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Kanekiyo M, Gillespie RA, Midgett M, O’Malley KJ, Williams C, Moin SM, Wallace M, Treaster L, Cooper K, Syeda H, Kettenburg G, Rannulu H, Schmer T, Ortiz L, Da Silva Castanha P, Corry J, Xia M, Olsen E, Perez D, Yun G, Graham BS, Barratt-Boyes SM, Reed DS. Refined semi-lethal aerosol H5N1 influenza model in cynomolgus macaques for evaluation of medical countermeasures. iScience 2023; 26:107830. [PMID: 37766976 PMCID: PMC10520834 DOI: 10.1016/j.isci.2023.107830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/04/2023] [Accepted: 09/01/2023] [Indexed: 09/29/2023] Open
Abstract
Highly pathogenic avian influenza A H5N1 viruses cause high mortality in humans and have pandemic potential. Effective vaccines and treatments against this threat are urgently needed. Here, we have refined our previously established model of lethal H5N1 infection in cynomolgus macaques. An inhaled aerosol virus dose of 5.1 log10 plaque-forming unit (pfu) induced a strong febrile response and acute respiratory disease, with four out of six macaques succumbing after challenge. Vaccination with three doses of adjuvanted seasonal quadrivalent influenza vaccine elicited low but detectable neutralizing antibody to H5N1. All six vaccinated macaques survived four times the 50% lethal dose of aerosolized H5N1, while four of six unvaccinated controls succumbed to disease. Although vaccination did not protect against severe influenza, vaccinees had reduced respiratory dysfunction and lower viral load in airways compared to controls. We anticipate that our macaque model will play a vital role in evaluating vaccines and antivirals against influenza pandemics.
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Affiliation(s)
- Masaru Kanekiyo
- Molecular Engineering Section, Vaccine Research Center, National Institutes of Health, Bethesda, MD, USA
| | - Rebecca A. Gillespie
- Molecular Engineering Section, Vaccine Research Center, National Institutes of Health, Bethesda, MD, USA
| | - Morgan Midgett
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Connor Williams
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Syed M. Moin
- Molecular Engineering Section, Vaccine Research Center, National Institutes of Health, Bethesda, MD, USA
| | - Megan Wallace
- Department of Infectious Disease and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Luke Treaster
- Division of Cardiothoracic Imaging, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kristine Cooper
- Biostatistics Facility, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hubza Syeda
- Molecular Engineering Section, Vaccine Research Center, National Institutes of Health, Bethesda, MD, USA
| | - Gwenddolen Kettenburg
- Department of Infectious Disease and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hasala Rannulu
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tabitha Schmer
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lucia Ortiz
- Department of Population Health, University of Georgia, Athens, GA, USA
| | | | - Jacqueline Corry
- Department of Infectious Disease and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mengying Xia
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Emily Olsen
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel Perez
- Department of Population Health, University of Georgia, Athens, GA, USA
| | - Gabin Yun
- Division of Cardiothoracic Imaging, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Barney S. Graham
- Molecular Engineering Section, Vaccine Research Center, National Institutes of Health, Bethesda, MD, USA
| | - Simon M. Barratt-Boyes
- Department of Infectious Disease and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Douglas S. Reed
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, PA, USA
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McDowell LJ, Gough K, Fua T, Coleman A, Drosdowsky A, Rischin D, Corry J. Fear of Cancer Recurrence (FCR) in Human Papillomavirus-Associated Oropharyngeal Cancer (HPVOPC) Patients 12 months (12m) after (Chemo)Radiation (RT/CRT). Int J Radiat Oncol Biol Phys 2023; 117:e250-e251. [PMID: 37784975 DOI: 10.1016/j.ijrobp.2023.06.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) This study constitutes a planned secondary endpoint analysis from a longitudinal unmet needs study. The aim was to: (1) describe FCR outcomes 12m after RT/CRT; (2) examine associations between FCR severity scores 12m after RT/CRT and patient and disease characteristics and other patient-reported outcomes (PROs); and (3) to evaluate preferred FCR referral pathways. MATERIALS/METHODS Eligible HPVOPC patients scheduled for curative RT/CRT were approached for enrolment. FCR was assessed with the 42-item Fear of Cancer Recurrence Inventory (FCRI) 12m after RT/CRT, as were patients' preferences for FCR referral pathways, using customized questions. Optimism (LOT-R) and resilience (Connor-Davidson Resilience Scale) were assessed at enrolment. Health-related quality of life (HRQL, EORTC QLQ-C30), disease-specific symptom severity and interference (MDASI-HN) and emotional distress (PROMIS Anxiety 7a, Depression 8a) were assessed 12m after RT/CRT. RESULTS A total of 100/129 eligible patients were enrolled between October 2020 and November 2021. 85/93 (91%) alive patients without recurrence completed the FCRI; patients were mostly men (n = 73, 86%), with a median age of 60 years (range 44-77). A majority had stage I disease (n = 46, 54%) and received CRT (n = 82, 96%). The mean FCRI total score was 45.4 (SD = 26.3, range 0-102, possible range 0-168). The mean FCRI severity score was 12.1 (SD = 7.4, median = 11.0, range 0-29); 13%, 31% and 56% of respondents scored in the severe (≥22), moderate (>12-22) and low (≤12) range, respectively. Univariable regression analysis indicated that lower resilience, lower HRQL (global health status, all functional domains), higher emotional distress (anxiety, depression), and higher symptom severity and interference were associated with higher FCR severity scores 12m after RT/CRT. Apart from lower levels of education, associations between FCRI severity scores and other patient and disease factors were not statistically significant. If FCR had been a problem (n = 66), 86%, 44%, 14% and 5% of patients indicated they would like to discuss it with their oncologist, primary care physician, a psychologist or nurse, respectively (multiple responses allowed). If specific FCR interventions were available, 70/85 indicated their preferred sources for delivery (ordered by median rank) were oncologist, primary care physician, psychologist or nurse (tied), self-management or group sessions (tied). CONCLUSION Almost half of HPVOPC patients reported moderate-to-severe FCR 12m after RT/CRT. Increased FCR severity was associated with education and self-reported resilience at baseline and with other measures of HRQL, toxicity and emotional distress at 12m. While patients view oncologists as central in FCR management, education about the benefits of other FCR-reducing approaches may be necessary.
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Affiliation(s)
- L J McDowell
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia
| | - K Gough
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - T Fua
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - A Coleman
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - A Drosdowsky
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - D Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Corry
- GenesisCare St. Vincent's Hospital, Melbourne, Australia
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McDowell LJ, Gough K, Fua T, Coleman A, Drosdowsky A, Rischin D, Corry J. A Prospective Study Evaluating Sexual Health Outcomes in Patients Undergoing (Chemo)Radiation (CRT/RT) for Human Papillomavirus-Associated Oropharyngeal Cancer (HPVOPC). Int J Radiat Oncol Biol Phys 2023; 117:S121. [PMID: 37784315 DOI: 10.1016/j.ijrobp.2023.06.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The primary endpoint of this study was to describe the course of sexual health outcomes prior to, during and following CRT/RT and to determine the importance of sexual function in a broader context of other oncological and functional outcomes. MATERIALS/METHODS Eligible patients with locoregionally confined HPVOPC suitable for curative CRT/RT were approached for enrolment. Patients were assessed before treatment (baseline), week 7 of treatment (FU1), and 3- and 12-months post-treatment (FU2 and FU3, respectively). Study outcomes included sexual health (EORTC SHQ-22), quality of life (EORTC QLQ-C30), symptom burden (MDASI-HN), emotional distress (PROMIS Anxiety 7a, Depression 8b) and facial appearance and appearance distress (FACE-Q). Patient preferences were elicited using a modified version ('keeping sexual function' added) of the Chicago Priorities Scale (CPS) at baseline and FU3; items were sorted into top, middle or lower priorities; then ranked from 1-13. RESULTS From October 2020 to November 2021, 100/129 eligible patients were enrolled from 3 centers: median age 61 (range 44-79), male (n = 87, 87%), partnered (n = 75, 77%), heterosexual (n = 95, 95%). Most patients received CRT (n = 97, 97%), 52% had stage I disease (n = 52). Compliance with SHQ-22 at FU3 was 89/98 alive patients. Mean sexual satisfaction scores were 52 (SD = 27, range 0-100) at baseline, 27 (SD = 20) at FU1, 40 (SD = 24) at FU2 and 48 (SD = 28) at FU3. Mixed model results indicated a clinically significant reduction in sexual satisfaction at FU1 (-25, 95% CI = -31, -20; p < 0.001) and FU2 (-12, 95% CI = -17, -7; p<0.001) from baseline, but not FU3 (-4, 95% CI = -9, 1; p = 0.15). Univariable regression analysis indicated that patient factors (cohabiting, having a sexual partner, being sexually active, non-smoker), higher global health status, other SHQ-22 items (higher importance of sex life, libido, security with satisfying their partner, erection confidence, lower fatigue affecting sex life), lower depression, as well as 'keeping sexual function' being a top priority were associated with higher sexual satisfaction at FU3. Associations with MDASI-HN symptom and interference scales, and oral toxicity measures (pain, dry mouth, taste, mouth/throat sores) were not statistically significant. For 30/87 patients, treatment affected their sexual activity quite a bit or very much. Amongst the 13 CPS priorities, 'keeping sexual function' had a median rank of 10 and 9 at baseline and FU3, respectively; 24% and 26% identified it as a top priority at these assessments. CONCLUSION Sexual satisfaction is affected during and after CRT/RT for HPVOPC; however, on average, score differences before and 12 months after treatment are not clinically significant. Approximately one-quarter of patients consider sexual function a 'top' priority during survivorship.
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Affiliation(s)
- L J McDowell
- Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - K Gough
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - T Fua
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - A Coleman
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - A Drosdowsky
- Peter MacCallum Cancer Center, Melbourne, VIC, Australia
| | - D Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - J Corry
- GenesisCare St. Vincent's Hospital, Melbourne, Australia
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Corry J, Connell C, Wilson C, Young S, Lai K. Assessing the Compliance and Accuracy of a National Australian Head and Neck Cancer (HNC) Database. Int J Radiat Oncol Biol Phys 2023; 117:e574. [PMID: 37785749 DOI: 10.1016/j.ijrobp.2023.06.1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Accurate cancer databases enable auditing of patient management, and this knowledge facilitates optimizing care. A multi-institutional organization, the largest single provider of radiation oncology services in Australia, has developed its own national database (ND). All patients are entered on the ND as a prerequisite for generating a radiotherapy prescription. A significant component of the ND is automated, but manual input from the treating radiation oncologist (RO) is also required. The purpose of this study was to assess the compliance and accuracy of the data entered on this ND for head and neck cancer (HNC) patients. MATERIALS/METHODS We included all HNC patients with either oral cavity cancer or oropharynx cancer (ICD-10 coding) treated between September 2021 and September 2022 to assess compliance. We randomly selected 25% of these cases and assigned them to 3 HNC ROs to manually review the accuracy of all clinical data points. RESULTS There were 166 HNC patients, 139 oropharynx and 27 oral cavity. Compliance in the 166 patients was excellent (94% or higher) for the majority of data points - age, gender, diagnosis ICD code, diagnosis date, laterality, TNM classification, radiotherapy dose, fractionation and technique and start and completion dates. Compliance was good (85% or more) for smoking history, use of chemotherapy, and p16 status (oropharynx). Compliance was poor (43%) for specific chemotherapy regimens. Accuracy was high (92% or higher) for diagnosis ICD code, smoking history, use of chemotherapy; good (87% or higher) for p16 status (oropharynx), laterality and histopathology; and poor for date of diagnosis (75%), TNM classification (62%) and specific chemotherapy regimens (29%). CONCLUSION The ND is a powerful tool for assessing patient care. Overall, compliance was very good. Accuracy was very good for most items, and we have highlighted areas where improvements can be made. This study shows that a compliant and accurate ND is achievable and supports the next goal of additional items to be included in the ND, specifically patient outcome data.
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Affiliation(s)
- J Corry
- Genesiscare St Vincent's Hospital, Fitzroy, VIC, Australia
| | - C Connell
- Adelaide Radiotherapy Centre, Adelaide, SA, Australia
| | | | - S Young
- Genesiscare, Sydney, NSW, Australia
| | - K Lai
- Genesiscare, Sydney, NSW, Australia
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Upadhyay AA, Viox EG, Hoang TN, Boddapati AK, Pino M, Lee MYH, Corry J, Strongin Z, Cowan DA, Beagle EN, Horton TR, Hamilton S, Aoued H, Harper JL, Edwards CT, Nguyen K, Pellegrini KL, Tharp GK, Piantadosi A, Levit RD, Amara RR, Barratt-Boyes SM, Ribeiro SP, Sekaly RP, Vanderford TH, Schinazi RF, Paiardini M, Bosinger SE. TREM2 + and interstitial-like macrophages orchestrate airway inflammation in SARS-CoV-2 infection in rhesus macaques. Nat Commun 2023; 14:1914. [PMID: 37024448 PMCID: PMC10078029 DOI: 10.1038/s41467-023-37425-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
The immunopathological mechanisms driving the development of severe COVID-19 remain poorly defined. Here, we utilize a rhesus macaque model of acute SARS-CoV-2 infection to delineate perturbations in the innate immune system. SARS-CoV-2 initiates a rapid infiltration of plasmacytoid dendritic cells into the lower airway, commensurate with IFNA production, natural killer cell activation, and a significant increase of blood CD14-CD16+ monocytes. To dissect the contribution of lung myeloid subsets to airway inflammation, we generate a longitudinal scRNA-Seq dataset of airway cells, and map these subsets to corresponding populations in the human lung. SARS-CoV-2 infection elicits a rapid recruitment of two macrophage subsets: CD163+MRC1-, and TREM2+ populations that are the predominant source of inflammatory cytokines. Treatment with baricitinib (Olumiant®), a JAK1/2 inhibitor is effective in eliminating the influx of non-alveolar macrophages, with a reduction of inflammatory cytokines. This study delineates the major lung macrophage subsets driving airway inflammation during SARS-CoV-2 infection.
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Affiliation(s)
- Amit A Upadhyay
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Elise G Viox
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Timothy N Hoang
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Arun K Boddapati
- Emory NPRC Genomics Core Laboratory, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Maria Pino
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Michelle Y-H Lee
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Jacqueline Corry
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Zachary Strongin
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - David A Cowan
- Emory NPRC Genomics Core Laboratory, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Elizabeth N Beagle
- Emory NPRC Genomics Core Laboratory, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Tristan R Horton
- Emory NPRC Genomics Core Laboratory, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Sydney Hamilton
- Emory NPRC Genomics Core Laboratory, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Hadj Aoued
- Emory NPRC Genomics Core Laboratory, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Justin L Harper
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Christopher T Edwards
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Kevin Nguyen
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Kathryn L Pellegrini
- Emory NPRC Genomics Core Laboratory, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Gregory K Tharp
- Emory NPRC Genomics Core Laboratory, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Anne Piantadosi
- Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Rebecca D Levit
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Rama R Amara
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
- Department of Microbiology and Immunology, Emory School of Medicine, Emory University, Atlanta, GA, USA
| | - Simon M Barratt-Boyes
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Susan P Ribeiro
- Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Rafick P Sekaly
- Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Thomas H Vanderford
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA
| | - Raymond F Schinazi
- Department of Pediatrics, School of Medicine, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Mirko Paiardini
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA.
- Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
| | - Steven E Bosinger
- Division of Microbiology and Immunology, Emory National Primate Research Center, Emory University, Atlanta, GA, USA.
- Department of Pathology and Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
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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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McDowell L, Rischin D, King M, Kenny L, Porceddu S, Wratten C, Macann A, Jackson J, Bressel M, Fua T, Lin C, Liu C, Corry J. PD-0822 Impact of radiotherapy laterality on patient-reported outcomes in T1-2 HPV tonsillar carcinoma. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02963-2] [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: 11/28/2022]
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8
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Corry J, Kettenburg G, Upadhyay AA, Wallace M, Marti MM, Wonderlich ER, Bissel SJ, Goss K, Sturgeon TJ, Watkins SC, Reed DS, Bosinger SE, Barratt-Boyes SM. Infiltration of inflammatory macrophages and neutrophils and widespread pyroptosis in lung drive influenza lethality in nonhuman primates. PLoS Pathog 2022; 18:e1010395. [PMID: 35271686 PMCID: PMC8939778 DOI: 10.1371/journal.ppat.1010395] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/22/2022] [Accepted: 02/24/2022] [Indexed: 01/04/2023] Open
Abstract
Severe influenza kills tens of thousands of individuals each year, yet the mechanisms driving lethality in humans are poorly understood. Here we used a unique translational model of lethal H5N1 influenza in cynomolgus macaques that utilizes inhalation of small-particle virus aerosols to define mechanisms driving lethal disease. RNA sequencing of lung tissue revealed an intense interferon response within two days of infection that resulted in widespread expression of interferon-stimulated genes, including inflammatory cytokines and chemokines. Macaques with lethal disease had rapid and profound loss of alveolar macrophages (AMs) and infiltration of activated CCR2+ CX3CR1+ interstitial macrophages (IMs) and neutrophils into lungs. Parallel changes of AMs and neutrophils in bronchoalveolar lavage (BAL) correlated with virus load when compared to macaques with mild influenza. Both AMs and IMs in lethal influenza were M1-type inflammatory macrophages which expressed neutrophil chemotactic factors, while neutrophils expressed genes associated with activation and generation of neutrophil extracellular traps (NETs). NETs were prominent in lung and were found in alveolar spaces as well as lung parenchyma. Genes associated with pyroptosis but not apoptosis were increased in lung, and activated inflammatory caspases, IL-1β and cleaved gasdermin D (GSDMD) were present in bronchoalveolar lavage fluid and lung homogenates. Cleaved GSDMD was expressed by lung macrophages and alveolar epithelial cells which were present in large numbers in alveolar spaces, consistent with loss of epithelial integrity. Cleaved GSDMD colocalized with viral NP-expressing cells in alveoli, reflecting pyroptosis of infected cells. These novel findings reveal that a potent interferon and inflammatory cascade in lung associated with infiltration of inflammatory macrophages and neutrophils, elaboration of NETs and cell death by pyroptosis mediates lethal H5N1 influenza in nonhuman primates, and by extension humans. These innate pathways represent promising therapeutic targets to prevent severe influenza and potentially other primary viral pneumonias in humans. Influenza can cause acute lung injury and death, but the mechanisms resulting in lethal influenza in humans are not well understood. We used a novel model of lethal influenza in nonhuman primates caused by aerosol infection with highly pathogenic avian influenza virus that closely resembles human disease to define how the virus causes severe pneumonia. We found that a potent innate immune response starting with high-level production of interferons and inflammatory factors in the lung drives severe disease. Inflammatory cells including macrophages and neutrophils were recruited into lung because of this early response, which in turn led to release of neutrophil extracellular traps that blocked lung alveoli. In addition, a particularly inflammatory form of cell death known as pyroptosis occurred in lungs during lethal influenza. These new findings show that an intense interferon response leading to an inflammatory cascade of macrophages and neutrophils, release of neutrophil extracellular traps, and cell death by pyroptosis is responsible for acute lung injury in lethal influenza. These innate pathways could be targeted by drugs to prevent lung injury in critically ill influenza patients.
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Affiliation(s)
- Jacqueline Corry
- Department of Infectious Diseases & Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail: (JC); (SMBB)
| | - Gwenddolen Kettenburg
- Department of Infectious Diseases & Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Amit A. Upadhyay
- Yerkes NHP Genomics Core Laboratory, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
| | - Megan Wallace
- Department of Infectious Diseases & Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michelle M. Marti
- Department of Infectious Diseases & Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Elizabeth R. Wonderlich
- Department of Infectious Diseases & Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Stephanie J. Bissel
- Division of Neuropathology, Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Kyndal Goss
- Yerkes NHP Genomics Core Laboratory, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
| | - Timothy J. Sturgeon
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Simon C. Watkins
- Department of Cell Biology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Douglas S. Reed
- Center for Vaccine Research, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Steven E. Bosinger
- Yerkes NHP Genomics Core Laboratory, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, United States of America
| | - Simon M. Barratt-Boyes
- Department of Infectious Diseases & Microbiology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- Department of Immunology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail: (JC); (SMBB)
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Upadhyay AA, Hoang TN, Pino M, Boddapati AK, Viox EG, Lee MYH, Corry J, Strongin Z, Cowan DA, Beagle EN, Horton TR, Hamilton S, Aoued H, Harper JL, Nguyen K, Pellegrini KL, Tharp GK, Piantadosi A, Levit RD, Amara RR, Barratt-Boyes SM, Ribeiro SP, Sekaly RP, Vanderford TH, Schinazi RF, Paiardini M, Bosinger SE. TREM2+ and interstitial macrophages orchestrate airway inflammation in SARS-CoV-2 infection in rhesus macaques. bioRxiv 2021. [PMID: 34642693 PMCID: PMC8509096 DOI: 10.1101/2021.10.05.463212] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The COVID-19 pandemic remains a global health crisis, yet, the immunopathological mechanisms driving the development of severe disease remain poorly defined. Here, we utilize a rhesus macaque (RM) model of SARS-CoV-2 infection to delineate perturbations in the innate immune system during acute infection using an integrated systems analysis. We found that SARS-CoV-2 initiated a rapid infiltration (two days post infection) of plasmacytoid dendritic cells into the lower airway, commensurate with IFNA production, natural killer cell activation, and induction of interferon-stimulated genes. At this early interval, we also observed a significant increase of blood CD14-CD16+ monocytes. To dissect the contribution of lung myeloid subsets to airway inflammation, we generated a novel compendium of RM-specific lung macrophage gene expression using a combination of sc-RNA-Seq data and bulk RNA-Seq of purified populations under steady state conditions. Using these tools, we generated a longitudinal sc-RNA-seq dataset of airway cells in SARS-CoV-2-infected RMs. We identified that SARS-CoV-2 infection elicited a rapid recruitment of two subsets of macrophages into the airway: a C206+MRC1-population resembling murine interstitial macrophages, and a TREM2+ population consistent with CCR2+ infiltrating monocytes, into the alveolar space. These subsets were the predominant source of inflammatory cytokines, accounting for ~75% of IL6 and TNF production, and >90% of IL10 production, whereas the contribution of CD206+MRC+ alveolar macrophages was significantly lower. Treatment of SARS-CoV-2 infected RMs with baricitinib (Olumiant ® ), a novel JAK1/2 inhibitor that recently received Emergency Use Authorization for the treatment of hospitalized COVID-19 patients, was remarkably effective in eliminating the influx of infiltrating, non-alveolar macrophages in the alveolar space, with a concomitant reduction of inflammatory cytokines. This study has delineated the major subsets of lung macrophages driving inflammatory and anti-inflammatory cytokine production within the alveolar space during SARS-CoV-2 infection. One sentence summary Multi-omic analyses of hyperacute SARS-CoV-2 infection in rhesus macaques identified two population of infiltrating macrophages, as the primary orchestrators of inflammation in the lower airway that can be successfully treated with baricitinib.
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Jenkins T, Wang R, Harder O, Xue M, Chen P, Corry J, Walker C, Teng M, Mejias A, Ramilo O, Niewiesk S, Li J, Peeples ME. A Novel Live Attenuated Respiratory Syncytial Virus Vaccine Candidate with Mutations in the L Protein SAM Binding Site and the G Protein Cleavage Site Is Protective in Cotton Rats and a Rhesus Macaque. J Virol 2021; 95:e01568-20. [PMID: 33177201 PMCID: PMC7925107 DOI: 10.1128/jvi.01568-20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/06/2020] [Indexed: 11/20/2022] Open
Abstract
Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infections in children of <5 years of age worldwide, infecting the majority of infants in their first year of life. Despite the widespread impact of this virus, no vaccine is currently available. For more than 50 years, live attenuated vaccines (LAVs) have been shown to protect against other childhood viral infections, offering the advantage of presenting all viral proteins to the immune system for stimulation of both B and T cell responses and memory. The RSV LAV candidate described here, rgRSV-L(G1857A)-G(L208A), contains two modifications: an attenuating mutation in the S-adenosylmethionine (SAM) binding site of the viral mRNA cap methyltransferase (MTase) within the large (L) polymerase protein and a mutation in the attachment (G) glycoprotein that inhibits its cleavage during production in Vero cells, resulting in virus with a "noncleaved G" (ncG). RSV virions containing the ncG have an increased ability to infect primary well-differentiated human bronchial epithelial (HBE) cultures which model the in vivo site of immunization, the ciliated airway epithelium. This RSV LAV candidate is produced efficiently in Vero cells, is highly attenuated in HBE cultures, efficiently induces neutralizing antibodies that are long lasting, and provides protection against an RSV challenge in the cotton rat, without causing enhanced disease. Similar results were obtained in a rhesus macaque.IMPORTANCE Globally, respiratory syncytial virus (RSV) is a major cause of death in children under 1 year of age, yet no vaccine is available. We have generated a novel RSV live attenuated vaccine candidate containing mutations in the L and G proteins. The L polymerase mutation does not inhibit virus yield in Vero cells, the cell type required for vaccine production, but greatly reduces virus spread in human bronchial epithelial (HBE) cultures, a logical in vitro predictor of in vivo attenuation. The G attachment protein mutation reduces its cleavage in Vero cells, thereby increasing vaccine virus yield, making vaccine production more economical. In cotton rats, this RSV vaccine candidate is highly attenuated at a dose of 105 PFU and completely protective following immunization with 500 PFU, 200-fold less than the dose usually used in such studies. It also induced long-lasting antibodies in cotton rats and protected a rhesus macaque from RSV challenge. This mutant virus is an excellent RSV live attenuated vaccine candidate.
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Affiliation(s)
- Tiffany Jenkins
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Rongzhang Wang
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Olivia Harder
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Miaoge Xue
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Phylip Chen
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Jacqueline Corry
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Christopher Walker
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Michael Teng
- Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Asuncion Mejias
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Octavio Ramilo
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stefan Niewiesk
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Jianrong Li
- Department of Veterinary Biosciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Mark E Peeples
- Center for Vaccines and Immunity, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Cafone J, Kennedy K, Corry J, Lee J. A COMMON THERAPY FOR ALLERGIC REACTION YET A RARELY SUSPECTED CAUSE OF HYPERSENSITIVITY. Ann Allergy Asthma Immunol 2018. [DOI: 10.1016/j.anai.2018.09.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Pollard A, Burchell J, Castle D, Neilson K, Ftanou M, Corry J, Rischin D, Kissane D, Krishnasamy M, Carlson L, Couper J. Individualised mindfulness-based stress reduction for head and neck cancer patients undergoing radiotherapy of curative intent: a descriptive pilot study. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12474] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2016] [Indexed: 02/04/2023]
Affiliation(s)
- A. Pollard
- Department of Clinical Psychology, Psychosocial Oncology; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
| | - J.L. Burchell
- Department of Psychiatry; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Department of Medicine; St. Vincent's Hospital; The University of Melbourne; Fitzroy Vic. Australia
| | - D. Castle
- Department of Psychiatry; St. Vincent's Hospital and University of Melbourne; Fitzroy Vic. Australia
| | - K. Neilson
- Department of Clinical Psychology; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - M. Ftanou
- Department of Clinical Psychology; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
| | - J. Corry
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
| | - D. Rischin
- Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- University of Melbourne; Melbourne Vic. Australia
| | - D.W. Kissane
- Department of Psychiatry; Monash Medical Centre; Monash University; Clayton Vic. Australia
| | - M. Krishnasamy
- Department of Patient Cancer Experiences; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
| | - L.E. Carlson
- Department of Psychosocial Resources; Holy Cross Site Cancer Control Alberta; Calgary AB Canada
- Department of Oncology; Cumming School of Medicine; University of Calgary; Calgary AB Canada
| | - J. Couper
- Department of Psychiatry; Psychosocial Oncology; Peter MacCallum Cancer Centre; Melbourne Vic. Australia
- Department of Psychiatry; St. Vincent's Hospital and University of Melbourne; Fitzroy Vic. Australia
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13
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Young RJ, Urban D, Angel C, Corry J, Lyons B, Vallance N, Kleid S, Iseli TA, Solomon B, Rischin D. Frequency and prognostic significance of p16(INK4A) protein overexpression and transcriptionally active human papillomavirus infection in laryngeal squamous cell carcinoma. Br J Cancer 2015; 112:1098-104. [PMID: 25688737 PMCID: PMC4366899 DOI: 10.1038/bjc.2015.59] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 11/18/2014] [Accepted: 01/19/2015] [Indexed: 12/30/2022] Open
Abstract
Background: Human papillomavirus (HPV) infection is a powerful prognostic biomarker in a subset of head and neck squamous cell carcinomas, specifically oropharyngeal cancers. However, the role of HPV in non-oropharyngeal sites, such as the larynx, remains unconfirmed. Methods: We evaluated a cohort of 324 laryngeal squamous cell carcinoma (LSCC) patients for the expression of p16INK4A (p16) protein by immunohistochemistry (IHC) and for high-risk HPV E6 and E7 mRNA transcripts by RNA in situ hybridisation (ISH). p16 expression and HPV status were correlated with clinicopathological features and outcomes. Results: Of 307 patients assessable for p16 IHC, 20 (6.5%) were p16 positive. Females and node-positive patients were more likely to be p16 positive (P<0.05). There were no other significant clinical or demographic differences between p16-positive and -negative cases. There was no difference in overall survival (OS) between p16-positive and -negative patients with 2-year survival of 79% in each group (HR=0.83, 95% CI 0.36–1.89, P=0.65). There was no statistically significant difference in failure-free survival (FFS) with 2-year FFS of 79% and 66% for p16-positive and -negative patients, respectively (HR=0.60, 95% CI 0.26–1.36, P=0.22). Only seven cases were found to be HPV RNA ISH positive, all of which were p16 IHC positive. There was no statistically significant difference in OS between patients with HPV RNA ISH-positive tumours compared with -negative tumours with 2-year survival of 86% and 71%, respectively (HR=0.76, 95% CI 0.23–2.5, P=0.65). The 2-year FFS was 86% and 59%, respectively (HR=0.62, 95% CI 0.19–2.03, P=0.43). Conclusions: p16 overexpression is infrequent in LSCC and the proportion of cases with high-risk HPV transcripts is even lower. There are no statistically significant correlations between p16 IHC or HPV RNA ISH status and OS or disease outcomes.
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Affiliation(s)
- R J Young
- 1] Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - D Urban
- 1] Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia [2] Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C Angel
- 1] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia [2] Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J Corry
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - B Lyons
- Department of Surgery, St Vincent's Hospital, Melbourne, Australia
| | - N Vallance
- Department of Otorhinolaryngology, Monash Medical Centre, Melbourne, Australia
| | - S Kleid
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T A Iseli
- Department of Surgery, Melbourne University, Royal Melbourne Hospital, Melbourne, Australia
| | - B Solomon
- 1] Research Division, Peter MacCallum Cancer Centre, Melbourne, Australia [2] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia [3] Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - D Rischin
- 1] Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia [2] Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Lim A, Wong N, Pidsley R, Zontenko E, Corry J, Dobrovic A, Solomon B, Rischin D, Clark S. PO-097: Genome-scale methylation assessment did not identify prognostic biomarkers in oral tongue carcinomas. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)34857-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: 10/23/2022]
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15
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Lim A, Candiloro I, Wong N, Collins M, Do H, Angel C, Corry J, Rischin D, Solomon B, Dobrovic A. Reassessing Locus-Specific DNA Methylation in Head-and-Neck Squamous Cell Carcinoma (HNSCC) With Quantitative Methodology and Correlation With Patient Outcome. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2013.11.149] [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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16
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Webster Marketon JI, Corry J, Teng MN. The respiratory syncytial virus (RSV) nonstructural proteins mediate RSV suppression of glucocorticoid receptor transactivation. Virology 2014; 449:62-9. [PMID: 24418538 PMCID: PMC3904736 DOI: 10.1016/j.virol.2013.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/12/2013] [Accepted: 11/06/2013] [Indexed: 12/22/2022]
Abstract
Respiratory syncytial virus (RSV)-induced bronchiolitis in infants is not responsive to glucocorticoids. We have shown that RSV infection impairs glucocorticoid receptor (GR) function. In this study, we have investigated the mechanism by which RSV impairs GR function. We have shown that RSV repression of GR-induced transactivation is not mediated through a soluble autocrine factor. Knock-down of mitochondrial antiviral signaling protein (MAVS), but not retinoic acid-inducible gene 1 (RIG-I) or myeloid differentiation primary response gene 88 (MyD88), impairs GR-mediated gene activation even in mock-infected cells. Over-expression of the RSV nonstructural protein NS1, but not NS2, impairs glucocorticoid-induced transactivation and viruses deleted in NS1 and/or NS2 are unable to repress glucocorticoid-induction of the known GR regulated gene glucocorticoid-inducible leucine zipper (GILZ). These data suggest that the RSV nonstructural proteins mediate RSV repression of GR-induced transactivation and that inhibition of the nonstructural proteins may be a viable target for therapy against RSV-related disease.
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Affiliation(s)
- Jeanette I Webster Marketon
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus, OH 43210, United States; Institute for Behavioral Medicine Research, Wexner Medical Center at The Ohio State University, Columbus, OH 43210, United States.
| | - Jacqueline Corry
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus, OH 43210, United States.
| | - Michael N Teng
- Joy McCann Culverhouse Airway Disease Research Center, Division of Allergy and Immunology, Department of Internal Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, United States
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Shah K, Te Marvelde L, Collins M, Lau E, Rischin D, Jarman S, Corry J. EP-1087: Post treatment PET-CT to stratify follow-up for head and neck cancers - a matched cohort analysis of safety and cost. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)31205-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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Webster Marketon JI, Corry J. Respiratory syncytial virus (RSV) suppression of glucocorticoid receptor phosphorylation does not account for repression of transactivation. FEBS Open Bio 2013; 3:305-9. [PMID: 23951552 PMCID: PMC3741917 DOI: 10.1016/j.fob.2013.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 05/31/2013] [Revised: 06/28/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022] Open
Abstract
Respiratory syncytial virus (RSV)-induced bronchiolitis in infants, although inflammatory in nature, is not responsive to glucocorticoids. We have recently shown that RSV-infected lung epithelial cells have impaired glucocorticoid receptor (GR)-mediated transactivation. In this study, we show that the N-terminal region of GR is required for RSV repression of GR transactivation and that RSV infection of lung epithelial cells reduces ligand-dependent GR phosphorylation at serine 211 and serine 226. However, we also show that these changes in GR phosphorylation do not account for the RSV repression of GR transactivation suggesting other regions of the GR N-terminus must also be involved.
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Affiliation(s)
- Jeanette I Webster Marketon
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus, OH 43210, United States ; Institute for Behavioral Medicine Research, Wexner Medical Center at The Ohio State University, Columbus, OH 43210, United States
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19
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Webster Marketon JI, Corry J. Poly I:C and respiratory syncytial virus (RSV) inhibit glucocorticoid receptor (GR)-mediated transactivation in lung epithelial, but not monocytic, cell lines. Virus Res 2013; 176:303-6. [PMID: 23830998 DOI: 10.1016/j.virusres.2013.06.011] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 06/20/2013] [Accepted: 06/21/2013] [Indexed: 12/23/2022]
Abstract
Respiratory syncytial virus (RSV)-induced bronchiolitis in infants is not responsive to glucocorticoids. We have recently shown that RSV infection of lung epithelial cells impairs glucocorticoid receptor (GR) function. In this current study, we have shown that the viral mimic poly I:C also represses GR-mediated gene activation in lung epithelial cells, suggesting that this might be a common phenomenon of other viral infections. However, we also show that neither RSV infection nor poly I:C affect GR-mediated gene activation in the monocytic cell line THP-1, suggesting that these effects on GR function may be cell-type specific.
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Affiliation(s)
- Jeanette I Webster Marketon
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, Wexner Medical Center at The Ohio State University, Columbus, OH 43210, United States.
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20
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Mitchell PB, Johnston AK, Frankland A, Slade T, Green MJ, Roberts G, Wright A, Corry J, Hadzi-Pavlovic D. Bipolar disorder in a national survey using the World Mental Health Version of the Composite International Diagnostic Interview: the impact of differing diagnostic algorithms. Acta Psychiatr Scand 2013; 127:381-93. [PMID: 22906117 DOI: 10.1111/acps.12005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The World Mental Health Version of the Composite International Diagnostic Interview (WMH-CIDI) DSM-IV bipolar disorder diagnostic algorithms were recalibrated in about 2006 following evidence of over-diagnosis of bipolar I disorder. There have been no reports of the impact of this recalibration on epidemiological findings. METHOD Data were taken from the 2007 Australian National Survey of Mental Health and Wellbeing. Findings for cases identified by the recalibrated bipolar disorder definition were contrasted against those identified by the un-recalibrated definition. RESULTS The 12-month prevalence of recalibrated bipolar disorder and un-recalibrated bipolar disorder were 0.9% and 1.7% respectively. The un-recalibrated bipolar disorder group was younger and more likely to have never married than the recalibrated bipolar disorder group. They were also more likely to have a comorbid alcohol use disorder, substance use disorder and asthma or arthritis. While they were more likely to have at least severe interference in at least one of the Sheehan Scale domains of functioning, they were less likely to have made a suicide attempt. Similarly, they were less likely to have consulted a psychiatrist. CONCLUSION It is not possible to be certain about the nature of these differences. Some may be artifactual (reflecting greater statistical power to detect differences with the larger un-recalibrated bipolar disorder defined sample), while others may be indicative of the inclusion of a clinically distinct subpopulation with the un-recalibrated bipolar disorder definition, thereby producing a more heterogeneous sample. These findings indicate the need for clarity in the diagnostic algorithm used in epidemiological reports on bipolar disorder using the World Mental Health Version of the Composite International Diagnostic Interview.
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Affiliation(s)
- P B Mitchell
- School of Psychiatry, University of New South Wales, Sydney, Australia.
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21
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Salazar R, James E, Elsayed M, Varelas P, Bartscher J, Corry J, Abdelhak T. Profuse sialorrhea in a case of anti N-methyl-d-aspartate receptor (NMDAR) encephalitis. Clin Neurol Neurosurg 2012; 114:1066-9. [DOI: 10.1016/j.clineuro.2012.02.011] [Citation(s) in RCA: 4] [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] [Received: 11/28/2011] [Revised: 02/04/2012] [Accepted: 02/07/2012] [Indexed: 10/28/2022]
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Burnsides C, Corry J, Alexander J, Balint C, Cosmar D, Phillips G, Marketon JIW. Ex vivo stimulation of whole blood as a means to determine glucocorticoid sensitivity. J Inflamm Res 2012; 5:89-97. [PMID: 22952414 PMCID: PMC3430009 DOI: 10.2147/jir.s33569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Glucocorticoids are commonly prescribed to treat a number of diseases including the majority of inflammatory diseases. Despite considerable interpersonal variability in response to glucocorticoids, an insensitivity rate of about 30%, and the risk of adverse side effects of glucocorticoid therapy, currently no assay is performed to determine sensitivity. PATIENTS AND METHODS Here we propose a whole blood ex vivo stimulation assay to interrogate known glucocorticoid receptor (GR) up- and downregulated genes to indicate glucocorticoid sensitivity. We have chosen to employ real-time PCR in order to provide a relatively fast and inexpensive assay. RESULTS We show that the GR-regulated genes, GILZ and FKBP51, are upregulated in whole blood by treatment with dexamethasone and that LPS-induction of cytokines (IL-6 and TNFα) are repressed by dexamethasone in a dose responsive manner. There is considerable interpersonal variability in the maximum induction of these genes but little variation in the EC(50) and IC(50) concentrations. The regulation of the GR-induced genes differs throughout the day whereas the suppression of LPS-induced cytokines is not as sensitive to time of day. CONCLUSION In all, this assay would provide a method to determine glucocorticoid receptor responsiveness in whole blood.
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Affiliation(s)
- Christopher Burnsides
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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23
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Hong AM, Martin A, Armstrong BK, Lee CS, Jones D, Chatfield MD, Zhang M, Harnett G, Clark J, Elliott M, Milross C, Smee R, Corry J, Liu C, Porceddu S, Vaska K, Veness M, Morgan G, Fogarty G, Veivers D, Rees G, Rose B. Human papillomavirus modifies the prognostic significance of T stage and possibly N stage in tonsillar cancer. Ann Oncol 2012; 24:215-9. [PMID: 22887467 DOI: 10.1093/annonc/mds205] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Despite the association with more advanced nodal stage, patients with human papillomavirus (HPV) positive oropharyngeal cancers have better outcomes. We examined whether the HPV can modify the effect of known prognostic factors in tonsillar cancer. PATIENTS AND METHODS A total of 489 patients from 10 centres were followed up for recurrence or death for a median of 3.2 years. Determinants of the rate of locoregional recurrence, death from tonsillar cancer and overall survival were modelled using Cox regression. RESULTS The prognostic value of T and N stages were modified by HPV as indicated by statistically significant interaction terms. After adjusting for age, gender and treatment, T stage appeared relevant only for HPV-positive cancers (where a higher T stage was associated with worse outcomes). There was some evidence that N stage was a more relevant prognostic factor for HPV-negative than -positive cancers. There was no evidence that the HPV modifies the effect of age, gender or grade on outcomes. CONCLUSIONS This study suggests that the prognostic significance of the conventional staging system in tonsillar cancer is modified by HPV.
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Affiliation(s)
- A M Hong
- Sydney Medical School, The University of Sydney, and Department of Radiation Oncology, Royal Prince Alfred Hospital, Sydney, Australia.
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Varelas P, Abdelhak T, Corry J, James E, Rai V, Patel K, Schultz L, Bartscher J. Treating Status Epilepticus in Specialized Versus General Intensive Care Units: Is Outcome Better? (P06.271). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p06.271] [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: 11/15/2022] Open
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Saltzman R, Kelleher M, Brown-Whitehorn T, Fiedler J, Corry J, Gober L, Dudek E, Cianferoni A, Spergel J. Milk Oral Immunotherapy: A Single-Center Pilot Study of Safety and Efficacy. J Allergy Clin Immunol 2012. [DOI: 10.1016/j.jaci.2011.12.956] [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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Montero RS, James E, Elsayed M, Varelas P, Bartscher J, Corry J, Abdelhak T. 1.246 PROFUSE SIALORRHEA AND HEMIBALLISM IN A CASE OF ANTI N-METHYL-D-ASPARTATE RECEPTOR (NMDAR) ENCEPHALITIS. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70304-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mak D, Corry J, Lau E, Rischin D, Hicks RJ. Role of FDG-PET/CT in staging and follow-up of head and neck squamous cell carcinoma. Q J Nucl Med Mol Imaging 2011; 55:487-499. [PMID: 22019706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The established and emerging roles of FDG positron-emission tomography/computed tomography (PET/CT) in the evaluation of squamous cell carcinoma of head and neck region is reviewed with a strong clinical focus on recommended applications and methodologies. In the staging of newly diagnosed disease, detection of cervical nodal involvement is the major indication but exclusion of distant metastases and of synchronous primary malignancy is also a valuable adjunct. Use in radiotherapy planning is advantageous for locally-advanced disease. Although there are few data yet to assess the use of FDG PET/CT to assess response during therapy, there is good evidence that this technique can accurately assess the post-treatment neck to identify those who might benefit from salvage therapy and those in whom observation or palliative treatment might be more appropriate. Although more expensive than other imaging modalities used for assessing this disease, the superior diagnostic accuracy and impact of incremental information provided by this technology has been shown to be cost-effective in several clinical scenarios.
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Affiliation(s)
- D Mak
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Australia
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Trinkaus ME, Hicks RJ, Young RJ, Peters LJ, Solomon BJ, Bressel M, Corry J, Fisher R, Binns D, McArthur GA, Rischin D. Correlation of HPV status and hypoxic imaging using [18F]-misonidazole (FMISO) PET in head and neck squamous cell carcinoma (HNSCC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5527] [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: 11/20/2022] Open
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29
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Haworth A, Grand M, Corry J, Jackson M, Ng M, Kron T, Burmeister B, Cornes D, Amin R, Duchesne G. 1579 poster COSTLY NEW TREATMENTS – WHAT SHOULD WE PAY FOR? Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71701-7] [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: 11/28/2022]
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Hinzey A, Alexander J, Corry J, Adams KM, Claggett AM, Traylor ZP, Davis IC, Webster Marketon JI. Respiratory syncytial virus represses glucocorticoid receptor-mediated gene activation. Endocrinology 2011; 152:483-94. [PMID: 21190962 PMCID: PMC3037158 DOI: 10.1210/en.2010-0774] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Respiratory syncytial virus (RSV) is a common cause of bronchiolitis in infants. Although antiinflammatory in nature, glucocorticoids have been shown to be ineffective in the treatment of RSV-induced bronchiolitis and wheezing. In addition, the effectiveness of glucocorticoids at inhibiting RSV-induced proinflammatory cytokine production in cell culture has been questioned. In this study, we have investigated the effect of RSV infection on glucocorticoid-induced gene activation in lung epithelium-derived cells. We show that RSV infection inhibits dexamethasone induction of three glucocorticoid receptor (GR)-regulated genes (glucocorticoid-inducible leucine zipper, FK506 binding protein, and MAPK phosphatase 1) in A549, BEAS-2B cells, and primary small airway epithelial cells. UV irradiation of the virus prevents this repression, suggesting that viral replication is required. RSV is known to activate the nuclear factor κB (NFκB) pathway, which is mutually antagonistic towards the GR pathway. However, specific inhibition of NFκB had no effect on the repression of GR-induced genes by RSV infection, indicating that RSV repression of GR is independent of NFκB. RSV infection of A549 cells does not alter GR protein levels or GR nuclear translocation but does reduce GR binding to the promoters of the glucocorticoid responsive genes analyzed in this study. Repression of GR by RSV infection may account for the apparent clinical ineffectiveness of glucocorticoids in RSV bronchiolitis therapy. In addition, this data adds to our previously published data suggesting that GR may be a general target for infectious agents. Identifying the mechanisms through which this suppression occurs may lead to the development of novel therapeutics.
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Affiliation(s)
- Adam Hinzey
- Division of Pulmonary, Department of Internal Medicine, The Ohio State University, Columbus, Ohio 43210, USA
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Koay K, Schofield P, Gough K, Buchbinder R, Rischin D, Corry J, Jefford M. An evaluation of health literacy (HL) in a consecutive sample of patients (pts) with cancer (ca) of the head and neck (H+N) region. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.9069] [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: 11/20/2022] Open
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Germain F, Brennan S, Corry J, Herschtal A. 196 HYPOPHARYNX CARCINOMA – REVIEW OF THE PETER MACCALLUM CANCER CENTRE (PMCC) EXPERIENCE. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72583-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Corry J, Poon W, McPhee N, Milner AD, Cruickshank D, Porceddu SV, Rischin D, Peters LJ. Randomized study of percutaneous endoscopic gastrostomy versus nasogastric tubes for enteral feeding in head and neck cancer patients treated with (chemo)radiation. J Med Imaging Radiat Oncol 2009; 52:503-10. [PMID: 19032398 DOI: 10.1111/j.1440-1673.2008.02003.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Percutaneous endoscopic gastrostomy (PEG) tubes have largely replaced nasogastric tubes (NGT) for nutritional support of patients with head and neck cancer undergoing curative (chemo)radiotherapy without any good scientific basis. A randomized trial was conducted to compare PEG tubes and NGT in terms of nutritional outcomes, complications, patient satisfaction and cost. The study was closed early because of poor accrual, predominantly due to patients' reluctance to be randomized. There were 33 patients eligible for analysis. Nutritional support with both tubes was good. There were no significant differences in overall complication rates, chest infection rates or in patients' assessment of their overall quality of life. The cost of a PEG tube was 10 times that of an NGT. The duration of use of PEG tubes was significantly longer, a median 139 days compared with a median 66 days for NGT. We found no evidence to support the routine use of PEG tubes over NGT in this patient group.
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Affiliation(s)
- J Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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35
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Ng MK, Porceddu SV, Milner AD, Corry J, Hornby C, Hope G, Rischin D, Peters LJ. Parotid-sparing radiotherapy: does it really reduce xerostomia? Clin Oncol (R Coll Radiol) 2006; 17:610-7. [PMID: 16372486 DOI: 10.1016/j.clon.2005.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 11/21/2022]
Abstract
AIMS Parotid-sparing radiotherapy (PSRT) was introduced for patients with selected head and neck cancer requiring bilateral upper-neck irradiation at our centre in 2000. The aim of this study was to compare the subjective degree of xerostomia in patients treated with PSRT between January 2000 and June 2003 with patients treated using conventional techniques (radiotherapy) over the same period. MATERIALS AND METHODS Eligible patients were required to have completed treatment 6 months previously and be recurrence-free at the time of interview. PSRT was defined as conformal radiotherapy, in which the mean dose to at least one parotid gland was 33 Gy or less, as determined by the dose-volume histogram. Patients receiving radiotherapy were treated with standard parallel-opposed fields, such that both parotids received a minimum of 40 Gy. Xerostomia was assessed using a validated questionnaire containing six questions with a rating between 0 and 10. Lower scores indicated less difficulty with xerostomia. RESULTS Thirty-eight eligible patients treated with PSRT were identified: 25 with oropharyngeal cancer and 13 with nasopharyngeal cancer (NPC). The mean overall questionnaire score (Q1-5) for this group was 4.20 (standard error = 0.33). Forty-four patients (24 oropharyngeal, 21 NPC) treated with radiotherapy over the same period were eligible. The mean overall questionnaire score (Q1-5) for this group was 5.86 (standard error = 0.35). The difference in mean overall scores between the two groups of patients was statistically significant (P < 0.001), as were the scores for four of the six individual questions. CONCLUSION These results suggest that PSRT offers improved long-term xerostomia-related quality of life compared with conventional radiotherapy.
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Affiliation(s)
- M K Ng
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
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Corry J, Fisher R, Rischin D, Porceddu S, Peters LJ. Clinical verification of the superiority of the current International Union Against Cancer staging criteria in an Australian population of patients with nasopharyngeal carcinoma. ACTA ACUST UNITED AC 2004; 48:509-15. [PMID: 15601332 DOI: 10.1111/j.1440-1673.2004.01356.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The purpose of this study is to assess the prognostic abilities of the fourth and fifth edition International Union Against Cancer (UICC) staging systems for nasopharyngeal carcinoma (NPC) in Australian patients. All patients planned for curative treatment at the Peter MacCallum Cancer Centre from April 1985 to December 1999 were included in this study. There were 181 patients eligible for this study. The median follow up was 7.6 years. Histological subgroups were World Health Organization (WHO) 1 (23), WHO 2 (12), and WHO 3 (146). Presentation with stage IV disease was 83% by UICC fourth edition staging and 34% by UICC fifth edition staging. The 5 years failure-free survival (FFS) rates for stage 1, 2, 3 and 4 disease by the fourth edition was 77, 100, 93, and 49% respectively,and by the fifth edition was 85, 76, 57 and 36%, respectively. The 5 years overall survival (OS) for stage 1, 2, 3, and 4 disease by the fourth edition was 77, 100, 100 and 61%; respectively, and by the fifth edition was 85, 82, 67 and 53%, respectively. Stage 4 patients by the fourth edition were reclassified as stages 2, 3 and 4 by the fifth edition with hazard ratios of 0.77, 1.01 and 1.79, respectively. In multifactor analysis, the fifth edition staging system was significantly related to FFS and OS after allowing for the fourth edition (FFS: P = 0.002; OS: P = 0.005), but the fourth edition was not significantly related to FFS or OS after allowing for the fifth edition (FFS: P = 0.96; OS: P = 0.96). This study confirms the prognostic superiority of the fifth edition UICC staging system over the fourth edition staging system in an Australian NPC population.
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Affiliation(s)
- J Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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Rischin D, Hicks R, Fisher R, Binns D, Corry J, Porceddu S, Grossi M, O'Kane C, Peters L. 491 The prognostic significance of 18F-misonidazole (FMISO) PET-detected tumor hypoxia in patients with advanced head and neck cancer randomly assigned to chemoradiation with and without tirapazamine. EJC Suppl 2004. [DOI: 10.1016/s1359-6349(04)80499-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Hicks R, Rischin D, Fisher R, Binns D, Corry J, Porceddu S, Grossi M, Okane C, Peters L. Superiority of tirapazamine-containing chemoradiation in head and neck cancers showing evidence of hypoxia on 18F-misonidazole (FMISO) pet scanning. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.5520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- R. Hicks
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - D. Rischin
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - R. Fisher
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - D. Binns
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J. Corry
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - S. Porceddu
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - M. Grossi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - C. Okane
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - L. Peters
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Issakidis C, Sanderson K, Corry J, Andrews G, Lapsley H. Modelling the population cost-effectiveness of current and evidence-based optimal treatment for anxiety disorders. Psychol Med 2004; 34:19-35. [PMID: 14971624 DOI: 10.1017/s003329170300881x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [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: 11/07/2022]
Abstract
BACKGROUND The present paper describes a component of a large population cost-effectiveness study that aimed to identify the averted burden and economic efficiency of current and optimal treatment for the major mental disorders. This paper reports on the findings for the anxiety disorders (panic disorder/agoraphobia, social phobia, generalized anxiety disorder, post-traumatic stress disorder and obsessive compulsive disorder). METHOD Outcome was calculated as averted 'years lived with disability' (YLD), a population summary measure of disability burden. Costs were the direct health care costs in 1997-8 Australian dollars. The cost per YLD averted (efficiency) was calculated for those already in contact with the health system for a mental health problem (current care) and for a hypothetical optimal care package of evidence-based treatment for this same group. Data sources included the Australian National Survey of Mental Health and Well-being and published treatment effects and unit costs. RESULTS Current coverage was around 40% for most disorders with the exception of social phobia at 21%. Receipt of interventions consistent with evidence-based care ranged from 32% of those in contact with services for social phobia to 64% for post-traumatic stress disorder. The cost of this care was estimated at dollar 400 million, resulting in a cost per YLD averted ranging from dollar 7761 for generalized anxiety disorder to dollar 34 389 for panic/agoraphobia. Under optimal care, costs remained similar but health gains were increased substantially, reducing the cost per YLD to < dollar 20 000 for all disorders. CONCLUSIONS Evidence-based care for anxiety disorders would produce greater population health gain at a similar cost to that of current care, resulting in a substantial increase in the cost-effectiveness of treatment.
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Affiliation(s)
- C Issakidis
- School of Psychiatry, University of New South Wales, WHO Collaborating Centre for Evidence and Health Policy in Mental Health, St Vincent's Hospital, Sydney, NSW, Australia
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Abstract
A case of chronic, fluctuating plasma cell gingivostomatitis that progressed despite chemotherapy and surgery is reported. This is the first case reported of treatment with radiation therapy, and one of the few cases reported where the infiltrate has reached the larynx. After receiving low dose radiation therapy, via a conformal technique encompassing the respiratory mucosal lining from the base of tongue to carina, there has been symptomatic improvement.
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Affiliation(s)
- G Fogarty
- Peter MacCallum Cancer Institute, St Andrews Place, East Melbourne, Victoria, Australia.
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Corry J, Smith JG, Peters LJ. The concept of a planned neck dissection is obsolete. Cancer J 2001; 7:472-4. [PMID: 11769857] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- J Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia
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Ma B, Corry J, Rischin D, Leong T, Peters LJ. Combined modality treatment for locally advanced squamous-cell carcinoma of the oropharynx in a woman with Bloom's syndrome: a case report and review of the literature. Ann Oncol 2001; 12:1015-7. [PMID: 11521786 DOI: 10.1023/a:1011106202939] [Citation(s) in RCA: 14] [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: 11/12/2022] Open
Abstract
We describe a case of locally advanced unresectable squamous-cell carcinoma of the oropharynx in a young woman with Bloom's syndrome. She was treated with radical radiation therapy and concurrent chemotherapy (cisplatin and 5-flurouracil). She was unable to complete treatment due to the development of severe side effects: confluent mucositis, moist desquamating skin reaction, severe diarrhea and severe myelosupression with neutropenic sepsis. The limited relevant literature is presented. We conclude that chemotherapy should be used with extreme caution in Bloom's syndrome patients.
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Affiliation(s)
- B Ma
- Division of Medical Oncology, Petcr MacCallum Cancer Institute, Melbourne, Victoria, Australia
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Corry J, Rischin D, Smith JG, D'Costa IA, Huges PG, Sexton MA, Sizeland A, Lyons B, Peters LJ. Radiation with concurrent late chemotherapy intensification ('chemoboost') for locally advanced head and neck cancer. Radiother Oncol 2000; 54:123-7. [PMID: 10699474 DOI: 10.1016/s0167-8140(99)00182-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [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: 11/19/2022]
Abstract
The aim of this study was to review our experience with a treatment regimen that combined conventionally fractionated radiation therapy (70 Gy over 7 weeks) with chemotherapy (cisplatin and fluorouracil), given concurrently in the last 2 weeks of radiation therapy in patients with previously untreated advanced squamous cell cancer of the head and neck region.Twenty-eight patients, all but two having UICC stage IV disease, were treated at the Peter MacCallum Cancer Institute between November 1995 and April 1998. Planned chemotherapy consisted initially of continuous infusion at 10 mg/m(2) per day of cisplatin and 400 mg/m(2) per day of fluorouracil on days 1-5 of weeks 6 and 7 of a conventionally fractionated course of radiotherapy. After the first 14 patients, the dose of fluorouracil was reduced to 360 mg/m(2) per day because of acute toxicity.36.8 months), with an estimated 50% surviving at 2 years (CI, 29-71%). Sixteen patients (57%) developed confluent mucositis and 11 (39%) developed patchy mucositis. The median duration of mucositis for these 27 patients was 1.5 months. Seventeen patients (61%) required nutritional support for a median duration of 1.4 months. Fourteen patients (50%) had grade three skin reactions, and 12 (43%) had one or more other significant (Grade 3) toxicities, predominantly infective. Grade 3 late toxicity has been observed in three patients to date (three xerostomia, including one with severe depression), and one patient had chronic ulceration of the oral tongue (grade 4). This chemoradiation regimen achieved an excellent complete response rate and good locoregional control at 2 years in patients with a poor initial prognosis. Acute toxicity was significant but manageable. The regimen offers an alternative to surgery and postoperative radiation therapy in locally advanced head and neck cancer.
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Affiliation(s)
- J Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Institute, St. Andrews Place, East, Melbourne, Australia
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Abstract
PURPOSE The aim of this retrospective study was to review our experience of radiation therapy to regional nodes in patients with proven nodal metastases, with respect to regional control, late toxicity, and overall survival. METHODS AND MATERIALS All patients with a histological diagnosis of malignant melanoma, with involvement of the regional nodes but without distant metastases, who commenced nodal irradiation between January 1985 and July 1995 at Peter MacCallum Cancer Institute were studied. The study population of 113 patients was divided into two categories: those with no residual macroscopic disease following nodal surgery (adjuvant group, 42 patients) and those who had no surgery (8) or had macroscopic residual disease following nodal surgery (63) (palliative group, 71 patients). RESULTS In the adjuvant group at 5 years following commencement of nodal irradiation 26% were estimated to be failure-free. Of the 74% who had experienced treatment failure by 5 years, an estimated 20% failed first with nodal relapse, 52% with distant metastases, and 2% with both nodal relapse and distant metastases. The estimated 5-year overall survival for this group was 33%. In the palliative group 16 patients (23%) had an objective complete response. Altogether 48 patients (68%) had a symptomatic response. At 5 years the overall survival in this group was 8% and an estimated 4% were failure-free. Of the 96% who had failed by 5 years, 68% failed first in the regional nodes, 25% had distant metastases as the first failure, and 3% had both nodal relapse and distant metastases. CONCLUSION We recommend adjuvant postoperative radiation therapy for patients with proven nodal metastases and high risk of regional recurrence (multiple nodes, extracapsular extension, or recurrent nodal disease) in addition to adjuvant interferon.
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Affiliation(s)
- J Corry
- Division of Radiation Oncology, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
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Wirth A, Chao M, Corry J, Laidlaw C, Yuen K, Ryan G, Byram D, Davis S, Kiffer J, Quong G, Liew K. Mantle irradiation alone for clinical stage I-II Hodgkin's disease: long-term follow-up and analysis of prognostic factors in 261 patients. J Clin Oncol 1999; 17:230-40. [PMID: 10458238 DOI: 10.1200/jco.1999.17.1.230] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [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: 11/20/2022] Open
Abstract
PURPOSE To evaluate mantle radiotherapy (MRT) alone as the initial therapy of patients with clinical stage (CS) I-II Hodgkin's disease (HD). PATIENTS AND METHODS We performed a retrospective study of patients treated with MRT alone for CS I-II supradiaphragmatic HD between 1969 and 1994. Prognostic factor analysis was performed for progression-free survival (PFS) and overall survival (OS). Outcome was also assessed in favorable cohorts defined in the literature. RESULTS There were 261 eligible patients. The median follow-up period for surviving patients was 8.4 years (range, 1.8 to 27.4 years). The 10-year OS rate was 73%. Multifactor analysis for OS showed that age was the only important prognostic factor. The 10-year PFS rate was 58%. On multifactor analysis for PFS, the most important prognostic factors were clinical stage, B symptoms, histology, number of sites, and tumor bulk. The 10-year PFS rate for lymphocyte-predominant disease was 81% for stage I and 78% for stage II. In favorable patient cohorts defined in the literature, the 10-year PFS rate ranged from 70% to 73% for the whole group and from 71% to 90% in patients with favorable stage I disease, but only from 48% to 57% in patients with favorable stage II disease. On competing-risks analysis, the cumulative 10-year incidence of first site of failure in the para-aortic/splenic region alone was 10.5%. Sixty percent of relapsed patients remain progression-free at 10 years after chemotherapy salvage. CONCLUSION These results support the use of MRT alone in patients with favorable CS I HD and CS I-II HD with lymphocyte-predominant histology. The remainder of patients with CS I-II HD require more intensive treatment.
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Affiliation(s)
- A Wirth
- Division of Radiation Oncology, Peter MacCallum Cancer Institute, Melbourne, Australia.
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Ryan J, Corry J, Speldewinde G. Endurance training to be no more effective than physiotherapy or chiropractic treatment in terms of reducing pain and disability or increasing muscle strength. Spine (Phila Pa 1976) 1998; 23:2147-9. [PMID: 9794063 DOI: 10.1097/00007632-199810010-00023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Wirth A, Smith JG, Ball DL, Mameghan H, Corry J, Bernshaw DL, Drummond RM. Symptom duration and delay in referral for palliative radiotherapy in cancer patients: a pilot study. Med J Aust 1998; 169:32-6. [PMID: 9695700 DOI: 10.5694/j.1326-5377.1998.tb141475.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [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: 11/17/2022]
Abstract
OBJECTIVE To estimate the frequency of delay in referral for palliative radiotherapy (PRT), and to identify factors associated with delay. DESIGN Prospective survey over three months in 1997. SETTING Radiotherapy department of a cancer centre in Melbourne, Victoria. PARTICIPANTS 158 consecutive patients prescribed PRT in the lung, breast, urology and haematology units. MAIN OUTCOME MEASURES Duration of symptoms; incidence of "unreasonable" delay in referral; and incidence of negative clinical outcome associated with referral delay. RESULTS The median duration of symptoms before prescription of radiotherapy was four weeks. Thirty-eight patients (24%) were considered to have had an unreasonable delay in referral, with median symptom duration of 15 weeks, and median delay in referral of 12 weeks. Causes of delay were classified as "diagnostic uncertainty" (29%), "other treatment given" (18%), "patient related" (18%), "language difficulty" (3%), and "unexplained" (32%). Twenty-seven of these 38 patients (71%) had negative outcomes, including persistent pain, neurological deterioration and persistent respiratory symptoms. CONCLUSIONS These data suggest that delay in referral for PRT is not uncommon, has a variety of causes and can result in negative clinical outcomes. There appears to be a need for greater awareness of patients' symptoms and of the role of PRT among clinicians caring for patients with cancer.
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Affiliation(s)
- A Wirth
- Peter MacCallum Cancer Institute, Melbourne, VIC.
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Corry J, Smith JG, Wirth A, Quong G, Liew KH. Primary central nervous system lymphoma: age and performance status are more important than treatment modality. Int J Radiat Oncol Biol Phys 1998; 41:615-20. [PMID: 9635710 DOI: 10.1016/s0360-3016(97)00571-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess prognostic factors and treatment modalities of patients with primary central nervous system lymphoma (PCNSL) in terms of response rates, patterns of failure and overall survival. METHODS AND MATERIALS Sixty-two patients presenting with PCNSL between 1982 and 1994 at Peter MacCallum Cancer Institute with no evidence of human immunodeficiency virus infection were included in the study. Their median age was 60 years; World Health Organisation (WHO) performance status was > or = 2 in 85%. All patients were planned to receive whole brain irradiation; 7 also received spinal irradiation. The median planned dose to the target volume was 50.4 Gy. Twenty patients were planned to receive chemotherapy as well. Patients were followed up to June 20, 1995, giving a median follow-up for 14 surviving patients of 5.4 years, range 0.3 to 10.2 years. RESULTS The clinical response rate to treatment was 77% [95% confidence interval (CI) 65 to 87%]. The estimated median overall survival was 20.6 months (CI 12.4 to 33.4 months). On univariate analysis male gender, age <60 years, WHO performance status < or = 1, treatment to the target volume > or = 45 Gy, and treatment with additional chemotherapy, were associated with a significantly better overall survival (p < 0.05). On multivariate analysis only age and performance status remained significant prognostic variables. Relapse involved the central nervous system or cerebrospinal fluid (CSF) in all patients with known sites of relapse except three who had ocular relapse only. There was a low incidence of relapse in the initial brain site (23% of known cases) and a high incidence (50%) of CSF/spinal cord relapse. Of 48 deaths, 15 were related to initial or subsequent treatment. CONCLUSIONS Patient outcome is strongly influenced by age and performance status. Studies suggesting better survival for patients treated with chemoradiation may reflect patient selection rather than treatment variables. Optimal management remains to be defined. The high CSF/spinal relapse rate deserves particular attention.
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Affiliation(s)
- J Corry
- Radiation Oncology Division, Peter MacCallum Cancer Institute, Melbourne, Victoria, Australia
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Abstract
PURPOSE This study aims to: 1) assess failure-free survival (FFS), overall survival (OS), and failure pattern after salvage radiotherapy (SRT) for patients with Hodgkin's disease (HD) who fail chemotherapy (CT); 2) identify patients suitable for SRT as an alternative to more aggressive salvage regimens. METHODS AND MATERIALS Between 1978 and 1992, 52 patients with relapsed/refractory HD following 26 CT received SRT at the Peter MacCallum Cancer Institute. Patient characteristics at diagnosis were: median age (range 12-63); male-31, female-21; Stage I-4, II-16, III-25, or IV-7. Prior to SRT 27 patients had received the equivalent of both MOPP and ABV(D). The duration of initial complete response (CR) from CT was greater than 12 months in 22 patients. SRT (dose 34-42 Gy) was given to active disease sites. RESULTS Five-year FFS and OS rates following SRT were 26 and 57%, respectively. Five-year FFS and OS rates of 36 and 75%, respectively, were achieved in patients who relapsed in supradiaphragmatic nodal sites without B symptoms; in a subset of patients with initial Stage I-II disease the FFS and OS rates were 50 and 86%, respectively. On multivariate analysis significant factors for FFS were B symptoms at the time of SRT (p = 0.003), extranodal involvement (p = 0.011) and histology (p = 0.018). For OS significant factors were B symptoms (p = 0.0007), age (p = 0.014) and number of prior CT regimens (p = 0.03). CONCLUSION The relatively poor results of SRT in terms of FFS justify the use of alternative salvage strategies for most patients with Hodgkin's disease who fail CT. However, SRT offers a low morbidity, potentially curative option for a subset of patients. Our data suggest that patients most suitable for SRT are those with relapse in supradiaphragmatic nodal sites and no B symptoms.
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Affiliation(s)
- A Wirth
- Division of Radiation Oncology, Peter MacCallum Cancer Institute, East Melbourne, Victoria, Australia
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Wirth A, Byram D, Chao M, Corry J, Davis S, Kiffer J, Laidlaw C, Quong G, Ryan G, Liew K. 78 Long term results of mantle irradiation(MRT) alone in 261 patients with clinical stage I–II supradiaphragmatic Hodgkin's disease. Int J Radiat Oncol Biol Phys 1997. [DOI: 10.1016/s0360-3016(97)80637-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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