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Tobias J, Garner-Spitzer E, Drinić M, Wiedermann U. Vaccination against Her-2/neu, with focus on peptide-based vaccines. ESMO Open 2022; 7:100361. [PMID: 35026721 PMCID: PMC8760406 DOI: 10.1016/j.esmoop.2021.100361] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 11/03/2021] [Revised: 11/29/2021] [Accepted: 11/29/2021] [Indexed: 12/11/2022] Open
Abstract
Immunotherapy has been a milestone in combatting cancer, by complementing or even replacing classic treatments like surgery, chemotherapy, radiation, and anti-hormonal therapy. In 15%-30% of breast cancers, overexpression of the human epidermal growth factor receptor 2 (Her-2/neu) is associated with more aggressive tumor development. Passive immunization/immunotherapy with the recombinantly produced Her-2/neu-targeting monoclonal antibodies (mAbs) pertuzumab and trastuzumab has been shown to effectively treat breast cancer and lead to a significantly better prognosis. However, allergic and hypersensitivity reactions, cardiotoxicity, development of resistance, lack of immunological memory which results in continuous application over a long period, and cost-intensiveness are among the drawbacks associated with this treatment. Furthermore, intrinsic or acquired resistance is associated with the application of therapeutic mAbs, leading to the disease recurrence. Conversely, these drawbacks could be potentially overcome by vaccination, i.e. an active immunization/immunotherapy approach by activating the patient’s own immune system to target cancer, along with inducing immunological memory. This review aims to summarize the main approaches investigated and undertaken for the production of Her-2/neu vaccine candidates, with the main focus on peptide-based vaccines and their evaluation in clinical settings. Her-2/neu is overexpressed in 10%-30% of breast and gastric cancer patients and this correlates with poor clinical outcomes. Passive application of trastuzumab and pertuzumab has outstandingly improved the Her-2/neu-related clinical outcomes. Treatment with mAbs is associated with frequent administration, cost-intensiveness, and resistance. Vaccination against Her-2/neu with e.g. mimotope- or peptide-based vaccines can alternatively overcome the mAbs’ drawbacks. Such alternatives may pave the way to therapeutics which could be used as monotherapy or in combination therapies with mAbs.
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Affiliation(s)
- J Tobias
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
| | - E Garner-Spitzer
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - M Drinić
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - U Wiedermann
- Institute of Specific Prophylaxis and Tropical Medicine, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.
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Heydinger G, Tobias J, Veneziano G. Fundamentals and innovations in regional anaesthesia for infants and children. Anaesthesia 2021; 76 Suppl 1:74-88. [PMID: 33426659 DOI: 10.1111/anae.15283] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 12/18/2022]
Abstract
Regional anaesthesia in children has evolved rapidly in the last decade. Although it previously consisted of primarily neuraxial techniques, the practice now incorporates advanced peripheral nerve blocks, which were only recently described in adults. These novel blocks provide new avenues for providing opioid-sparing analgesia while minimising invasiveness, and perhaps risk, associated with older techniques. At the same time, established methods, such as infant spinal anaesthesia, under-utilised in the last 20 years, are experiencing a revival. The impetus has been the concern regarding the potential long-term neurocognitive effects of general anaesthesia in the young child. These techniques have expanded from single shot spinal anaesthesia to combined spinal/epidural techniques, which can now effectively provide surgical anaesthesia for procedures below the umbilicus for a prolonged period of time, thereby avoiding the need for general anaesthesia. Continuous 2-chloroprocaine infusions, previously only described for intra-operative regional anaesthesia, have gained popularity as a means of providing prolonged postoperative analgesia in epidural and continuous nerve block techniques. The rapid, liver-independent metabolism of 2-chloroprocaine makes it ideal for prolonged local anaesthetic infusions in neonates and small infants, obviating the increased risk of local anaesthetic systemic toxicity that occurs with amide local anaesthetics. Debate continues over certain practices in paediatric regional anaesthesia. While the rarity of complications makes comparative analyses difficult, data from large prospective registries indicate that providing regional anaesthesia to children while under general anaesthesia appears to be at least as safe as in the sedated or awake patient. In addition, the estimated frequency of serious adverse events demonstrates that regional blocks in children under general anaesthesia are no less safe than in awake adults. In infants, the techniques of direct thoracic epidural placement or caudal placement with cephalad threading each have distinct advantages and disadvantages. As the data cannot support the safety of one technique over the other, the site of epidural insertion remains largely a matter of anaesthetist discretion.
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Affiliation(s)
- G Heydinger
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - J Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - G Veneziano
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
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Tobias J, Battin C, De Linhares AS, Lebens M, Baier K, Ambroz K, Högler S, Inic-Kanada A, Garner-Spitzer E, Preusser M, Kenner L, Kundi M, Zielinski C, Steinberger P, Wiedermann U. Active immunization with immune checkpoint inhibitors-mimotope elicits strong anti-tumour effect against HER-2/neu-expressing tumours. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz253.006] [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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Zakeri K, Rotolo F, Lacas B, Vitzthum L, Le QT, Gregoire V, Overgaard J, Tobias J, Zackrisson B, Parmar M, Burtness B, Ghi M, Sanguineti G, O'Sullivan B, Fortpied C, Bourhis J, Shen H, Harris J, Pignon JP, Mell L. Predictor of effectiveness of treatment intensification on overall survival in head and neck cancer (HNC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy287.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Morrison A, Tumin D, Hayes D, Phelps C, Tobias J, Gajarski R, Nandi D. Pediatric Marginal Donor Hearts: National Use and Center-Specific Variability. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.190] [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] Open
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Schaufler C, Lasky J, Lim B, Suzuki Y, Mallem D, Oyster M, Lederer D, Meyer K, Bermudez C, Tobias J, Van Deerlin V, Olthoff K, Shaked A, Diamond J, Cantu E, Christie J. Gene Set Enrichment Analysis Identifies a Potential Link Between Smoking and Upregulation of Olfactory Receptor and Cytokine Enrichment Pathways. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Petit C, Pignon J, Landais C, Trotti A, Gregoire V, Overgaard J, Tobias J, Zackrisson B, Parmar M, Lee J, Ghi M, Corvo R, Janot F, O'Sullivan B, Horiuchi M, Zhang Q, Fortpied C, Grau C, Bourhis J, Blanchard P. What is the most effective treatment for head and neck squamous cell carcinoma? An individual patient data network meta-analysis from the MACH-NC and MARCH collaborative groups. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30415-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Blanchard P, Landais C, Petit C, Zhang Q, Grégoire V, Tobias J, Burtness B, Ghi M, Janot F, Overgaard J, Wolf G, Lewin F, Hitt R, Corvo R, Budach V, Trotti A, Fortpied C, Hackshaw A, Bourhis J, Pignon JP. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 100 randomized trials and 19,248 patients, on behalf of MACH-NC group. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw376.02] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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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Al-Sari UA, Tobias J, Clark E. Health-related quality of life in older people with osteoporotic vertebral fractures: a systematic review and meta-analysis. Osteoporos Int 2016; 27:2891-900. [PMID: 27262840 DOI: 10.1007/s00198-016-3648-x] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/20/2016] [Indexed: 11/30/2022]
Abstract
Health-related quality of life in osteoporotic patients with vertebral fracture is of increasing interest, but relevant studies have yielded debatable results. This systematic review and meta-analysis of 16 observational studies demonstrate a clear association between physical health status and presence of vertebral fracture after accounting for age. This meta-analysis was conducted to identify if there are any differences between physical and/or mental health-related quality of life (HRQoL) in older people with osteoporosis based on conventional T-score definitions and the presence or absence of vertebral fracture. A comprehensive search was undertaken using the databases of PubMed, Embase, Medline, Web of Science, and the "grey" literature from 1950 to the end of April 2015. Search terms for vertebral fracture (VF) included VF, osteoporotic fracture, fragility fracture, and spinal fracture. Quality of life was searched using the following terms: quality of life, health-related quality of life, HRQoL, and QoL. Strict inclusion and exclusion criteria were used. The standardized mean difference (SMD) was calculated for each HRQoL domain by the difference in means between case and control groups divided by the pooled SD of participants. Sixteen eligible studies were identified involving 3131 men and women. There was evidence of publication bias and heterogeneity. The meta-analysis showed worse physical (SMD = 0.53, 95 % confidence interval (CI) 0.38 to 0.68; P < 0.001) and mental (SMD = 0.19, 95 % CI 0.05 to 0.33; P = 0.009) HRQoL in osteoporotic older people with vertebral fracture compared to those without fracture. Similar differences were observed for physical HRQoL in further analyses accounting for possible confounding effects of age. Sub-analysis to assess associations between number/severity of fractures and time since fracture was not possible due to small numbers of studies that accounted for age. Osteoporotic older people with vertebral fracture have worse physical HRQoL than osteoporotic older people without vertebral fracture, even after accounting for age differences.
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Affiliation(s)
- U A Al-Sari
- Academic Rheumatology, Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - J Tobias
- Academic Rheumatology, Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK
| | - E Clark
- Academic Rheumatology, Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, Southmead Hospital, Westbury-on-Trym, Bristol, BS10 5NB, UK.
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Souhami RL, Earl HM, Ash CM, Spiro SG, Geddes D, Harper PG, Tobias JS. Prognostic factors in patients with small-cell lung cancer: preliminary results from a large randomised study. Antibiot Chemother (1971) 2015; 41:77-82. [PMID: 2854449 DOI: 10.1159/000416185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R L Souhami
- Department of Clinical Oncology, University College and Middlesex School of Medicine, Faculty of Clinical Sciences, London, England
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Souhami RL, Ash CM, Earl HM, Harper PG, Geddes D, Tobias JS, Spiro SG. Intensive chemotherapy and thoracic irradiation as induction treatment in limited-stage small-cell lung cancer. Antibiot Chemother (1971) 2015; 41:155-62. [PMID: 2854435 DOI: 10.1159/000416197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R L Souhami
- Department of Clinical Oncology, University College and Middlesex School of Medicine, Faculty of Clinical Sciences, London, England
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Souhami RL, Morittu L, Ash CM, Earl H, Geddes D, Harper PG, Tobias JS, Spiro SG. Identification of patients at high risk of chemotherapy-induced toxicity in small-cell lung cancer. Antibiot Chemother (1971) 2015; 41:220-5. [PMID: 2854443 DOI: 10.1159/000416208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- R L Souhami
- Department of Clinical Oncology, University College and Middlesex School of Medicine, Faculty of Clinical Sciences, London, England
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Diamond J, Cantu E, Lederer D, Tobias J, Arcasoy S, Olthoff K, Chang B, Feng R, Meyer K, Emond J, Shaked A, Christie J. PGD Is Associated With Persistent Differential Gene Expression After Lung Transplantation. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.464] [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] Open
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Pitman JP, Wilkinson R, Basavaraju SV, von Finckenstein B, Sibinga CS, Marfin AA, Postma MJ, Mataranyika M, Tobias J, Lowrance DW. Investments in blood safety improve the availability of blood to underserved areas in a sub-Saharan African country. ACTA ACUST UNITED AC 2014; 9:325-333. [PMID: 26478742 DOI: 10.1111/voxs.12107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Since 2004, several African countries, including Namibia, have received assistance from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). Gains have been documented in the safety and number of collected units in these countries, but the distribution of blood has not been described. MATERIALS AND METHODS Nine years of data on blood requests and issues from Namibia were stratified by region to describe temporal and spatial changes in the number and type of blood components issued to Namibian healthcare facilities nationally. RESULTS Between 2004 and 2007 (early years of PEPFAR support) and 2008-2011 (peak years of PEPFAR support), the average number of red cell units issued annually increased by 23.5% in seven densely populated but less-developed regions in northern Namibia; by 30% in two regions with urban centres; and by 35.1% in four sparsely populated rural regions. CONCLUSION Investments in blood safety and a policy decision to emphasize distribution of blood to underserved regions improved blood availability in remote rural areas and increased the proportion of units distributed as components. However, disparities persist in the distribution of blood between Namibia's urban and rural regions.
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Affiliation(s)
- J P Pitman
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - R Wilkinson
- The Blood Transfusion Service of Namibia, Windhoek, Namibia
| | - S V Basavaraju
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | - A A Marfin
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - M J Postma
- Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy, University of Groningen, Groningen, Netherlands ; Institute of Science in Healthy Aging & health caRE (SHARE), University Medical Center Groningen (UMCG), Groningen, Netherlands
| | - M Mataranyika
- Directorate for Clinical Support Services, Ministry of Health and Social Services, Windhoek, Namibia
| | - J Tobias
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - D W Lowrance
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Vaidya J, Wenz F, Bulsara M, Massarut S, Tobias J, Williams N, Joseph D, Baum M. Omitting Whole Breast Radiation Therapy did not Increase Axillary Recurrence in the TARGIT-A Trial. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.025] [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: 10/26/2022]
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Vaidya J, Bulsara M, Wenz F, Massarut S, Joseph D, Tobias J, Williams N, Baum M. The Lower Non-Breast Cancer Mortality With TARGIT in the TARGIT-A Trial Could Be a Systemic Effect of TARGIT on Tumor Microenvironment. Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.623] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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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Cornell P, Trehane A, Thompson P, Rahmeh F, Greenwood M, Baqai TJ, Cambridge S, Shaikh M, Rooney M, Donnelly S, Tahir H, Ryan S, Kamath S, Hassell A, McCuish WJ, Bearne L, Mackenzie-Green B, Price E, Williamson L, Collins D, Tang E, Hayes J, McLoughlin YM, Chamberlain V, Campbell S, Shah P, McKenna F, Cornell P, Westlake S, Thompson P, Richards S, Homer D, Gould E, Empson B, Kemp P, Richards AG, Walker J, Taylor S, Bari SF, Alachkar M, Rajak R, Lawson T, O'Sullivan M, Samant S, Butt S, Gadsby K, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Edwards KR, Rowe I, Sanders T, Dunn K, Konstantinou K, Hay E, Jones LE, Adams J, White P, Donovan-Hall M, Hislop K, Barbosa Boucas S, Nichols VP, Williamson EM, Toye F, Lamb SE, Rodham K, Gavin J, Watts L, Coulson N, Diver C, Avis M, Gupta A, Ryan SJ, Stangroom S, Pearce JM, Byrne J, Manning VL, Hurley M, Scott DL, Choy E, Bearne L, Taylor J, Morris M, Dures E, Hewlett S, Wilson A, Adams J, Larkin L, Kennedy N, Gallagher S, Fraser AD, Shrestha P, Batley M, Koduri G, Scott DL, Flurey CA, Morris M, Hughes R, Pollock J, Richards P, Hewlett S, Kumar K, Raza K, Nightingale P, Horne R, Chapman S, Greenfield S, Gill P, Ferguson AM, Ibrahim F, Scott DL, Lempp H, Tierney M, Fraser A, Kennedy N, Barbosa Boucas S, Hislop K, Dziedzic K, Arden N, Burridge J, Hammond A, Stokes M, Lewis M, Gooberman-Hill R, Coales K, Adams J, Nutland H, Dean A, Laxminarayan R, Gates L, Bowen C, Arden N, Hermsen L, Terwee CB, Leone SS, vd Zwaard B, Smalbrugge M, Dekker J, vd Horst H, Wilkie R, Ferguson AM, Nicky Thomas V, Lempp H, Cope A, Scott DL, Simpson C, Weinman J, Agarwal S, Kirkham B, Patel A, Ibrahim F, Barn R, Brandon M, Rafferty D, Sturrock R, Turner D, Woodburn J, Rafferty D, Paul L, Marshall R, Gill J, McInnes I, Roderick Porter D, Woodburn J, Hennessy K, Woodburn J, Steultjens M, Siddle HJ, Hodgson RJ, Hensor EM, Grainger AJ, Redmond A, Wakefield RJ, Helliwell PS, Hammond A, Rayner J, Law RJ, Breslin A, Kraus A, Maddison P, Thom JM, Newcombe LW, Woodburn J, Porter D, Saunders S, McCarey D, Gupta M, Turner D, McGavin L, Freeburn R, Crilly A, Lockhart JC, Ferrell WR, Goodyear C, Ledingham J, Waterman T, Berkin L, Nicolaou M, Watson P, Lillicrap M, Birrell F, Mooney J, Merkel PA, Poland F, Spalding N, Grayson P, Leduc R, Shereff D, Richesson R, Watts RA, Roussou E, Thapper M, Bateman J, Allen M, Kidd J, Parsons N, Davies D, Watt KA, Scally MD, Bosworth A, Wilkinson K, Collins S, Jacklin CB, Ball SK, Grosart R, Marks J, Litwic AE, Sriranganathan MK, Mukherjee S, Khurshid MA, Matthews SM, Hall A, Sheeran T, Baskar S, Muether M, Mackenzie-Green B, Hetherington A, Wickrematilake G, Williamson L, Daniels LE, Gwynne CE, Khan A, Lawson T, Clunie G, Stephenson S, Gaffney K, Belsey J, Harvey NC, Clarke-Harris R, Murray R, Costello P, Garrett E, Holbrook J, Teh AL, Wong J, Dogra S, Barton S, Davies L, Inskip H, Hanson M, Gluckman P, Cooper C, Godfrey K, Lillycrop K, Anderton T, Clarke S, Rao Chaganti S, Viner N, Seymour R, Edwards MH, Parsons C, Ward K, Thompson J, Prentice A, Dennison E, Cooper C, Clark E, Cumming M, Morrison L, Gould VC, Tobias J, Holroyd CR, Winder N, Osmond C, Fall C, Barker D, Ring S, Lawlor D, Tobias J, Davey Smith G, Cooper C, Harvey NC, Toms TE, Afreedi S, Salt K, Roskell S, Passey K, Price T, Venkatachalam S, Sheeran T, Davies R, Southwood TR, Kearsley-Fleet L, Hyrich KL, Kingsbury D, Quartier P, Patel G, Arora V, Kupper H, Mozaffarian N, Kearsley-Fleet L, Baildam E, Beresford MW, Davies R, Foster HE, Mowbray K, Southwood TR, Thomson W, Hyrich KL, Saunders E, Baildam E, Chieng A, Davidson J, Foster H, Gardner-Medwin J, Wedderburn L, Thomson W, Hyrich K, McErlane F, Beresford M, Baildam E, Chieng SE, Davidson J, Foster HE, Gardner-Medwin J, Lunt M, Wedderburn L, Thomson W, Hyrich K, Rooney M, Finnegan S, Gibson DS, Borg FA, Bale PJ, Armon K, Cavelle A, Foster HE, McDonagh J, Bale PJ, Armon K, Wu Q, Pesenacker AM, Stansfield A, King D, Barge D, Abinun M, Foster HE, Wedderburn L, Stanley K, Morrissey D, Parsons S, Kuttikat A, Shenker N, Garrood T, Medley S, Ferguson AM, Keeling D, Duffort P, Irving K, Goulston L, Culliford D, Coakley P, Taylor P, Hart D, Spector T, Hakim A, Arden N, Mian A, Garrood T, Magan T, Chaudhary M, Lazic S, Sofat N, Thomas MJ, Moore A, Roddy E, Peat G, Rees F, Lanyon P, Jordan N, Chaib A, Sangle S, Tungekar F, Sabharwal T, Abbs I, Khamashta M, D'Cruz D, Dzifa Dey I, Isenberg DA, Chin CW, Cheung C, Ng M, Gao F, Qiong Huang F, Thao Le T, Yong Fong K, San Tan R, Yin Wong T, Julian T, Parker B, Al-Husain A, Yvonne Alexander M, Bruce I, Jordan N, Abbs I, D'cruz D, McDonald G, Miguel L, Hall C, Isenberg DA, Magee A, Butters T, Jury E, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Yee CS, Toescu V, Hickman R, Leung MH, Situnayake D, Bowman S, Gordon C, Lazarus MN, Isenberg DA, Ehrenstein M, Carter LM, Isenberg DA, Ehrenstein MR, Chanchlani N, Gayed M, Yee CS, Gordon C, Ball E, Rooney M, Bell A, Reynolds JA, Ray DW, O'Neill T, Alexander Y, Bruce I, Sutton EJ, Watson KD, Isenberg D, Rahman A, Gordon C, Yee CS, Lanyon P, Jayne D, Akil M, D'Cruz D, Khamashta M, Lutalo P, Erb N, Prabu A, Edwards CJ, Youssef H, McHugh N, Vital E, Amft N, Griffiths B, Teh LS, Zoma A, Bruce I, Durrani M, Jordan N, Sangle S, D'Cruz D, Pericleous C, Ruiz-Limon P, Romay-Penabad Z, Carrera-Marin A, Garza-Garcia A, Murfitt L, Driscoll PC, Giles IP, Ioannou Y, Rahman A, Pierangeli SS, Ripoll VM, Lambrianides A, Heywood WE, Ioannou J, Giles IP, Rahman A, Stevens C, Dures E, Morris M, Knowles S, Hewlett S, Marshall R, Reddy V, Croca S, Gerona D, De La Torre Ortega I, Isenberg DA, Leandro M, Cambridge G, Reddy V, Cambridge G, Isenberg DA, Glennie M, Cragg M, Leandro M, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Croca SC, Isenberg DA, Giles I, Ioannou Y, Rahman A, Artim Esen B, Pericleous C, MacKie I, Ioannou Y, Rahman A, Isenberg DA, Giles I, Skeoch S, Haque S, Pemberton P, Bruce I. BHPR: Audit and Clinical Evaluation * 103. Dental Health in Children and Young Adults with Inflammatory Arthritis: Access to Dental Care. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket196] [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: 11/12/2022] Open
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Clark KE, Tam FWK, Unwin R, Khan K, Abraham DJ, Denton C, Stratton RJ, Nihtyanova S, Schreiber B, Ong V, Denton CP, Seng Edwin Lim C, Dasgupta B, Corsiero E, Sutcliffe N, Wardemann H, Pitzalis C, Bombardieri M, Tahir H, Donnelly S, Greenwood M, Smith TO, Easton V, Bacon H, Jerman E, Armon K, Poland F, Macgregor A, van der Heijde D, Sieper J, Elewaut D, Pangan AL, Nguyen D, Badenhorst C, Kirby S, White D, Harrison A, Garcia JA, Stebbings S, MacKay JW, Aboelmagd S, Gaffney K, van der Heijde D, Deodhar A, Braun J, Mack M, Hsu B, Gathany T, Han C, Inman RD, Cooper-Moss N, Packham J, Strauss V, Freeston JE, Coates L, Nam J, Moverley AR, Helliwell P, Hensor E, Wakefield R, Emery P, Conaghan P, Mease P, Fleischmann R, Wollenhaupt J, Deodhar A, Kielar D, Woltering F, Stach C, Hoepken B, Arledge T, van der Heijde D, Gladman D, Fleischmann R, Coteur G, Woltering F, Mease P, Kavanaugh A, Gladman D, van der Heijde D, Purcaru O, Mease P, McInnes I, Kavanaugh A, Gottlieb AB, Puig L, Rahman P, 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Kumar V, Reid DM, Macfarlane GJ, Jones G, Yates M, Watts RA, Igali L, Mukhtyar C, Macgregor A, Robson J, Doll H, Yew S, Flossmann O, Suppiah R, Harper L, Hoglund P, Jayne D, Mukhtyar C, Westman K, Luqmani R, Win Maw W, Patil P, Williams M, Adizie T, Christidis D, Borg F, Dasgupta B, Robertson A, Croft AP, Smith S, Carr S, Youssouf S, Salama A, Pusey C, Harper L, Morgan M. Basic Science * 208. Stem Cell Factor Expression is Increased in the Skin of Patients with Systemic Sclerosis and Promotes Proliferation and Migration of Fibroblasts in vitro. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket195] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Tobias J, Deere K, Palmer S, Clark E, Clinch J, Fikree A, Aktar R, Wellstead G, Knowles C, Grahame R, Aziz Q, Amaral B, Murphy G, Ioannou Y, Isenberg DA, Tansley SL, Betteridge ZE, Gunawardena H, Shaddick G, Varsani H, Wedderburn L, McHugh N, De Benedetti F, Ruperto N, Espada G, Gerloni V, Flato B, Horneff G, Myones BL, Onel K, Frane J, Kenwright A, Lipman TH, Bharucha KN, Martini A, Lovell DJ, Baildam E, Ruperto N, Brunner H, Zuber Z, Keane C, Harari O, Kenwright A, Cuttica RJ, Keltsev V, Xavier R, Penades IC, Nikishina I, Rubio-Perez N, Alekseeva E, Chasnyk V, Chavez J, Horneff G, Opoka-Winiarska V, Quartier P, Silva CA, Silverman ED, Spindler A, Lovell DJ, Martini A, De Benedetti F, Hendry GJ, Watt GF, Brandon M, Friel L, Turner D, Lorgelly PK, Gardner-Medwin J, Sturrock RD, Woodburn J, Firth J, Waxman R, Law G, Siddle H, Nelson AE, Helliwell P, Otter S, Butters V, Loughrey L, Alcacer-Pitarch B, Tranter J, Davies S, Hryniw R, Lewis S, Baker L, Dures E, Hewlett S, Ambler N, Clarke J, Gooberman-Hill R, Jenkins R, Wilkie R, Bucknall M, Jordan K, McBeth J, Norton S, Walsh D, Kiely P, Williams R, Young A, Harkess JE, McAlarey K, Chesterton L, van der Windt DA, Sim J, Lewis M, Mallen CD, Mason E, Hay E, Clarson LE, Hider SL, Belcher J, Heneghan C, Roddy E, Mallen CD, Gibson J, Whiteford S, Williamson E, Beatty S, Hamilton-Dyer N, Healey EL, Ryan S, McHugh GA, Main CJ, Porcheret M, Nio Ong B, Pushpa-Rajah A, Dziedzic KS, MacRae CS, Shortland A, Lewis J, Morrissey M, Critchley D, Muller S, Mallen CD, Belcher J, Helliwell T, Hider SL, Cole Z, Parsons C, Crozier S, Robinson S, Taylor P, Inskip H, Godfrey K, Dennison E, Harvey NC, Cooper C, Prieto Alhambra D, Lalmohamed A, Abrahamsen B, Arden N, de Boer A, Vestergaard P, de Vries F, Kendal A, Carr A, Prieto-Alhambra D, Judge A, Cooper C, Chapurlat R, Bellamy N, Czerwinski E, Pierre Devogelaer J, March L, Pavelka K, Reginster JY, Kiran A, Judge A, Javaid MK, Arden N, Cooper C, Sundy JS, Baraf HS, Becker M, Treadwell EL, Yood R, Ottery FD. Oral Abstracts 3: Adolescent and Young Adult * O13. Hypermobility is a Risk Factor for Musculoskeletal Pain in Adolescence: Findings From a Prospective Cohort Study. Rheumatology (Oxford) 2013. [DOI: 10.1093/rheumatology/ket200] [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: 11/13/2022] Open
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Tobias J, Vaidya J. OC-0236: The TARGIT-A trial of intra-operative radiotherapy for breast cancer: Updated recurrence and survival. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32542-1] [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: 10/23/2022]
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Lundgren A, Leach S, Tobias J, Carlin N, Gustafsson B, Jertborn M, Bourgeois L, Walker R, Holmgren J, Svennerholm AM. Clinical trial to evaluate safety and immunogenicity of an oral inactivated enterotoxigenic Escherichia coli prototype vaccine containing CFA/I overexpressing bacteria and recombinantly produced LTB/CTB hybrid protein. Vaccine 2013; 31:1163-70. [DOI: 10.1016/j.vaccine.2012.12.063] [Citation(s) in RCA: 40] [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] [Received: 10/02/2012] [Revised: 12/18/2012] [Accepted: 12/26/2012] [Indexed: 11/30/2022]
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Aad G, Abbott B, Abdallah J, Abdelalim AA, Abdesselam A, Abdinov O, Abi B, Abolins M, Abramowicz H, Abreu H, Acerbi E, Acharya BS, Adams DL, Addy TN, Adelman J, Aderholz M, Adomeit S, Adragna P, Adye T, Aefsky S, Aguilar-Saavedra JA, Aharrouche M, Ahlen SP, Ahles F, Ahmad A, Ahsan M, Aielli G, Akdogan T, Akesson TPA, Akimoto G, Akimov AV, Akiyama A, Alam MS, Alam MA, Albert J, Albrand S, Aleksa M, Aleksandrov IN, Alessandria F, Alexa C, Alexander G, Alexandre G, Alexopoulos T, Alhroob M, Aliev M, Alimonti G, Alison J, Aliyev M, Allport PP, Allwood-Spiers SE, Almond J, Aloisio A, Alon R, Alonso A, Alvarez Gonzalez B, Alviggi MG, Amako K, Amaral P, Amelung C, Ammosov VV, Amorim A, Amorós G, Amram N, Anastopoulos C, Ancu LS, Andari N, Andeen T, Anders CF, Anders G, Anderson KJ, Andreazza A, Andrei V, Andrieux ML, Anduaga XS, Angerami A, Anghinolfi F, Anjos N, Annovi A, Antonaki A, Antonelli M, Antonov A, Antos J, Anulli F, Aoun S, Aperio Bella L, Apolle R, Arabidze G, Aracena I, Arai Y, 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Beauchemin PH, Beccherle R, Bechtle P, Beck HP, Becker S, Beckingham M, Becks KH, Beddall AJ, Beddall A, Bedikian S, Bednyakov VA, Bee CP, Begel M, Behar Harpaz S, Behera PK, Beimforde M, Belanger-Champagne C, Bell PJ, Bell WH, Bella G, Bellagamba L, Bellina F, Bellomo M, Belloni A, Beloborodova O, Belotskiy K, Beltramello O, Ben Ami S, Benary O, Benchekroun D, Benchouk C, Bendel M, Benekos N, Benhammou Y, Benjamin DP, Benoit M, Bensinger JR, Benslama K, Bentvelsen S, Berge D, Bergeaas Kuutmann E, Berger N, Berghaus F, Berglund E, Beringer J, Bernat P, Bernhard R, Bernius C, Berry T, Bertin A, Bertinelli F, Bertolucci F, Besana MI, Besson N, Bethke S, Bhimji W, Bianchi RM, Bianco M, Biebel O, Bieniek SP, Bierwagen K, Biesiada J, Biglietti M, Bilokon H, Bindi M, Binet S, Bingul A, Bini C, Biscarat C, Bitenc U, Black KM, Blair RE, Blanchard JB, Blanchot G, Blazek T, Blocker C, Blocki J, Blondel A, Blum W, Blumenschein U, Bobbink GJ, Bobrovnikov VB, Bocchetta SS, Bocci A, Boddy CR, 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Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhuravlov V, Zieminska D, Zimmermann R, Zimmermann S, Zimmermann S, Ziolkowski M, Zitoun R, Zivković L, Zmouchko VV, Zobernig G, Zoccoli A, Zolnierowski Y, Zsenei A, Zur Nedden M, Zutshi V, Zwalinski L. Measurement of the ZZ production cross section and limits on anomalous neutral triple gauge couplings in proton-proton collisions at sqrt[s] = 7 TeV with the ATLAS detector. Phys Rev Lett 2012; 108:041804. [PMID: 22400826 DOI: 10.1103/physrevlett.108.041804] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Indexed: 05/31/2023]
Abstract
A measurement of the ZZ production cross section in proton-proton collisions at sqrt[s] = 7 TeV using data corresponding to an integrated luminosity of 1.02 fb(-1) recorded by the ATLAS experiment at the LHC is presented. Twelve events containing two Z boson candidates decaying to electrons and/or muons are observed, with an expected background of 0.3 ± 0.3(stat)(-0.3)(+0.4)(syst) events. The cross section measured in a phase-space region with good detector acceptance and for dilepton masses within the range 66 to 116 GeV is σ(ZZ → ℓ+ ℓ- ℓ+ ℓ-)(fid) = 19.4(-5.2)(+6.3)(stat)(-0.7)(+0.9)(syst) ± 0.7(lumi) fb. The resulting total cross section for on-shell ZZ production, σ(ZZ)(tot) = 8.5(-2.3)(+2.7)(stat)(-0.3)(+0.4)(syst) ± 0.3(lumi) pb, is consistent with the standard model expectation of 6.5(-0.2)(+0.3) pb calculated at the next-to-leading order in QCD. Limits on anomalous neutral triple gauge boson couplings are derived.
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Affiliation(s)
- G Aad
- Fakultät für Mathematik und Physik, Albert-Ludwigs-Universität, Freiburg i.Br., Germany
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Vaidya JS, Baum M, Wenz F, Bulsara M, Tobias J, Alvarodo M, Saunders C, Williams N, Joseph D. P3-13-07: The TARGIT-A Trial Update Confirms No Increase in Local Recurrence. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-13-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: In June 2010, we published the results of the TARGIT-A trial (1) that compared “one-size fits” all radiotherapy (whole breast radiotherapy-EBRT group) with risk -adjusted radiotherapy (TARGIT- group: single dose TARGeted Intraoperative radioTherapy with additional whole breast radiotherapy if adverse prognostic factors were found). These results showed that the risk of local recurrence in the TARGIT group was non-inferior to that of the EBRT group (the difference between the two arms was 0.25% at 4 years). We now report the results analyzed after further follow up of the total trial cohort without unblinding.
Method: As often repeated, unplanned analysis comparing two groups in a randomized trial can result in an increased alpha-spent as well as carry the risk of a false positive result, we have remained blinded to the further recurrences in the trial according to allocated treatment, since the original publication in the Lancet. Instead we proposed and performed a blinded analysis of the local recurrence rate for the whole cohort. We plotted the Kaplan Meier plots and compared the estimated 4-year recurrences.
Results: Amongst the 2232 patients randomized, there were 13 recurrences at the time of Lancet publication and since then, we have had 8 additional recurrences. The number of patients who have completed at least 4 years of follow up has increased from 420 to 717. We found that the 4-year Kaplan Meier estimate of local recurrence was 1.08% (95% CI 0.59 −1.96) at the time of the Lancet publication and it is 1.09% (95% CI 0.65 - 1.85) now.
Conclusion: We found that the overall 4-year recurrence rates of the TARGIT-A trial have remained stable with a longer follow up and therefore; it is statistically implausible, that one particular arm has a significantly higher local recurrence.
References
1. Vaidya JS, Joseph DJ, Tobias JS, Bulsara M, Wenz F, Saunders C, Alvarado M, Flyger HL, Massarut S, Eiermann W, Keshtgar M, Dewar J, Kraus-Tiefenbacher U, Sutterlin M, Esserman L, Holtveg HM, Roncadin M, Pigorsch S, Metaxas M, Falzon M, Matthews A, Corica T, Williams NR, Baum M. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 2010;376(9735):91–102.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-13-07.
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Affiliation(s)
- JS Vaidya
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - M Baum
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - F Wenz
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - M Bulsara
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - J Tobias
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - M Alvarodo
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - C Saunders
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - N Williams
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
| | - D Joseph
- 1University College London, London, United Kingdom; University of Heidelberg, Mannheim, United Kingdom; University of Notre Dame, Fremantle, United Kingdom; University College Hospital and Whittington Hospital, London, United Kingdom; School of Surgery, University of Western Australia, London (All), United Kingdom; University of San Francisco, London (All), United Kingdom; Sir Charles Gairdener Hospital, London (All), United Kingdom
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Vagadia V, Bartholomew P, Kelly M, Handley G, Kelly C, Bridges M, Ruddick S, Malik R, Gilleece Y, Fisher M, Walker-Bone K, Selvan S, Collins DA, Meryon I, Pattle J, Scurr C, Davies G, Callan M, Mercieca C, Down M, Webb J, Shipley J, Bhalla AK, Poole KE, Treece GM, Ridgway GR, Mayhew PM, Borggrefe J, Gee AH, Mehta P, Nelson M, Boag F, Oldroyd AG, Halsey J, Goodson NJ, Greenbank C, Evans B, Bukhari M, Azagra R, Roca G, Encabo G, Aguye A, Zwart M, Casado E, Iglesias M, Puchol N, Sola S, Guell S, Harvey NC, Garrett E, Sheppard A, McLean C, Lillycrop K, Burdge G, Slater-Jefferies J, Rodford J, Crozier S, Inskip H, Starling Emerald B, Gale C, Hanson M, Gluckman P, Godfrey K, Cooper C, Edwards MH, Jameson K, Denison H, Aihie Sayer A, Cooper C, Dennison E, Cole Z, Harvey NC, Kim M, Robinson S, Inskip H, Godfrey KM, Cooper C, Dennison E, Clark EM, Morrison L, Gould V, Cuming M, Tobias J. Osteoporosis and metabolic bone disease: 73. Do Low Vitamin D Levels Predict Osteoporosis? Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Clark E, Tobias J, Fraser B. What's new in metabolic bone disease?: IP73. Is Frax Useful for Identifying People with Vertebral Fracture? Rheumatology (Oxford) 2011. [DOI: 10.1093/rheumatology/ker081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Vaidya JS, Joseph DJ, Tobias JS, Wenz FK, Bulsara M, Alvarado M, Keshtgar MR, Eiermann W, Williams NR, Baum M. Abstract PD06-01: A Single Treatment with Targeted Intraoperative Radiotherapy (TARGIT) Is Similar to Several Weeks of External Beam Radiotherapy (EBRT) with Respect to Efficacy and Safety, and Has Obvious Advantages to the Patient and the Economy. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd06-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: After breast-conserving surgery, 90% of local recurrences occur within the index quadrant despite the presence of multicentric cancers elsewhere in the breast. Thus, restriction of radiation therapy to the tumour bed during surgery might be adequate for selected patients. Materials and methods: Having safely piloted the new technique of single-dose targeted intraoperative radiotherapy (TARGIT) with Intrabeam, we launched the TARGIT-A trial on March 24, 2000. In this prospective, randomised, non-inferiority trial, women aged 45 years or older with invasive ductal breast carcinoma undergoing breast-conserving surgery were enrolled to compare TARGIT with whole breast external beam radiotherapy (EBRT). The primary outcome was local recurrence in the conserved breast with a predefined absolute non-inferiority margin of 2-5%. Analysis was by intention-to-treat.
Results: 1113 patients were randomly allocated to TARGIT and 1119 were allocated to EBRT. The Kaplan-Meier estimate of local recurrence in the conserved breast at 4 years was 1-20% (95% CI 0-53-2-71) in the TARGIT and 0-95% (0.39-2-31) in the EBRT group (difference between groups 0.25%, −1.04 to 1.54; p=0.41). The frequency of any complications and major toxicity (TARGIT 3.3% vs. EBRT 3.9% p=0·44) was similar. Radiotherapy toxicity was lower in the TARGIT group (0.5% vs. 2.1%, p=0.002). 14% of patients who received TARGIT also received EBRT as per the protocol, i.e., the remaining 86% patients could safely avoid 3-6 weeks of daily radiotherapy treatments and its obvious associated costs in economic and human terms.
Discussion: For selected patients with early breast cancer, a single-dose targeted intraoperative radiotherapy should be considered as an alternative to whole breast EBRT delivered over several weeks. It could save time, effort, and money for the patient and the healthcare system, which is particularly relevant in the present times of healthcare reform. NB the main trial results have been presented in ASCO 2010 and published in the Lancet Online First.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD06-01.
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Affiliation(s)
- JS Vaidya
- on behalf of the TARGIT Trialists’ Group. UCL, London, United Kingdom; Sir Charles Gairdner Hospital, Perth, Australia; University College London Hospitals, United Kingdom; University Medical Centre of Mannheim, Germany; University of Notre Dame, Fremantle, Australia; UCSF Comprehensive Cancer Center, San Francisco, CA; Royal Free Hospital, London, United Kingdom; Rotkreuzklinikum, München, Germany
| | - DJ Joseph
- on behalf of the TARGIT Trialists’ Group. UCL, London, United Kingdom; Sir Charles Gairdner Hospital, Perth, Australia; University College London Hospitals, United Kingdom; University Medical Centre of Mannheim, Germany; University of Notre Dame, Fremantle, Australia; UCSF Comprehensive Cancer Center, San Francisco, CA; Royal Free Hospital, London, United Kingdom; Rotkreuzklinikum, München, Germany
| | - JS Tobias
- on behalf of the TARGIT Trialists’ Group. UCL, London, United Kingdom; Sir Charles Gairdner Hospital, Perth, Australia; University College London Hospitals, United Kingdom; University Medical Centre of Mannheim, Germany; University of Notre Dame, Fremantle, Australia; UCSF Comprehensive Cancer Center, San Francisco, CA; Royal Free Hospital, London, United Kingdom; Rotkreuzklinikum, München, Germany
| | - FK Wenz
- on behalf of the TARGIT Trialists’ Group. UCL, London, United Kingdom; Sir Charles Gairdner Hospital, Perth, Australia; University College London Hospitals, United Kingdom; University Medical Centre of Mannheim, Germany; University of Notre Dame, Fremantle, Australia; UCSF Comprehensive Cancer Center, San Francisco, CA; Royal Free Hospital, London, United Kingdom; Rotkreuzklinikum, München, Germany
| | - M Bulsara
- on behalf of the TARGIT Trialists’ Group. UCL, London, United Kingdom; Sir Charles Gairdner Hospital, Perth, Australia; University College London Hospitals, United Kingdom; University Medical Centre of Mannheim, Germany; University of Notre Dame, Fremantle, Australia; UCSF Comprehensive Cancer Center, San Francisco, CA; Royal Free Hospital, London, United Kingdom; Rotkreuzklinikum, München, Germany
| | - M Alvarado
- on behalf of the TARGIT Trialists’ Group. UCL, London, United Kingdom; Sir Charles Gairdner Hospital, Perth, Australia; University College London Hospitals, United Kingdom; University Medical Centre of Mannheim, Germany; University of Notre Dame, Fremantle, Australia; UCSF Comprehensive Cancer Center, San Francisco, CA; Royal Free Hospital, London, United Kingdom; Rotkreuzklinikum, München, Germany
| | - MR Keshtgar
- on behalf of the TARGIT Trialists’ Group. UCL, London, United Kingdom; Sir Charles Gairdner Hospital, Perth, Australia; University College London Hospitals, United Kingdom; University Medical Centre of Mannheim, Germany; University of Notre Dame, Fremantle, Australia; UCSF Comprehensive Cancer Center, San Francisco, CA; Royal Free Hospital, London, United Kingdom; Rotkreuzklinikum, München, Germany
| | - W Eiermann
- on behalf of the TARGIT Trialists’ Group. UCL, London, United Kingdom; Sir Charles Gairdner Hospital, Perth, Australia; University College London Hospitals, United Kingdom; University Medical Centre of Mannheim, Germany; University of Notre Dame, Fremantle, Australia; UCSF Comprehensive Cancer Center, San Francisco, CA; Royal Free Hospital, London, United Kingdom; Rotkreuzklinikum, München, Germany
| | - NR Williams
- on behalf of the TARGIT Trialists’ Group. UCL, London, United Kingdom; Sir Charles Gairdner Hospital, Perth, Australia; University College London Hospitals, United Kingdom; University Medical Centre of Mannheim, Germany; University of Notre Dame, Fremantle, Australia; UCSF Comprehensive Cancer Center, San Francisco, CA; Royal Free Hospital, London, United Kingdom; Rotkreuzklinikum, München, Germany
| | - M, Baum
- on behalf of the TARGIT Trialists’ Group. UCL, London, United Kingdom; Sir Charles Gairdner Hospital, Perth, Australia; University College London Hospitals, United Kingdom; University Medical Centre of Mannheim, Germany; University of Notre Dame, Fremantle, Australia; UCSF Comprehensive Cancer Center, San Francisco, CA; Royal Free Hospital, London, United Kingdom; Rotkreuzklinikum, München, Germany
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Clark E, Tobias J. Educational achievement and fracture risk. Osteoporos Int 2010; 21:1625; author reply 1623. [PMID: 20012019 DOI: 10.1007/s00198-009-1115-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 09/29/2009] [Indexed: 11/30/2022]
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Gillmore R, Laurence V, Raouf S, Tobias J, Blackman G, Meyer T, Goodchild K, Collis C, Bridgewater J. Chemoradiotherapy with or without induction chemotherapy for locally advanced pancreatic cancer: a UK multi-institutional experience. Clin Oncol (R Coll Radiol) 2010; 22:564-9. [PMID: 20605709 DOI: 10.1016/j.clon.2010.05.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 03/16/2010] [Accepted: 05/05/2010] [Indexed: 01/19/2023]
Abstract
AIMS The optimal management for patients with unresectable locally advanced adenocarcinoma of the pancreas (LAPC) is unclear. The aim of this study was to determine the outcome of patients treated with chemoradiotherapy (CRT) with or without induction chemotherapy. MATERIALS AND METHODS We conducted a multi-centre retrospective analysis of 48 patients with biopsy-proven LAPC treated with CRT in four regional oncology centres in the UK between March 2000 and October 2007. The prescribed radiotherapy dose was 4500-5040 cGy in 25-28 fractions and was given concurrent with gemcitabine (n=37), gemcitabine/cisplatin (n=9), 5-fluorouracil (n=1) or capecitabine (n=1). RESULTS Four patients (8.3%) did not complete the intended treatment due to CRT-related toxicities. The disease control rate (Objective response rate (ORR) and stable disease (SD)) was 81.3%. The median overall survival was 17 months (range 5-66 months). In subgroup analysis, a trend towards improved survival was seen in patients who completed the intended treatment (17.1 months vs 11.0 months, P=0.06) and in patients undergoing surgery (27 months vs 16 months, P=0.023). CONCLUSIONS This is the largest reported series from the UK focussing on patients who received CRT for pancreas cancer. It shows that it is possible to deliver pancreatic CRT with acceptable toxicity. Induction chemotherapy followed by gemcitabine-based CRT shows promising activity and should be evaluated in phase III studies.
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Affiliation(s)
- R Gillmore
- University College Hospital, University College London Cancer Institute, London, UK
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Keshtgar M, Vaidya J, Stacey C, Tobias J, Williams N, Baum M. Single dose radiotherapy during surgery for breast cancer patients where external beam radiation was not feasible - results after 3 years of follow-up. Eur J Surg Oncol 2009. [DOI: 10.1016/j.ejso.2009.07.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Baum M, Williams N, Vaidya J, Keshtgar M, Tobias J. TARGIT: an international trial of intraoperative versus external beam radiotherapy. Breast Cancer Res 2008. [PMCID: PMC3300776 DOI: 10.1186/bcr1957] [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: 11/10/2022] Open
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Ebinuma H, Nakamoto N, Li Y, Price DA, Gostick E, Levine BL, Tobias J, Kwok WW, Chang KM. Identification and in vitro expansion of functional antigen-specific CD25+ FoxP3+ regulatory T cells in hepatitis C virus infection. J Virol 2008; 82:5043-53. [PMID: 18337568 PMCID: PMC2346728 DOI: 10.1128/jvi.01548-07] [Citation(s) in RCA: 135] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2007] [Accepted: 03/04/2008] [Indexed: 01/14/2023] Open
Abstract
CD4(+)CD25(+) regulatory T cells (CD25(+) Tregs) play a key role in immune regulation. Since hepatitis C virus (HCV) persists with increased circulating CD4(+)CD25(+) T cells and virus-specific effector T-cell dysfunction, we asked if CD4(+)CD25(+) T cells in HCV-infected individuals are similar to natural Tregs in uninfected individuals and if they include HCV-specific Tregs using the specific Treg marker FoxP3 at the single-cell level. We report that HCV-infected patients display increased circulating FoxP3(+) Tregs that are phenotypically and functionally indistinguishable from FoxP3(+) Tregs in uninfected subjects. Furthermore, HCV-specific FoxP3(+) Tregs were detected in HCV-seropositive persons with antigen-specific expansion, major histocompatibility complex class II/peptide tetramer binding affinity, and preferential suppression of HCV-specific CD8 T cells. Transforming growth factor beta contributed to antigen-specific Treg expansion in vitro, suggesting that it may contribute to antigen-specific Treg expansion in vivo. Interestingly, FoxP3 expression was also detected in influenza virus-specific CD4 T cells. In conclusion, functionally active and virus-specific FoxP3(+) Tregs are induced in HCV infection, thus providing targeted immune regulation in vivo. Detection of FoxP3 expression in non-HCV-specific CD4 T cells suggests that immune regulation through antigen-specific Treg induction extends beyond HCV.
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Affiliation(s)
- Hirotoshi Ebinuma
- Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, USA
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Yang S, Farias M, Kapfhamer D, Tobias J, Grant G, Abel T, Bućan M. Biochemical, molecular and behavioral phenotypes of Rab3A mutations in the mouse. Genes Brain Behav 2007; 6:77-96. [PMID: 16734774 PMCID: PMC2914309 DOI: 10.1111/j.1601-183x.2006.00235.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ras-associated binding (Rab) protein 3A is a neuronal guanosine triphosphate (GTP)-binding protein that binds synaptic vesicles and regulates synaptic transmission. A mouse mutant, earlybird (Ebd), with a point mutation in the GTP-binding domain of Rab3A (D77G), exhibits anomalies in circadian behavior and homeostatic response to sleep loss. Here, we show that the D77G substitution in the Ebd allele causes reduced GTP and GDP binding, whereas GTPase activity remains intact, leading to reduced protein levels of both Rab3A and rabphilin3A. Expression profiling of the cortex and hippocampus of Ebd and Rab3a-deficient mice revealed subtle differences between wild-type and mutant mice. Although mice were backcrossed for three generations to a C57BL/6J background, the most robust changes at the transcriptional level between Rab3a(-/-) and Rab3a(+/+) mice were represented by genes from the 129/Sv-derived chromosomal region surrounding the Rab3a gene. These results showed that differences in genetic background have a stronger effect on gene expression than the mutations in the Rab3a gene. In behavioral tests, the Ebd/Ebd mice showed a more pronounced mutant phenotype than the null mice; Ebd/Ebd have reduced anxiety-like behavior in the elevated zero-maze test, reduced response to stress in the forced swim test and a deficit in cued fear conditioning (FC), whereas Rab3a(-/-) showed only a deficit in cued FC. Our data implicate Rab3A in learning and memory as well as in the regulation of emotion. A combination of forward and reverse genetics has provided multiple alleles of the Rab3a gene; our studies illustrate the power and complexities of the parallel analysis of these alleles at the biochemical, molecular and behavioral levels.
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Affiliation(s)
- S. Yang
- Department of Genetics, University of Pennsylvania, Philadelphia, PA
| | - M. Farias
- Department of Genetics, University of Pennsylvania, Philadelphia, PA
| | - D. Kapfhamer
- Department of Genetics, University of Pennsylvania, Philadelphia, PA
| | - J. Tobias
- Penn Center for Bioinformatics, University of Pennsylvania, Philadelphia, PA, USA
| | - G. Grant
- Department of Genetics, University of Pennsylvania, Philadelphia, PA
- Penn Center for Bioinformatics, University of Pennsylvania, Philadelphia, PA, USA
| | - T. Abel
- Department of Biology, University of Pennsylvania, Philadelphia, PA, USA
| | - M. Bućan
- Department of Genetics, University of Pennsylvania, Philadelphia, PA
- Penn Center for Bioinformatics, University of Pennsylvania, Philadelphia, PA, USA
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Keshtgar M, Tobias J, Vaidya J, Murphy O, Stacey C, Metaxas M, Douek M, Sainsbury R, Houghton J, Baum M. 286 POSTER Use of intra-operative radiotherapy [IORT] alone in breast cancer patients when conventional external beam radiation therapy [EBRT] was not possible. Eur J Surg Oncol 2006. [DOI: 10.1016/s0748-7983(06)70721-1] [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: 12/01/2022] Open
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Bourhis J, Le Maı̂tre A, Pignon J, Ang K, Bernier J, Overgaard J, Tobias J, Saunders M, Adelstein D, O’Sullivan B. Impact of age on treatment effect in locally advanced head and neck cancer (HNC): Two individual patient data meta-analyses. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.5501] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5501 Background: The Meta-Analysis of Radiotherapy in Carcinomas of Head & Neck (MARCH; Bourhis J, ASTRO 2002) showed that altered fractionation radiotherapy (Alt-RT) could improve survival as compared to standard RT in patients with locally advanced HNC (pooled hazard ratio - HR -: 0.92, 95% confidence interval: 0.86–0.97). The Meta-Analysis of Chemotherapy in Head and Neck Cancer (MACH-NC; Bourhis J, ASCO 2004) demonstrated that concomitant chemotherapy (CT), added to RT, improved survival (HR: 0.82, 95% CI: 0.78–0.86). This study considers age as a potential modifier of the treatment effect. Methods: 15 randomized trials with 6,515 patients were included in MARCH (median follow up: 6.0 years), and 50 with 9,471 patients in concomitant part of MACH-NC (median follow up: 5.6 years). The interaction between age and treatment effect, using HR of death, was tested with heterogeneity test. Effect of prognostic factors on the interaction was analysed using Cox model. Results: The effect of Alt-RT in MARCH and of concomitant CT in MACH-NC on overall survival decreased with increased age ( table ). Patients aged 71+ had a lower performance status, less advanced stage, and more often laryngeal cancer than the younger patients; there were more women in the oldest patients group. However, adjusting on covariates did not modify the results. Causes of death was available in MARCH and in recent (1994–2000) trials of MACH-NC. The proportion of deaths not due to HNC increased with age, from 18% at age 50 to 41% at age 71+ in MARCH, and from 15% to 39% in MACH-NC. Conclusions: Treatment benefit decreases with increasing age. Patients aged 71+ did not benefit from Alt- RT nor from concomitant CT. The increasing risk of death from other causes with age may explain part of these observations. Supported by PHRC, ARC, LNCC [Table: see text] No significant financial relationships to disclose.
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Affiliation(s)
- J. Bourhis
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - A. Le Maı̂tre
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - J. Pignon
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - K. Ang
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - J. Bernier
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - J. Overgaard
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - J. Tobias
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - M. Saunders
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - D. Adelstein
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
| | - B. O’Sullivan
- Institut Gustave Roussy, Villejuif, France; Radiation Therapy Oncology Group, Philadelphia, PA; EORTC, Brussels, Belgium; Danish Head and Neck Cancer Group, Aarhus, Denmark; UKHAN, London, United Kingdom; Mount Vernon Hospital, Middlesex, United Kingdom; Eastern Cooperative Oncology Group, Boston, MA; Princess Margaret Hospital, Toronto, PQ, Canada
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Tobias JS, Vaidya JS, Keshtgar M, Douek M, Metaxas M, Stacey C, Sainsbury R, D'Souza D, Baum M. Breast-conserving Surgery with Intra-operative Radiotherapy: The Right Approach for the 21st Century? Clin Oncol (R Coll Radiol) 2006; 18:220-8. [PMID: 16605053 DOI: 10.1016/j.clon.2005.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Wide local excision followed by external beam radiation therapy (EBRT) to the whole breast has become the standard of care for most patients with localised 'early' breast cancer in the UK, Europe, and the USA. Local relapse rates are low, and overall survival figures have improved during the past decade, with the advent of more effective systemic endocrine- and chemo-therapy. A policy of EBRT for every patient undergoing breast conserving surgery (BCS) is however associated with a number of practical difficulties, acute radiation side effects and longer term toxicity, all of which detract from the obvious benefits of EBRT. In addition, with a disease as common as early breast cancer and a treatment programme typically requiring sophisticated radiation planning and many fractions of treatment, the policy of BCS plus EBRT has enormous resource implications within departments of oncology, greatly contributing to lengthy pre-treatment delays. For all these reasons, we and others have developed an increasing interest in techniques of partial breast irradiation, with an emphasis in our own Department on the emerging technique of intra-operative radiotherapy (IORT), which we initially employed as a boost to the tumour bed for use in conjunction with EBRT to the whole breast. To test the possibility of replacing the whole of the EBRT 3-6 week programme by a single application of IORT at the time of surgery, we and others have commenced a large scale prospectively randomised clinical trail in selected patients. Nine international centres are currently participating, and 350 patients have now been randomised to receive either IORT as part of the initial surgical excision or conventional EBRT with a pragmatic dose policy according to the preference of the contributing centre. The majority of patients undergoing IORT receive this at the time of initial surgery but it is also permissible within the trial programme to randomise suitable patients after the excised specimen has been histologically examined, thus avoiding any unsuitable patients - for example, those with a lobular carcinoma. These patients will be stratified and assessed separately from the 'pre-pathology' group, whose surgery and IORT is completed within a single session; if the latter patients are found to have unfavourable histology we have the facility, within the trial, to add EBRT. The trial is ongoing and our early experience has been encouraging. We have also recently assessed the long term local failure rate in patients offered IORT as a tumour bed boost, in conjunction with conventional EBRT. This methodology will also be the subject of a future randomised clinical trial.
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Affiliation(s)
- J S Tobias
- Department of Oncology, University College Hospital, London NW1 2BU, UK.
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Tobias JS. Interventional radiation therapy: Techniques — brachytherapy. R. Sauer. 275 × 220 mm. Pp, 398 + xii. Illustrated. 1991. Germany: Springer-Verlag. Br J Surg 2005. [DOI: 10.1002/bjs.1800790533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- J S Tobias
- University College Hospital, London WCIE 6AU, UK
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Abstract
BACKGROUND In the treatment of advanced breast cancer, third-generation aromatase inhibitors (AIs) have shown superior efficacy and tolerability compared with tamoxifen and megestrol acetate, the previous standard endocrine therapies in the first- and second-line settings, respectively. AIs are now being assessed in the adjuvant and prevention settings. DESIGN Literature review (PubMed search). RESULTS Tamoxifen is currently the only endocrine option available for adjuvant therapy and chemoprevention in postmenopausal women. However, results from the ATAC ('Arimidex', Tamoxifen, Alone or in Combination) trial have shown anastrozole to be more effective than tamoxifen as adjuvant therapy for postmenopausal women with hormone-responsive early breast cancer. Other third-generation AIs, including letrozole and exemestane, are also being investigated as adjuvant therapies. In the chemoprevention setting, tamoxifen is the only available endocrine option for women at high risk of breast cancer but, given that these are healthy subjects, is associated with an unacceptable rate of adverse events. Raloxifene is being further assessed in the STAR (Study of Tamoxifen and Raloxifene) trial, while anastrozole is being evaluated in the second IBIS-II (International Breast Intervention Study II). CONCLUSIONS AIs, in particular anastrozole, are set to change the way that early breast cancer is treated. Effective and better-tolerated endocrine alternatives for breast cancer prevention may become available in the future.
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Affiliation(s)
- J S Tobias
- Meyerstein Institute of Oncology, Middlesex Hospital, London, UK.
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Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, Hoctin-Boes G, Houghton J, Locker GY, Tobias JS. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet 2005; 365:60-2. [PMID: 15639680 DOI: 10.1016/s0140-6736(04)17666-6] [Citation(s) in RCA: 1411] [Impact Index Per Article: 74.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The standard adjuvant endocrine treatment for postmenopausal women with hormone-receptor-positive localised breast cancer is 5 years of tamoxifen, but recurrences and side-effects restrict its usefulness. The aromatase inhibitor anastrozole was compared with tamoxifen for 5 years in 9366 postmenopausal women with localised breast cancer. After a median follow-up of 68 months, anastrozole significantly prolonged disease-free survival (575 events with anastrozole vs 651 with tamoxifen, hazard ratio 0.87, 95% CI 0.78-0.97, p=0.01) and time-to-recurrence (402 vs 498, 0.79, 0.70-0.90, p=0.0005), and significantly reduced distant metastases (324 vs 375, 0.86, 0.74-0.99, p=0.04) and contralateral breast cancers (35 vs 59, 42% reduction, 12-62, p=0.01). Almost all patients have completed their scheduled treatment, and fewer withdrawals occurred with anastrozole than with tamoxifen. Anastrozole was also associated with fewer side-effects than tamoxifen, especially gynaecological problems and vascular events, but arthralgia and fractures were increased. Anastrozole should be the preferred initial treatment for postmenopausal women with localised hormone-receptor-positive breast cancer.
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Affiliation(s)
- A Howell
- Christie Hospital, Manchester, UK.
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Tobias JS, Howell A. An open randomised trial of second-line endocrine therapy in advanced breast cancer: comparison of the Aromatase inhibitors letrozole and anastrozole. Eur J Cancer 2004; 40:1913. [PMID: 15288295 DOI: 10.1016/j.ejca.2004.02.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2004] [Accepted: 02/24/2004] [Indexed: 11/28/2022]
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Tobias JS, Vaidya JS, Keshtgar M, D'Souza DP, Baum M. Reducing radiotherapy dose in early breast cancer: the concept of conformal intraoperative brachytherapy. Br J Radiol 2004; 77:279-84. [PMID: 15107317 DOI: 10.1259/bjr/17186381] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- J S Tobias
- Meyerstein Institute of Oncology and Academic Department of Surgery, University College London Hospitals NHS Trust, London, UK
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Tobias JS. Medical and legal hazards of the use of radiation therapy. Med Leg J 2003; 71:96-105. [PMID: 14619620 DOI: 10.1258/rsmmlj.71.3.96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Affiliation(s)
- J S Tobias
- University College London Hospitals NHS Trust
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Kirwan JR, Averns H, Creamer P, Davies M, Hickling P, Hutton C, Jacoby R, Kyle V, Laversuch C, Palferman T, Tobias J, Viner N, Woolf A, Yates D. Changes in rheumatology out-patient workload over 12 years in the South West of England. Rheumatology (Oxford) 2003; 42:175-9. [PMID: 12509633 DOI: 10.1093/rheumatology/keg056] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J R Kirwan
- Academic Rheumatology, University Department of Medicine, Bristol Royal Infirmary, Bristol BS2 8HW, UK.
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Spencer GM, Thorpe SM, Blackman GM, Solano J, Tobias JS, Lovat LB, Bown SG. Laser augmented by brachytherapy versus laser alone in the palliation of adenocarcinoma of the oesophagus and cardia: a randomised study. Gut 2002; 50:224-7. [PMID: 11788564 PMCID: PMC1773102 DOI: 10.1136/gut.50.2.224] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
BACKGROUND Many patients with advanced malignant dysphagia are not suitable for definitive treatment. The best option for palliation of dysphagia varies between patients. This paper looks at a simple technique for enhancing laser recanalisation. AIM To assess the value of adjunctive brachytherapy in prolonging palliation of malignant dysphagia by endoscopic laser therapy. PATIENTS Twenty two patients with advanced malignant dysphagia due to adenocarcinoma of the oesophagus or gastric cardia, unsuitable for surgery or radical chemoradiotherapy. METHODS Patients able to eat a soft diet after laser recanalisation were randomised to no further therapy or a single treatment with brachytherapy (10 Gy). Results were judged on the quality and duration of dysphagia palliation, need for subsequent intervention, complications, and survival. RESULTS The median dysphagia score for all patients two weeks after initial treatment was 1 (some solids). The median dysphagia palliated interval from the end of initial treatment to recurrent dysphagia or death increased from five weeks (control group) to 19 weeks (brachytherapy group). Three patients had some odynophagia for up to six weeks after brachytherapy. There was no other treatment related morbidity or mortality. Further intervention was required in 10 of 11 control patients (median five further procedures) compared with 7/11 brachytherapy patients (median two further procedures). There was no difference in survival (median 20 weeks (control), 26 weeks (brachytherapy)). CONCLUSIONS Laser therapy followed by brachytherapy is a safe, straightforward, and effective option for palliating advanced malignant dysphagia, which is complementary to stent insertion.
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Affiliation(s)
- G M Spencer
- National Medical Laser Centre, Institute of Surgical Studies, Royal Free and University College Medical School, London, UK
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Tobias JS, Houghton J. Is informed consent essential for all chemotherapy studies? Eur J Cancer 2001; 30A:807-9. [PMID: 11644622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Vaidya JS, Baum M, Tobias JS, D'Souza DP, Naidu SV, Morgan S, Metaxas M, Harte KJ, Sliski AP, Thomson E. Targeted intra-operative radiotherapy (Targit): an innovative method of treatment for early breast cancer. Ann Oncol 2001; 12:1075-80. [PMID: 11583188 DOI: 10.1023/a:1011609401132] [Citation(s) in RCA: 148] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION We believe that conservative treatment of early breast cancer may not require radiotherapy that encompasses the whole breast. We present here the clinico-pathological basis for this view, as well as a novel therapeutic approach that allows intra-operative radiotherapy to be safely and accurately delivered to the target tissues in a standard operating theatre. THE RATIONALE: Whole-organ analysis of mastectomy specimens reveals that 80% of occult cancer foci are situated remote from the index quadrant. In contrast, over 90% of local recurrences after breast conservative therapy occur near the original tumour, even when radiotherapy is not given. Therefore, the remote occult cancer foci may be clinically irrelevant and radiotherapy to the index quadrant alone might be sufficient. A NOVEL TECHNIQUE: The Photon Radiosurgery System (PRS) is an ingenious portable electron-beam driven device that can typically deliver intra-operative doses of 5-20 Gy, respectively, to 1 cm and 0.2 cm from the tumour bed over about 22 min. The pliable breast tissue--the target--wraps around the source, providing perfect conformal radiotherapy. Being soft X-rays, the dose attenuates rapidly (alpha approximately 1/r3), reducing distant damage. RESULTS In our pilot study of 25 patients (age 30-80 years, T = 0.42-4.0 cm), we replaced the routine post-operative tumour bed boost with targeted intra-operative radiotherapy. There have been no major complications and no patient has developed local recurrence, although the median follow-up time is short, at 24 months. CONCLUSION It is safe and feasible to deliver targeted intraoperative radiotherapy (Targit) for early breast cancer. We have begun a randomised trial--the first of its kind--comparing Targit with conventional six-week course of radiotherapy. If proven equivalent in terms of local recurrence and cosmesis, it could eliminate the need for the usual six-week course of post-operative radiotherapy.
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Affiliation(s)
- J S Vaidya
- Department of Surgery, University College London, UK.
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Tobias JS. Research governance, consent and evidence-based medicine. Med Leg J 2001; 69:40-5. [PMID: 11388071 DOI: 10.1258/rsmmlj.69.1.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- J S Tobias
- Meyerstein Institute of Cancer, Middlesex Hospital
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