt P, Hartley A, Robinson M, Harrop V, Cashmore J, Wagstaff L, Babrah J, Bowden SJ, Mehanna H, Sanghera P. Feasibility of Dose-escalated Hypofractionated Chemoradiation in Human Papilloma Virus-negative or Smoking-associated Oropharyngeal Cancer. Clin Oncol (R Coll Radiol) 2018; 30:366-374. [PMID: 29478732 DOI: 10.1016/j.clon.2018.01.015] [Citation(s) in RCA: 9] [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: 06/07/2017] [Revised: 11/17/2017] [Accepted: 12/14/2017] [Indexed: 11/18/2022]
Abstract
AIMS Oropharyngeal squamous cell carcinoma (OPSCC) can be divided into favourable and poor prognostic groups by association with human papilloma virus (HPV) and smoking. This study prospectively investigated a dose-intensified schedule in poor/intermediate prognosis OPSCC. MATERIALS AND METHODS Patients with p16/HPV-negative or p16-positive N2b OPSCC with a greater than 10 pack-year smoking history were eligible. Patients were planned to receive 64 Gy in 25 fractions with cisplatin. The primary end point was absence of grade 3 mucositis at 3 months. RESULTS Fifteen patients were recruited over 14 months. All patients completed a minimum of 2 years of follow-up. All patients completed full-dose radiotherapy within a median treatment time of 32 days (31-35). Grade 3 mucositis was absent in all patients at 3 months. There was one grade 4 toxicity event due to cisplatin (hypokalaemia). Complete response rates at 3 months were 100% and 93% for local disease and lymph nodes, respectively. One patient developed metastatic disease and subsequently died. Overall survival at 2 years was 93% (95% confidence interval 61-99%). CONCLUSIONS The schedule of 64 Gy in 25 fractions with concomitant chemotherapy is tolerable in patients with poor and intermediate prognosis OPSCC.
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Affiliation(s)
- S Meade
- Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - P Gaunt
- CRUK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - A Hartley
- Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - M Robinson
- School of Dental Sciences, Newcastle University, Newcastle, UK
| | - V Harrop
- Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Cashmore
- Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - L Wagstaff
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - J Babrah
- CRUK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - S J Bowden
- CRUK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - H Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - P Sanghera
- Hall-Edwards Radiotherapy Research Group, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK.
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Siu L, Even C, Mesía R, Daste A, Krauss J, Saba N, Nabell L, Ready N, Garcia I, Kotecki N, Zandberg D, Gilbert J, Mehanna H, Jarkowski A, Melillo G, Armstrong J, Fayette J. A Randomized, Open-Label, Multicenter, Global Phase 2 Study of Durvalumab (D), Tremelimumab (T), or D Plus T, in Patients With PD-L1 Low/Negative Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: CONDOR. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hickman M, Kelly S, Fong C, Nightingale P, Sanghera P, Mehanna H, Hartley A. OC-0095: Use of a patient reported outcome as a potential radiobiological endpoint in oropharyngeal cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30405-5] [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: 10/14/2022]
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Hartley A, Best J, Fong C, Benhiat H, Mehanna H, Glaholm J. EP-2283: Squamous cell carcinoma of the head and neck: a low α/β when treated with synchronous cisplatin? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32592-1] [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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Fong C, McConkey C, Sanghera P, Hartley A, Rahman J, Nutting C, Al-Booz H, Robinson M, Mehanna H. OC-0274: Effect of radiotherapy technique/fractionation on 2-year primary local control in the PET-NECK study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30584-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: 10/14/2022]
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Smith AF, Hall PS, Hulme CT, Dunn JA, McConkey CC, Rahman JK, McCabe C, Mehanna H. Cost-effectiveness analysis of PET-CT-guided management for locally advanced head and neck cancer. Eur J Cancer 2017; 85:6-14. [PMID: 28881249 DOI: 10.1016/j.ejca.2017.07.054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 07/31/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND A recent large United Kingdom (UK) clinical trial demonstrated that positron-emission tomography-computed tomography (PET-CT)-guided administration of neck dissection (ND) in patients with advanced head and neck cancer after primary chemo-radiotherapy treatment produces similar survival outcomes to planned ND (standard care) and is cost-effective over a short-term horizon. Further assessment of long-term outcomes is required to inform a robust adoption decision. Here we present results of a lifetime cost-effectiveness analysis of PET-CT-guided management from a UK secondary care perspective. METHODS Initial 6-month cost and health outcomes were derived from trial data; subsequent incidence of recurrence and mortality was simulated using a de novo Markov model. Health benefit was measured in quality-adjusted life years (QALYs) and costs reported in 2015 British pounds. Model parameters were derived from trial data and published literature. Sensitivity analyses were conducted to assess the impact of uncertainty and broader National Health Service (NHS) and personal social services (PSS) costs on the results. RESULTS PET-CT management produced an average per-person lifetime cost saving of £1485 and an additional 0.13 QALYs. At a £20,000 willingness-to-pay per additional QALY threshold, there was a 75% probability that PET-CT was cost-effective, and the results remained cost-effective over the majority of sensitivity analyses. When adopting a broader NHS and PSS perspective, PET-CT management produced an average saving of £700 and had an 81% probability of being cost-effective. CONCLUSIONS This analysis indicates that PET-CT-guided management is cost-effective in the long-term and supports the case for wide-scale adoption.
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Affiliation(s)
- A F Smith
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, UK; National Institute of Health Research (NIHR) Diagnostic Evidence Cooperative (DEC) Leeds, UK.
| | - P S Hall
- National Institute of Health Research (NIHR) Diagnostic Evidence Cooperative (DEC) Leeds, UK; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | - C T Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, UK
| | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
| | - C C McConkey
- Warwick Clinical Trials Unit, University of Warwick, Coventry, West Midlands, UK
| | - J K Rahman
- Institute of Head & Neck Studies and Education, University of Birmingham, UK
| | - C McCabe
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
| | - H Mehanna
- Institute of Head & Neck Studies and Education, University of Birmingham, UK
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Reid KJ, Swift A, Mehanna H. A Q methodology study to investigate the experiences of head and neck cancer patients from diagnosis to 1 year. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12694] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2017] [Indexed: 11/30/2022]
Affiliation(s)
- K. J. Reid
- Department of Therapy Services; University Hospitals Birmingham NHSFT; Birmingham UK
| | - A. Swift
- Department of Nursing; Institute of Clinical Sciences; Medical School; University of Birmingham; Birmingham UK
| | - H. Mehanna
- School of Cancer Sciences; University of Birmingham; Birmingham UK
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Smith A, Hall P, Hulme C, McConkey C, Dunn J, Rahman J, Mehanna H. PET-CT surveillance for advanced head and neck cancer: a cost-effective alternative to planned neck dissection? Ann Oncol 2016. [DOI: 10.1093/annonc/mdw376.05] [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: 11/12/2022] Open
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23
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Hartley A, Fong C, Sanghera P, Wong W, McConkey C, Rahman J, Nutting C, Al-Booz H, Robinson M, Junor E, Rizwanullah M, Dunn J, Mehanna H. Radiation Therapy Variation in the Randomized Phase 3 Positron Emission Tomography Neck Study. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.285] [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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Abstract
For the first six months of 2001, tonsillectomy operations were effectively suspended in Scotland. This was due to concern regarding the potential transmission of vCJD prions by surgical instruments, and the subsequent gradual introduction of disposable instruments. The number of patients awaiting tonsillectomy therefore increased and theoretically there should have been an increase in the number of tonsillitis episodes in the community, or even in the number of tonsillitis-related complications seen in secondary care. We examined for these effects using available national data sources which record primary and secondary care activity. No increases in the incidences of acute tonsillitis or tonsillitis-related complications were found for this period. The reasons and implications are discussed.
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Affiliation(s)
- H Mehanna
- Department of Otolaryngology, Head and Neck Surgery, Green Lane Hospital, Auckland, New Zealand
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Cheng B, Benghiat H, Glaholm J, Mehanna H, Sanghera P, Hartley A. EP-1029: 20 v. 25-35 fractions in Oropharyngeal Carcinoma chemoIMRT: Could fraction number be de-escalated? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32279-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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26
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Sharma N, Imruetaicharoenchoke W, Watkins R, Gentillin E, Bosseboeuf E, Kwan P, Fletcher R, Mehanna H, Boelaert K, Read M, Watkinson J, Smith V, McCabe C. 26. A novel modulator of cellular invasion and metastasis. Eur J Surg Oncol 2015. [DOI: 10.1016/j.ejso.2015.08.102] [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] Open
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27
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McCaul J, Sutton D, Shaw R, Mehanna H, Hislop S, McMahon J, Dunn J. LIHNCS (Lugol's Iodine in Head and Neck Cancer Surgery) a UK multicentre prospective randomised controlled trial. Report of primary and secondary outcome measures. Int J Oral Maxillofac Surg 2015. [DOI: 10.1016/j.ijom.2015.08.699] [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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28
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Mehanna H, Wong W, McConkey C, Rahman J, Robinson M, Hartley A, Nutting C, Powell N, Al-Booz H, Robinson M, Junor E, Hulme C, Smith A, Hall P, Dunn J. 11LBA Differences in the quality of life (QoL) and functional outcomes of treatment between HPV associated (HPV+) and HPV- patients receiving primary chemoradiotherapy in PET-NECK - a multi-centre randomized phase III controlled trial (RCT) comparing PETCT guided active surveillance with planned neck dissection (ND) for locally advanced (N2/N3) nodal metastases (LANM) in patients with head and neck squamous cell cancer (HNC) treated with primary radical chemoradiotherapy (CRT). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31936-0] [Citation(s) in RCA: 2] [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: 11/30/2022]
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29
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Young E, Diakos E, Khalid-Raja M, Mehanna H. Resection of subsequent pulmonary metastases from treated head and neck squamous cell carcinoma: systematic review and meta-analysis. Clin Otolaryngol 2015; 40:208-18. [DOI: 10.1111/coa.12348] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2014] [Indexed: 11/29/2022]
Affiliation(s)
- E.R. Young
- Institute of Head and Neck Studies and Education; School of Cancer Sciences; University of Birmingham; Birmingham UK
| | - E. Diakos
- Institute of Head and Neck Studies and Education; School of Cancer Sciences; University of Birmingham; Birmingham UK
| | - M. Khalid-Raja
- Institute of Head and Neck Studies and Education; School of Cancer Sciences; University of Birmingham; Birmingham UK
| | - H. Mehanna
- Institute of Head and Neck Studies and Education; School of Cancer Sciences; University of Birmingham; Birmingham UK
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Owadally W, Baines H, Evans M, Jones G, Henderson J, Miles E, Dunn J, Nutting C, Mehanna H, Palaniappan N. EP-1156 Dosimetric impact of anatomic and volumetric methods of target outlining on normal structures in a UK clinical trial. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41148-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: 11/26/2022]
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31
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Yang H, Baines H, Conibear J, Evans M, Hartley A, Henderson J, Nutting C, Roques T, Mehanna H. PO-0643: Volumetric versus anatomical outlining: target delineation conformity in a multi-centre head and neck trial. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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32
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Harrop V, Meade S, Wagstaff L, Babrah J, Gaunt P, Robinson M, Cashmore J, Mehanna H, Hartley A, Sanghera P. PO-088: Chemoradiotherapy for poor/intermediate risk oropharyngeal carcinoma: First results of the ArCHIMEDEs study. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34848-9] [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: 11/26/2022]
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33
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Mehanna H. SP-023: Lessons learned from running surgical clinical trials. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34783-6] [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: 11/17/2022]
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34
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Mehanna H, Robinson M, Powell N, Paleri V, Hartley A, Fresco L, Al-Booz H, Junor E, Roberts S, Harrington K. PD-034: Data from Pet Neck and GSK trials: Regional and geographic variability in HPV-associated oropharyngeal cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34794-0] [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: 11/29/2022]
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35
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Mehanna H. SP-0558: Challenges and pitfalls in treatment de-escalation in HPV oropharyngeal cancer patients. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30664-2] [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: 12/01/2022]
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36
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Smith VE, Read ML, Turnell AS, Sharma N, Lewy GD, Fong JCW, Seed RI, Kwan P, Ryan G, Mehanna H, Chan SY, Darras VM, Boelaert K, Franklyn JA, McCabe CJ. PTTG-binding factor (PBF) is a novel regulator of the thyroid hormone transporter MCT8. Endocrinology 2012; 153:3526-36. [PMID: 22535767 DOI: 10.1210/en.2011-2030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Within the basolateral membrane of thyroid follicular epithelial cells, two transporter proteins are central to thyroid hormone (TH) biosynthesis and secretion. The sodium iodide symporter (NIS) delivers iodide from the bloodstream into the thyroid, and after TH biosynthesis, monocarboxylate transporter 8 (MCT8) mediates TH secretion from the thyroid gland. Pituitary tumor-transforming gene-binding factor (PBF; PTTG1IP) is a protooncogene that is up-regulated in thyroid cancer and that binds NIS and modulates its subcellular localization and function. We now show that PBF binds MCT8 in vitro, eliciting a marked shift in MCT8 subcellular localization and resulting in a significant reduction in the amount of MCT8 at the plasma membrane as determined by cell surface biotinylation assays. Colocalization and interaction between PBF and Mct8 was also observed in vivo in a mouse model of thyroid-specific PBF overexpression driven by a bovine thyroglobulin (Tg) promoter (PBF-Tg). Thyroidal Mct8 mRNA and protein expression levels were similar to wild-type mice. Critically, however, PBF-Tg mice demonstrated significantly enhanced thyroidal TH accumulation and reduced TH secretion upon TSH stimulation. Importantly, Mct8-knockout mice share this phenotype. These data show that PBF binds and alters the subcellular localization of MCT8 in vitro, with PBF overexpression leading to an accumulation of TH within the thyroid in vivo. Overall, these studies identify PBF as the first protein to interact with the critical TH transporter MCT8 and modulate its function in vivo. Furthermore, alongside NIS repression, PBF may thus represent a new regulator of TH biosynthesis and secretion.
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Affiliation(s)
- V E Smith
- School of Clinical and Experimental Medicine, Institute for Biomedical Research, University of Birmingham, Birmingham, B15 2TT, United Kingdom
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Hartley A, Meade S, Benghiat H, Glaholm J, Cashmore J, Sanghera P, Mehanna H. PD-0402 SAVING DAYS NOT GRAYS: RADIOBIOLOGICAL MODELLING OF GAPS DURING SYNCHRONOUS CHEMORADIATION IN HEAD AND NECK CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70741-7] [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: 10/28/2022]
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Abstract
The publication of the NHS Cancer Plan by the Department of Health in September 2000 led to an increase in the number of urgent referral clinics as the guidelines stipulated that cancer patients should not wait more than two months from referral to initiation of treatment. 1 following the implementation of these guidelines for head and neck cancer (HNC) referrals in December 2000, the National Institute for Health and Clinical Excellence (NICE) released an update as part of Clinical Guidance 27 in 2005 2 outlining eight key symptoms that should prompt urgent referral to secondary care.
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Affiliation(s)
- R Kumar
- SpR in Otolaryngology, Newcastle upon Tyne Hospitals NHS Foundation Trust
| | - M Drinnan
- Clinical Scientist, Newcastle upon Tyne Hospitals NHS Foundation Trust
| | - H Mehanna
- Consultant Head, Neck and Thyroid Surgeon, University Hospitals of Coventry and warwickshire
| | - V Paleri
- Consultant Head, Neck and Thyroid Surgeon, Newcastle upon Tyne Hospitals NHS Foundation Trust
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Diakos E, Gallos I, El-Shunnar S, Clarke M, Kazi R, Mehanna H. Dexamethasone reduces pain, vomiting and overall complications following tonsillectomy in adults: a systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol 2011; 36:531-42. [DOI: 10.1111/j.1749-4486.2011.02373.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [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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40
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Affiliation(s)
- H Mehanna
- Institute of Head and Neck Studies, And Education, University Hospitals Covertry, Coventry, UK.
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41
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Pettit L, Hartley A, Bowden SJ, Mehanna H, Glaholm J, Cashmore J, Sanghera P. Variation in volume definition between UK head and neck oncologists treating oropharyngeal carcinoma. Clin Oncol (R Coll Radiol) 2011; 23:654-5. [PMID: 21820293 DOI: 10.1016/j.clon.2011.07.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 07/18/2011] [Indexed: 11/16/2022]
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43
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Thomas L, Natesh B, Jones T, Mehanna H, Homer J, Paleri V. Open Conservation Laryngectomy in Newly Diagnosed Laryngeal Cancer? A Systematic Review of English Literature. Clin Oncol (R Coll Radiol) 2010. [DOI: 10.1016/j.clon.2010.08.013] [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: 10/18/2022]
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Thomas L, Paleri V, Natesh B, Jones T, Homer J, Mehanna H. Partial (Open Conservation) Laryngectomy for Radiorecurrent Tumours: a Systematic Review of English Literature. Clin Oncol (R Coll Radiol) 2010. [DOI: 10.1016/j.clon.2010.08.015] [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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46
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Gilbert E, Adams A, Mehanna H, Harrison B, Hartshorne GM. Who should be offered sperm banking for fertility preservation? A survey of UK oncologists and haematologists. Ann Oncol 2010; 22:1209-1214. [PMID: 21030380 DOI: 10.1093/annonc/mdq579] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Fertility after cancer therapy is a significant quality-of-life concern for many patients, their partners and families. Authoritative guidance states that men whose fertility may be affected by impending therapies should be offered sperm banking. Yet some patients are not offered this opportunity and are thereby disadvantaged. We sought to understand oncologists' and haematologists' decision making concerning sperm-banking referrals. DESIGN We surveyed all oncologists and haematologists on the Royal College of Radiotherapists' Faculty of Oncology and British Society for Haematology circulation lists. RESULTS From 2357 across all specialties, 499 responses were received: 253 haematologists and 246 oncologists (21% response rate). Twenty-one percent of respondents were unaware of local policies on sperm banking and 42% considered that sperm banking should be offered to more patients. Respondents' decisions reveal either assumptions about patients' needs based on characteristics such as age, sexual orientation and severity of illness or the influence of their own moral conclusions upon their patients. The survey identified paucity of training for clinicians, information for patients and systematic recording of discussions about fertility. CONCLUSIONS A robust care infrastructure supporting male fertility storage is needed urgently to include targeted information for cancer clinicians and patients, identified individuals responsible for coordination and documentation of discussions with patients.
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Affiliation(s)
- E Gilbert
- Warwick Medical School, University of Warwick
| | - A Adams
- Warwick Medical School, University of Warwick
| | - H Mehanna
- Warwick Medical School, University of Warwick; Institute of Head and Neck Studies and Education
| | | | - G M Hartshorne
- Warwick Medical School, University of Warwick; Centre for Reproductive Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
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Affiliation(s)
- H Mehanna
- Institute of Head and Neck Studies and Education, University Hospitals Coventry, Coventry CV2 2DX.
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Chan AK, Sanghera P, Choo BA, McConkey C, Mehanna H, Parmar S, Pracy P, Glaholm J, Hartley A. Hypofractionated accelerated radiotherapy with concurrent carboplatin for locally advanced squamous cell carcinoma of the head and neck. Clin Oncol (R Coll Radiol) 2010; 23:34-9. [PMID: 20863676 DOI: 10.1016/j.clon.2010.07.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 05/24/2010] [Accepted: 05/27/2010] [Indexed: 11/13/2022]
Abstract
AIMS Hypofractionated accelerated radiotherapy with concurrent carboplatin utilises both advantages of altered fractionation and synchronous chemotherapy to maximise local control in locally advanced head and neck cancer. Such fractionation schedules are increasingly used in the intensity-modulated radiotherapy era and the aim of this study was to determine the outcome of hypofractionated accelerated radiotherapy with carboplatin. MATERIALS AND METHODS One hundred and fifty consecutive patients with squamous cell carcinoma of the larynx, oropharynx, oral cavity and hypopharynx (International Union Against Cancer [IUAC] stage II-IV) treated with 55Gy in 20 fractions over 25 days with concurrent carboplatin were analysed. Outcome measures were 2 year overall survival, local control and disease-free survival. RESULTS The median follow-up in surviving patients was 25 months. IUAC stages: II n=15; III n=42; IV n=93. Two year overall survival for all patients was 74.9% (95% confidence interval 66.0-81.7%). Two year local control was 78.3% (95% confidence interval 69.6-84.8%). Two year disease-free survival was 67.2% (95% confidence interval 58.3-74.7%). There were 135 patients with stage III and IV disease. For these patients, the 2 year overall survival, local control and disease-free survival were 74.3% (95% confidence interval 64.7-81.6%), 79.1% (95% confidence interval 69.8-85.9%) and 67.6% (95% confidence interval 58.0-75.4%), respectively. Prolonged grade 3 and 4 mucositis seen at ≥4 weeks were present in 9 and 0.7%, respectively. Late feeding dysfunction (determined by dependence on a feeding tube at 1 year) was seen in 13% of the surviving patients at 1 year. CONCLUSION Hypofractionated accelerated radiotherapy with concurrent carboplatin achieves a high local control. This regimen should be considered for a radiotherapy dose-escalation study using intensity-modulated radiotherapy.
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Affiliation(s)
- A K Chan
- Hall-Edwards Radiotherapy Research Group, The Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK.
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49
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Affiliation(s)
- H Mehanna
- Institute of Head and Neck Studies and Education, University Hospitals Coventry, Coventry CV2 2DX.
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50
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Mehanna H, Paleri V, Robson A, Wight R, Helliwell T. Consensus statement by otorhinolaryngologists and pathologists on the diagnosis and management of laryngeal dysplasia. Clin Otolaryngol 2010; 35:170-6. [DOI: 10.1111/j.1749-4486.2010.02119.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [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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