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Sundaram R, Rooney K, Koteeswaran SK. The use of cerebral CT angiography as an ancillary investigation to support a clinical diagnosis of death using neurological criteria. Anaesthesia 2024; 79:321. [PMID: 37720964 DOI: 10.1111/anae.16132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2023] [Indexed: 09/19/2023]
Affiliation(s)
| | - K Rooney
- Royal Alexandra Hospital, Paisley, UK
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Nutting C, Finneran L, Roe J, Petkar I, Rooney K, Hall E. Dysphagia-optimised intensity-modulated radiotherapy versus standard radiotherapy in patients with pharyngeal cancer - Authors' reply. Lancet Oncol 2023; 24:e398. [PMID: 37797636 DOI: 10.1016/s1470-2045(23)00457-6] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Christopher Nutting
- Head and Neck Unit, The Royal Marsden Hospital, London, UK; Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK.
| | - Laura Finneran
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Justin Roe
- Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Imran Petkar
- Department of Oncology, Guys and St Thomas' Hospital, London, UK
| | - Keith Rooney
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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Nutting C, Finneran L, Roe J, Sydenham MA, Beasley M, Bhide S, Boon C, Cook A, De Winton E, Emson M, Foran B, Frogley R, Petkar I, Pettit L, Rooney K, Roques T, Srinivasan D, Tyler J, Hall E. Dysphagia-optimised intensity-modulated radiotherapy versus standard intensity-modulated radiotherapy in patients with head and neck cancer (DARS): a phase 3, multicentre, randomised, controlled trial. Lancet Oncol 2023; 24:868-880. [PMID: 37423227 DOI: 10.1016/s1470-2045(23)00265-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Most newly diagnosed oropharyngeal and hypopharyngeal cancers are treated with chemoradiotherapy with curative intent but at the consequence of adverse effects on quality of life. We aimed to investigate if dysphagia-optimised intensity-modulated radiotherapy (DO-IMRT) reduced radiation dose to the dysphagia and aspiration related structures and improved swallowing function compared with standard IMRT. METHODS DARS was a parallel-group, phase 3, multicentre, randomised, controlled trial done in 22 radiotherapy centres in Ireland and the UK. Participants were aged 18 years and older, had T1-4, N0-3, M0 oropharyngeal or hypopharyngeal cancer, a WHO performance status of 0 or 1, and no pre-existing swallowing dysfunction. Participants were centrally randomly assigned (1:1) using a minimisation algorithm (balancing factors: centre, chemotherapy use, tumour type, American Joint Committee on Cancer tumour stage) to receive DO-IMRT or standard IMRT. Participants and speech language therapists were masked to treatment allocation. Radiotherapy was given in 30 fractions over 6 weeks. Dose was 65 Gy to primary and nodal tumour and 54 Gy to remaining pharyngeal subsite and nodal areas at risk of microscopic disease. For DO-IMRT, the volume of the superior and middle pharyngeal constrictor muscle or inferior pharyngeal constrictor muscle lying outside the high-dose target volume had a mandatory 50 Gy mean dose constraint. The primary endpoint was MD Anderson Dysphagia Inventory (MDADI) composite score 12 months after radiotherapy, analysed in the modified intention-to-treat population that included only patients who completed a 12-month assessment; safety was assessed in all randomly assigned patients who received at least one fraction of radiotherapy. The study is registered with the ISRCTN registry, ISRCTN25458988, and is complete. FINDINGS From June 24, 2016, to April 27, 2018, 118 patients were registered, 112 of whom were randomly assigned (56 to each treatment group). 22 (20%) participants were female and 90 (80%) were male; median age was 57 years (IQR 52-62). Median follow-up was 39·5 months (IQR 37·8-50·0). Patients in the DO-IMRT group had significantly higher MDADI composite scores at 12 months than patients in the standard IMRT group (mean score 77·7 [SD 16·1] vs 70·6 [17·3]; mean difference 7·2 [95% CI 0·4-13·9]; p=0·037). 25 serious adverse events (16 serious adverse events assessed as unrelated to study treatment [nine in the DO-IMRT group and seven in the standard IMRT group] and nine serious adverse reactions [two vs seven]) were reported in 23 patients. The most common grade 3-4 late adverse events were hearing impairment (nine [16%] of 55 in the DO-IMRT group vs seven [13%] of 55 in the standard IMRT group), dry mouth (three [5%] vs eight [15%]), and dysphagia (three [5%] vs eight [15%]). There were no treatment-related deaths. INTERPRETATION Our findings suggest that DO-IMRT improves patient-reported swallowing function compared with standard IMRT. DO-IMRT should be considered a new standard of care for patients receiving radiotherapy for pharyngeal cancers. FUNDING Cancer Research UK.
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Affiliation(s)
- Christopher Nutting
- Head and Neck Unit, The Royal Marsden Hospital, London, UK; Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK.
| | - Laura Finneran
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Justin Roe
- Department of Speech, Voice and Swallowing, The Royal Marsden Hospital, London, UK; Department of Surgery and Cancer, Imperial College, London, UK
| | - Mark A Sydenham
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Matthew Beasley
- Bristol Cancer Institute, United Hospitals Bristol, Bristol, UK
| | - Shree Bhide
- Head and Neck Unit, The Royal Marsden Hospital, London, UK; The Institute of Cancer Research, London, UK
| | - Cheng Boon
- Oncology Department, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Audrey Cook
- Gloucestershire Oncology Centre, Cheltenham General Hospital, Cheltenham, UK
| | - Emma De Winton
- Department of Oncology, Royal United Hospital Bath, Bath, UK
| | - Marie Emson
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - Robert Frogley
- Patient and Carer's Advisory Group, The Royal Marsden Hospital, London, UK
| | - Imran Petkar
- Guys Cancer Centre, Guys and St Thomas' Hospital, London, UK
| | - Laura Pettit
- Lingen Davies Cancer Centre, Royal Shrewsbury Hospital, Shrewsbury, UK
| | - Keith Rooney
- Northern Ireland Cancer Centre, Belfast City Hospital, Belfast, UK
| | - Tom Roques
- Clinical Oncology, Norfolk and Norwich University Hospital, Norwich, UK
| | | | - Justine Tyler
- Department of Physics, The Royal Marsden Hospital, London, UK
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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Nutting C, Rooney K, Foran B, Pettit L, Beasley M, Finneran L, Roe J, Tyler J, Roques T, Cook A, Petkar I, Bhide S, Srinivasan D, Boon C, De Winton E, Frogley R, Sydenham MA, Emson M, Hall E. Quality of life and two-year results of a randomized phase III study of dysphagia-optimized intensity modulated radiotherapy (DO-IMRT) versus standard IMRT (S-IMRT) in head and neck cancer. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.6065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6065 Background: Most newly diagnosed oro- & hypopharngeal cancers (OPC, HPC) are treated with (chemo)RT with curative intent but at the consequence of adverse effects on quality of life. We investigated if using DO-IMRT to reduce RT dose to the dysphagia/aspiration related structures (DARS) improved swallowing function compared to S-IMRT. Methods: Patients with T1-4, N0-3, M0 OPC/HPC were randomised 1:1 to S-IMRT (65 Gray (Gy)/30 fractions (f) to primary & nodal tumour; 54Gy/30f to remaining pharyngeal subsite & nodal areas at risk of microscopic disease) or DO-IMRT. The volume of the superior & middle pharyngeal constrictor muscle (PCM) (OPC) or inferior PCM (HPC) lying outside the high-dose target volume was set a mandatory mean dose constraint in DO-IMRT. Treatment allocation was by minimisation balanced by centre, use of induction/concomitant chemotherapy, tumour site & AJCC stage. Primary endpoint was mean MD Anderson Dysphagia Inventory (MDADI) composite score 12 months after RT. Secondary endpoints included University of Washington (UW)-Qol, Performance Status Scale Head & Neck (PSS-HN) domain scores (range: 0-100), swallow volume, swallow capacity and local control. Results: 112 patients (56 S-IMRT, 56 DO-IMRT) were randomised from 22 UK & Ireland centres from 06/2016 - 04/2018. 111/112 had RT doses as prescribed (1 patient died before RT). Outcome measures at 12 and 24 months are summarised below. DO-IMRT had higher MDADI scores at 12 (p = 0.04) and 24 (p = 0.07) months. Clinically important improvements in swallowing function were seen in patients receiving DO-IMRT using PSS-HN domains and the UW-QoL tool. Conclusions: DO-IMRT improved patient reported swallowing function compared with S-IMRT. Improvements were seen in overall MDADI as well as functional scores in both PSS-HN and UW-QoL. Clinical trial information: 25458988. [Table: see text]
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Affiliation(s)
| | | | | | - Laura Pettit
- Royal Shrewsbury Hospital, Shrewsbury, United Kingdom
| | - Matthew Beasley
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | | | - Justin Roe
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Tom Roques
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Audrey Cook
- Cheltenham General Hospital, Cheltenham, United Kingdom
| | - Imran Petkar
- Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Shree Bhide
- The Royal Marsden Hospital and the Institute of Cancer Research, London, United Kingdom
| | | | - Cheng Boon
- Worcestershire Royal Hospital, Worcester, United Kingdom
| | | | | | - Mark Adrian Sydenham
- Institute of Cancer Research Clinical Trials and Statistics Unit, Sutton, United Kingdom
| | - Marie Emson
- The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
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Tyler J, Bernstein D, Seithel M, Rooney K, Petkar I, Miles E, Clark CH, Hall E, Nutting C. Quality assurance of dysphagia-optimised intensity modulated radiotherapy treatment planning for head and neck cancer. Phys Imaging Radiat Oncol 2021; 20:46-50. [PMID: 34754954 PMCID: PMC8560997 DOI: 10.1016/j.phro.2021.10.003] [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: 06/09/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 12/04/2022] Open
Abstract
This study aimed to assess the impact of the margin applied to the clinical target volume, to create the planning target volume, on plan quality of a novel dysphagia-optimised intensity modulated radiotherapy technique developed within a head and neck cancer multicentre randomised controlled trial. Protocol compliant plans were used for a single benchmark planning case. Larger margins were associated with higher doses to adjacent organs at risk, particularly the inferior pharyngeal constrictor muscle, but coincided with some improved low dose target coverage. A 3 mm margin is recommended for this technique if local practices allow.
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Key Words
- CERR, Computational Environment for Radiotherapy Research
- DARS, dysphagia/aspiration related structures
- DICOM, Digital Imaging and Communications in Medicine
- DO-IMRT, dysphagia optimised intensity modulated radiotherapy
- Dysphagia
- Head and neck cancer
- ICR-CTSU, Clinical Trials and Statistics Unit and the Institute of Cancer Research
- IPCM, inferior pharyngeal constrictor muscle
- Intensity modulated radiotherapy (IMRT)
- NIHR, National Institute for Health Research
- PAF, plan assessment form
- Quality assurance
- RTQA, radiotherapy quality assurance
- RTTQA, UK’s National Radiotherapy Trials Quality Assurance Group
- Randomised controlled trial
- S-IMRT, standard intensity modulated radiotherapy
- SMPCM, superior and middle pharyngeal constrictor muscles
- TMG, Trial Management Group
- Volumetric arc therapy (VMAT)
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Affiliation(s)
- Justine Tyler
- National Radiotherapy Trials Quality Assurance Group, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - David Bernstein
- National Radiotherapy Trials Quality Assurance Group, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Matthew Seithel
- National Radiotherapy Trials Quality Assurance Group, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Keith Rooney
- Radiotherapy Department, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Imran Petkar
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
- Radiotherapy Department, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK
| | - Catharine H Clark
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK
- Radiotherapy Physics, University College London Hospital NHS Foundation Trust, 5th Floor West, 250 Euston Road, NW1 2PG, UK
- Department of Medical Physics and Biomedical Engineering, University College London, WC1E 6BT, UK
- Metrology for Medical Physics, National Physical Laboratory, Hampton Rd, Teddington, TW11 0PX, UK
| | - Emma Hall
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Chris Nutting
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
- Radiotherapy Department, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
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Nutting C, Rooney K, Foran B, Pettit L, Beasley M, Finneran L, Roe J, Tyler J, Petkar I, Bhide S, Frogley R, Sydenham M, Emson M, Hall E. P-59 Results of DARS: a randomised phase III trial of dysphagia-optimised intensity modulated radiotherapy (DO-IMRT) versus standard IMRT (S-IMRT) in oropharyngeal (OPC) and hypopharyngeal (HPC) cancer. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jansen MB, Lund DW, Baume K, Lillyman S, Rooney K, Nielsen DS. International clinical placement - Experiences of nursing students' cultural, personal and professional development; a qualitative study. Nurse Educ Pract 2021; 51:102987. [PMID: 33610023 DOI: 10.1016/j.nepr.2021.102987] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Abstract
The purpose was to capture the experiences of cultural, personal and professional development during International Clinical Placement (ICP) among nursing students from three European countries. The paper presents findings based on the analysis of 23 reflections written by students immediately after returning from their ICP. The design builds on a qualitative study using a phenomenological approach and meaning condensation inspired by Kirsti Malterud. The analysis revealed four themes: Communication and barriers to be overcome, Culture as a serious business, Personal and professional achievements and Challenges and the importance of preceptorship. The ICP impacted on the participants' personal as well as professional way of understanding themselves as students and future nurses. A profound difference was seen between the achieved learning outcomes of participants completing an ICP in a high- or low-income country, respectively. Language barriers, the local culture and different nursing cultures were often challenging and pushed participants out of their comfort zone. All participants developed their cultural understanding in accordance with the Papadopoulos, Tilki and Taylor Model for Developing Cultural Competence. Findings indicate that educational institutions should establish well-planned exchange opportunities that adopt a two-way reciprocal (Erasmus) exchange programmes and be aware of the value of an appointed preceptor in the host country.
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Affiliation(s)
- M B Jansen
- UCL University College, Department of Nursing, Odense, Niels Bohrs Allé 1, 5230, Odense, Denmark.
| | - D W Lund
- UCL University College, Department of Nursing, Odense, Niels Bohrs Allé 1, 5230, Odense, Denmark.
| | - K Baume
- Department of Nursing, Three Counties School of Nursing & Midwifery, St John's Campus, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, Great Britain, UK.
| | - S Lillyman
- Department of Nursing, Three Counties School of Nursing & Midwifery, St John's Campus, University of Worcester, Henwick Grove, Worcester, WR2 6AJ, Great Britain, UK.
| | - K Rooney
- Department of Nursing, Midwifery & Health Studies, Dundalk Institute of Technology, Dundalk, Co. Louth, A91 K584, Ireland.
| | - D S Nielsen
- UCL University College, Department of Nursing, Odense, Niels Bohrs Allé 1, 5230, Odense, Denmark; University of Southern Denmark Centre for Global Health, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark; Migrant Health Clinic, Odense University Hospital, Soenderboulevard, 5000, Odense, Denmark.
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Schenkel LC, Aref-Eshghi E, Rooney K, Kerkhof J, Levy MA, McConkey H, Rogers RC, Phelan K, Sarasua SM, Jain L, Pauly R, Boccuto L, DuPont B, Cappuccio G, Brunetti-Pierri N, Schwartz CE, Sadikovic B. DNA methylation epi-signature is associated with two molecularly and phenotypically distinct clinical subtypes of Phelan-McDermid syndrome. Clin Epigenetics 2021; 13:2. [PMID: 33407854 PMCID: PMC7789817 DOI: 10.1186/s13148-020-00990-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 07/17/2020] [Accepted: 12/09/2020] [Indexed: 12/31/2022] Open
Abstract
Background Phelan-McDermid syndrome is characterized by a range of neurodevelopmental phenotypes with incomplete penetrance and variable expressivity. It is caused by a variable size and breakpoint microdeletions in the distal long arm of chromosome 22, referred to as 22q13.3 deletion syndrome, including the SHANK3 gene. Genetic defects in a growing number of neurodevelopmental genes have been shown to cause genome-wide disruptions in epigenomic profiles referred to as epi-signatures in affected individuals. Results In this study we assessed genome-wide DNA methylation profiles in a cohort of 22 individuals with Phelan-McDermid syndrome, including 11 individuals with large (2 to 5.8 Mb) 22q13.3 deletions, 10 with small deletions (< 1 Mb) or intragenic variants in SHANK3 and one mosaic case. We describe a novel genome-wide DNA methylation epi-signature in a subset of individuals with Phelan-McDermid syndrome. Conclusion We identified the critical region including the BRD1 gene as responsible for the Phelan-McDermid syndrome epi-signature. Metabolomic profiles of individuals with the DNA methylation epi-signature showed significantly different metabolomic profiles indicating evidence of two molecularly and phenotypically distinct clinical subtypes of Phelan-McDermid syndrome.
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Affiliation(s)
- L C Schenkel
- Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, ON, N6A5W9, Canada.,Department of Pathology and Laboratory Medicine, Western University, London, ON, N6A3K7, Canada
| | - E Aref-Eshghi
- Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, ON, N6A5W9, Canada
| | - K Rooney
- Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, ON, N6A5W9, Canada
| | - J Kerkhof
- Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, ON, N6A5W9, Canada
| | - M A Levy
- Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, ON, N6A5W9, Canada
| | - H McConkey
- Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, ON, N6A5W9, Canada
| | - R C Rogers
- Greenville Office, Greenwood Genetic Center, Greenville, SC, 29605, USA
| | - K Phelan
- Genetics Laboratory, Florida Cancer Specialists and Research Institute, Fort Myers, FL, 33816, USA
| | | | - L Jain
- Greenwood Genetic Center, Greenwood, SC, 29646, USA.,Clemson University, Clemson, SC, 29634, USA
| | - R Pauly
- Greenwood Genetic Center, Greenwood, SC, 29646, USA
| | - L Boccuto
- Greenwood Genetic Center, Greenwood, SC, 29646, USA.,Clemson University, Clemson, SC, 29634, USA
| | - B DuPont
- Greenwood Genetic Center, Greenwood, SC, 29646, USA
| | - G Cappuccio
- Department of Translational Medicine, University Federico II, 80131, Naples, NA, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli, NA, Italy
| | - N Brunetti-Pierri
- Department of Translational Medicine, University Federico II, 80131, Naples, NA, Italy.,Telethon Institute of Genetics and Medicine, Pozzuoli, NA, Italy
| | - C E Schwartz
- Greenwood Genetic Center, Greenwood, SC, 29646, USA.
| | - B Sadikovic
- Molecular Genetics Laboratory, Molecular Diagnostics Division, London Health Sciences Centre, London, ON, N6A5W9, Canada. .,Department of Pathology and Laboratory Medicine, Western University, London, ON, N6A3K7, Canada.
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Nutting C, Rooney K, Foran B, Pettit L, Beasley M, Finneran L, Roe J, Tyler J, Roques T, Cook A, Petkar I, Bhide S, Srinivasan D, Boon C, De Winton E, Frogley R, Mertens K, Emson M, Hall E. Results of a randomized phase III study of dysphagia-optimized intensity modulated radiotherapy (Do-IMRT) versus standard IMRT (S-IMRT) in head and neck cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.6508] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6508 Background: Most newly diagnosed oro- & hypopharngeal cancers (OPC, HPC) are treated with (chemo)RT with curative intent but at the consequence of adverse effects on quality of life. CRUK/14/014 investigated if using Do-IMRT to reduce RT dose to the dysphagia/aspiration related structures (DARS) improved swallowing function compared to S-IMRT. Methods: Patients with T1-4, N0-3, M0 OPC/HPC were randomised 1:1 to S-IMRT (65 Gray (Gy)/30 fractions (f) to primary & nodal tumour; 54Gy/30f to remaining pharyngeal subsite & nodal areas at risk of microscopic disease) or Do-IMRT. The volume of the superior & middle pharyngeal constrictor muscle (PCM) (OPC) or inferior PCM (HPC) lying outside the high-dose target volume was set a mandatory mean dose constraint in Do-IMRT. Treatment allocation was by minimisation balanced by centre, use of induction/concomitant chemotherapy, tumour site & AJCC stage. Primary endpoint was mean MD Anderson Dysphagia Inventory (MDADI) composite score 12 months after RT with 102 patients needed to detect a 10 point improvement (assuming S-IMRT score of 72, standard deviation (SD) 13.8; 90% power, 2-sided 5% alpha). Patients were blind to treatment allocation. Secondary endpoints included local control. Results: 112 patients (56 S-IMRT, 56 Do-IMRT) were randomised from 22 UK centres from 06/2016 to 04/2018. Mean age was 57 years; 80% were male; 97% had OPC; 90% had AJCC stage 3&4 disease; 86% had concomitant chemotherapy only, 4% induction & concomitant and 10% no chemotherapy. 111/112 had RT doses as prescribed (1 patient died before RT). Median of the mean inferior PCM dose was S-IMRT 49.8Gy (IQR 47.1-52.4) vs. Do-IMRT 28.4Gy (21.3–37.4), p < 0.0001; superior & middle PCM dose was S-IMRT 57.2Gy (56.3–58.3) vs. Do-IMRT 49.7Gy (49.4–49.9), p < 0.0001. Do-IMRT had significantly higher MDADI scores: S-IMRT 70.3 (SD 17.3) vs. Do-IMRT 77.7 (16.1), p = 0.016. 3 local recurrences (1 S-IMRT, 2 Do-IMRT) have been reported. Conclusions: Do-IMRT reduced RT dose to the DARS and improved patient reported swallowing function compared with S-IMRT. This is the first randomised study to demonstrate functional benefit of swallow-sparing IMRT in OPC. Clinical trial information: 25458988 .
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Affiliation(s)
| | | | | | - Laura Pettit
- Royal Shrewsbury Hospital, Shrewsbury, United Kingdom
| | - Matthew Beasley
- Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | | | - Justin Roe
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Justine Tyler
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Tom Roques
- Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Audrey Cook
- Cheltenham General Hospital, Cheltenham, United Kingdom
| | - Imran Petkar
- Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Shree Bhide
- The Royal Marsden Hospital and the Institute of Cancer Research, London, United Kingdom
| | | | - Cheng Boon
- Worcestershire Royal Hospital, Worcester, United Kingdom
| | | | | | | | - Marie Emson
- The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
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Craig SG, Anderson LA, Moran M, Graham L, Currie K, Rooney K, Robinson M, Bingham V, Cuschieri KS, McQuaid S, Schache AG, Jones TM, McCance D, Salto-Tellez M, McDade SS, James JA. Comparison of Molecular Assays for HPV Testing in Oropharyngeal Squamous Cell Carcinomas: A Population-Based Study in Northern Ireland. Cancer Epidemiol Biomarkers Prev 2020; 29:31-38. [PMID: 31666283 PMCID: PMC9158515 DOI: 10.1158/1055-9965.epi-19-0538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/26/2019] [Accepted: 10/23/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Determination of human papillomavirus (HPV) status has become clinically relevant for patient stratification under UICC TNM8 staging. Within the United Kingdom, a combination of p16 IHC and HPV DNA-ISH is recommended for classifying HPV status. This study will assess a series of clinically applicable second-line molecular tests to run in combination with p16 IHC to optimally determine HPV status. METHODS The ability of HPV RNA-ISH, HPV DNA-ISH, and HPV DNA-PCR to identify p16-positive/HPV-positive patients was investigated in a population-based oropharyngeal squamous cell carcinoma (OPSCC) cohort of patients diagnosed in Northern Ireland from 2000 to 2011. RESULTS Only 41% of the Northern Irish OPSCC patient population was associated with HPV-driven carcinogenesis. Both ISH assays were more specific than the DNA-PCR assay (100% and 95% vs. 67%) and were less likely to be affected by preanalytic factors such as increasing block age. A pooled HPV genotype probe for RNA-ISH was found to be the most accurate molecular assay assessed (95% accuracy) when compared with p16 positivity. CONCLUSIONS Our study demonstrates the advantage of tissue-based molecular assays when determining HPV status in retrospective samples. Specifically, we demonstrate the enhanced sensitivity and specificity of ISH techniques compared with PCR-based methodology when working with formalin-fixed paraffin-embedded tissue, and found HPV RNA-ISH to be the most effective assay for determining HPV status. IMPACT As p16 IHC is a relatively inexpensive, accessible, and sensitive test for stratifying patients by HPV status, this study finds that more patients would benefit from first-line p16 IHC followed by specific HPV testing using HPV RNA-ISH to confirm HPV status.
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Affiliation(s)
- Stephanie G Craig
- Northern Ireland Molecular Pathology Laboratory, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Lesley A Anderson
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, United Kingdom
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | | | - Laura Graham
- Northern Ireland Molecular Pathology Laboratory, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Keith Currie
- Northern Ireland Molecular Pathology Laboratory, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Keith Rooney
- Northern Ireland Cancer Centre, Belfast, Northern Ireland, United Kingdom
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, England, United Kingdom
| | - Victoria Bingham
- Northern Ireland Molecular Pathology Laboratory, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Kate S Cuschieri
- National Health Service Lothian, Edinburgh, Scotland, United Kingdom
| | - Stephen McQuaid
- Northern Ireland Molecular Pathology Laboratory, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Andrew G Schache
- Liverpool Head and Neck Centre, Institute of Translational Medicine, University of Liverpool, England, United Kingdom
| | - Terry M Jones
- Liverpool Head and Neck Centre, Institute of Translational Medicine, University of Liverpool, England, United Kingdom
| | - Dennis McCance
- Department of Pathology and the University of New Mexico Comprehensive Cancer Centre, University of New Mexico Medical School, Albuquerque, New Mexico
| | - Manuel Salto-Tellez
- Northern Ireland Molecular Pathology Laboratory, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | - Simon S McDade
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Jacqueline A James
- Northern Ireland Molecular Pathology Laboratory, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom.
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
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Craig SG, Anderson LA, Schache AG, Moran M, Graham L, Currie K, Rooney K, Robinson M, Upile NS, Brooker R, Mesri M, Bingham V, McQuaid S, Jones T, McCance DJ, Salto-Tellez M, McDade SS, James JA. Recommendations for determining HPV status in patients with oropharyngeal cancers under TNM8 guidelines: a two-tier approach. Br J Cancer 2019; 120:827-833. [PMID: 30890775 PMCID: PMC6474272 DOI: 10.1038/s41416-019-0414-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND TNM8 staging for oropharyngeal squamous cell carcinomas (OPSCC) surrogates p16 immunohistochemistry for HPV testing. Patients with p16+ OPSCC may lack HPV aetiology. Here, we evaluate the suitability of TNM8 staging for guiding prognosis in such patients. METHODS HPV status was ascertained using p16 immunohistochemistry and high-risk HPV RNA and DNA in situ hybridisation. Survival by stage in a cohort of OPSCC patients was evaluated using TNM7/TNM8 staging. Survival of p16+/HPV- patients was compared to p16 status. RESULTS TNM8 staging was found to improve on TNM7 (log rank p = 0·0190 for TNM8 compared with p = 0·0530 for TNM7) in p16+ patients. Patients who tested p16+ but were HPV- (n = 20) had significantly reduced five-year survival (33%) compared to p16+ patients (77%) but not p16- patients (35%). Cancer stage was reduced in 95% of p16+/HPV- patients despite having a mortality rate twice (HR 2.66 [95% CI: 1.37-5.15]) that of p16+/HPV+ patients under new TNM8 staging criteria. CONCLUSION Given the significantly poorer survival of p16+/HPV- OPSCCs, these data provide compelling evidence for use of an HPV-specific test for staging classification. This has particular relevance in light of potential treatment de-escalation that could expose these patients to inappropriately reduced treatment intensity as treatment algorithms evolve.
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Affiliation(s)
- Stephanie G Craig
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Lesley A Anderson
- Northern Ireland Cancer Registry, Belfast, Northern Ireland, UK
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Andrew G Schache
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England, UK
| | | | - Laura Graham
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Keith Currie
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Keith Rooney
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Max Robinson
- Centre for Oral Health Research, Newcastle University, England, UK
| | - Navdeep S Upile
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England, UK
| | - Rachel Brooker
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England, UK
| | - Mina Mesri
- Aintree University Hospital NHS Foundation Trust, Liverpool, England, UK
| | - Victoria Bingham
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Stephen McQuaid
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Terry Jones
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, England, UK
| | - Dennis J McCance
- Department of Pathology, University of New Mexico Medical School, Albuquerque, NM, 87131, USA
| | - Manuel Salto-Tellez
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Simon S McDade
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Jacqueline A James
- Centre for Cell Research and Cell Biology, Queen's University Belfast, Belfast, Northern Ireland, UK.
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK.
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Howse E, Freeman B, Wu J, Rooney K. Perceptions and attitudes about the sale and promotion of sugar-sweetened beverages in a university. Eur J Public Health 2017. [DOI: 10.1093/eurpub/ckx187.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- E Howse
- The University of Sydney, Sydney, Australia
| | - B Freeman
- The University of Sydney, Sydney, Australia
| | - J Wu
- The George Institute for Global Health, Sydney, Australia
| | - K Rooney
- The University of Sydney, Sydney, Australia
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McCauley S, McCloskey P, Lyons C, Brown K, Rooney K, Houghton F. Should all oropharyngeal squamous cell carcinomas be stratified by HPV p16 status? Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McCauley S, McCloskey P, Lyons C, Brown K, Rooney K, Houghton F. PO-105: Is there justification for age bias in HPV p16 testing for Oropharyngeal Squamous Cell Carcinoma? Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30239-6] [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: 10/19/2022]
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Maplethorpe N, Rooney K, Nicholson S. Sodium intake in England and Scotland: Assessment of dietary sodium. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw169.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Petkar I, Rooney K, Roe JWG, Patterson JM, Bernstein D, Tyler JM, Emson MA, Morden JP, Mertens K, Miles E, Beasley M, Roques T, Bhide SA, Newbold KL, Harrington KJ, Hall E, Nutting CM. DARS: a phase III randomised multicentre study of dysphagia- optimised intensity- modulated radiotherapy (Do-IMRT) versus standard intensity- modulated radiotherapy (S-IMRT) in head and neck cancer. BMC Cancer 2016; 16:770. [PMID: 27716125 PMCID: PMC5052945 DOI: 10.1186/s12885-016-2813-0] [Citation(s) in RCA: 64] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 09/26/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persistent dysphagia following primary chemoradiation (CRT) for head and neck cancers can have a devastating impact on patients' quality of life. Single arm studies have shown that the dosimetric sparing of critical swallowing structures such as the pharyngeal constrictor muscle and supraglottic larynx can translate to better functional outcomes. However, there are no current randomised studies to confirm the benefits of such swallow sparing strategies. The aim of Dysphagia/Aspiration at risk structures (DARS) trial is to determine whether reducing the dose to the pharyngeal constrictors with dysphagia-optimised intensity- modulated radiotherapy (Do-IMRT) will lead to an improvement in long- term swallowing function without having any detrimental impact on disease-specific survival outcomes. METHODS/DESIGN The DARS trial (CRUK/14/014) is a phase III multicentre randomised controlled trial (RCT) for patients undergoing primary (chemo) radiotherapy for T1-4, N0-3, M0 pharyngeal cancers. Patients will be randomised (1:1 ratio) to either standard IMRT (S-IMRT) or Do-IMRT. Radiotherapy doses will be the same in both groups; however in patients allocated to Do-IMRT, irradiation of the pharyngeal musculature will be reduced by delivering IMRT identifying the pharyngeal muscles as organs at risk. The primary endpoint of the trial is the difference in the mean MD Anderson Dysphagia Inventory (MDADI) composite score, a patient-reported outcome, measured at 12 months post radiotherapy. Secondary endpoints include prospective and longitudinal evaluation of swallow outcomes incorporating a range of subjective and objective assessments, quality of life measures, loco-regional control and overall survival. Patients and speech and language therapists (SLTs) will both be blinded to treatment allocation arm to minimise outcome-reporting bias. DISCUSSION DARS is the first RCT investigating the effect of swallow sparing strategies on improving long-term swallowing outcomes in pharyngeal cancers. An integral part of the study is the multidimensional approach to swallowing assessment, providing robust data for the standardisation of future swallow outcome measures. A translational sub- study, which may lead to the development of future predictive and prognostic biomarkers, is also planned. TRIAL REGISTRATION This study is registered with the International Standard Randomised Controlled Trial register, ISRCTN25458988 (04/01/2016).
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Affiliation(s)
- Imran Petkar
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - Keith Rooney
- Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB UK
| | - Justin W. G. Roe
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | - Joanne M. Patterson
- Speech and Language Therapy Department, Sunderland City Hospitals NHS Foundation Trust, Kayll Road, Sunderland, SR4 7TP UK
- Institute of Health and Society, University of Newcastle, Newcastle upon Tyne, NE1 7RU UK
| | - David Bernstein
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | - Justine M. Tyler
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | - Marie A. Emson
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - James P. Morden
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - Kathrin Mertens
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - Elizabeth Miles
- Mount Vernon Hospital, Rickmansworth Road, Northwood, HA6 2RN UK
| | - Matthew Beasley
- University Hospitals Bristol, Horfield Road, Bristol, BS2 8ED UK
| | - Tom Roques
- Norfolk and Norwich University Hospital NHS Trust, Colney Lane, Norwich, NR4 7UY UK
| | - Shreerang A. Bhide
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - Kate L. Newbold
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
| | - Kevin J. Harrington
- The Royal Marsden NHS Foundation Trust, Fulham Road, London, SW3 6JJ UK
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
| | - Emma Hall
- The Institute of Cancer Research (ICR), 123 Old Brompton Road, London, SW7 3RP UK
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Alper M, Matin M, French B, Widra E, Copperman A, Levy M, Lee J, Granger S, Rooney K, Sakkas D. Blind validation of estrogen monitoring in controlled ovarian stimulation IVF cycles using a “patient-friendly” saliva-based estradiol assay. Fertil Steril 2016. [DOI: 10.1016/j.fertnstert.2016.07.566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Barr J, Ogden K, Rooney K. Building the community of patient-centred care practice across all sectors of health care and health professional education. Intern Med J 2016; 46:122-3. [PMID: 26813909 DOI: 10.1111/imj.12932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 08/18/2015] [Indexed: 12/01/2022]
Affiliation(s)
- J Barr
- School of Medicine, University of Tasmania, Launceston, Tasmania, Australia.
| | - K Ogden
- School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
| | - K Rooney
- School of Medicine, University of Tasmania, Launceston, Tasmania, Australia
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Tyler J, Bernstein D, Rooney K, Nutting C. PO-0858: Development of dysphagia optimised IMRT for head and neck cancer treatment in the DARS trial. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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21
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Lexmond WS, Pardo M, Rooney K, Goettel JA, Snapper SB, Yen EH, Dehlink E, Nurko S, Fiebiger E. Elevated levels of leukotriene C4 synthase mRNA distinguish a subpopulation of eosinophilic oesophagitis patients. Clin Exp Allergy 2014; 43:902-13. [PMID: 23889244 DOI: 10.1111/cea.12146] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 03/23/2013] [Accepted: 05/03/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND Cysteinyl leukotrienes contribute to Th2-type inflammatory immune responses. Their levels in oesophageal tissue, however, do not distinguish patients with eosinophilic oesophagitis (EoE) from controls. OBJECTIVE We asked whether mRNA levels of leukotriene C4 synthase (LTC4 S), a key regulator of leukotriene production, could serve as a marker for EoE. METHODS Digital mRNA expression profiling (nCounter(®) Technology) was performed on proximal and distal oesophageal biopsies of 30 paediatric EoE patients and 40 non-EoE controls. Expression data were confirmed with RT-qPCR. LTC4 S mRNA levels were quantified in whole blood samples. Leukotriene E4 was measured in urine. RESULTS LTC4 S mRNA levels were elevated in proximal (2.6-fold, P < 0.001) and distal (2.9-fold, P < 0.001) oesophageal biopsies from EoE patients. Importantly, increased LTC4 S mRNA transcripts identified a subpopulation of EoE patients (28%). This patient subgroup had higher serum IgE levels (669 U/mL vs. 106 U/mL, P = 0.01), higher mRNA transcript numbers of thymic stromal lymphopoietin (TSLP) (1.6-fold, P = 0.009) and CD4 (1.4-fold, P = 0.04) but lower IL-23 mRNA levels (0.5-fold, P = 0.04). In contrast, elevated levels of IL-23 mRNA were found in oesophageal biopsies of patients with reflux oesophagitis. LTC4 S mRNA transcripts in whole blood and urinary excretion of leukotriene E4 were similar in EoE patient subgroups and non-EoE patients. CONCLUSION & CLINICAL RELEVANCE Elevated oesophageal expression of LTC4 S mRNA is found in a subgroup of EoE patients, concomitant with higher serum IgE levels and an oesophageal transcriptome indicative of a more-pronounced allergic phenotype. Together with TSLP and IL-23 mRNA levels, oesophageal LTC4 S mRNA may facilitate diagnosis of an EoE subpopulation for personalized therapy.
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Affiliation(s)
- W S Lexmond
- Division of Gastroenterology and Nutrition, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
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Jayewardene A, Gwinn T, Hancock D, Rooney K. The effects of a polymorphism in the CD36 gene on metabolic response to a short-term endurance training program: A pilot study. J Sci Med Sport 2013. [DOI: 10.1016/j.jsams.2013.10.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The Knowledge Network (www.knowledge.scot.nhs.uk) is Scotland's online knowledge service for health and social care. It is designed to support practitioners to apply knowledge in frontline delivery of care, helping to translate knowledge into better health-care outcomes through safe, effective, person-centred care. The Knowledge Network helps to combine the worlds of evidence-based practice and quality improvement by providing access to knowledge about the effectiveness of clinical interventions ('know-what') and knowledge about how to implement this knowledge to support individual patients in working health-care environments ('know-how'). An 'evidence and guidance' search enables clinicians to quickly access quality-assured evidence and best practice, while point of care and mobile solutions provide knowledge in actionable formats to embed in clinical workflow. This research-based knowledge is complemented by social networking services and improvement tools which support the capture and exchange of knowledge from experience, facilitating practice change and systems improvement. In these cases, the Knowledge Network supports key components of the knowledge-to-action cycle--acquiring, creating, sharing and disseminating knowledge to improve performance and innovate. It provides a vehicle for implementing the recommendations of the national Knowledge into Action review, which outlines a new national approach to embedding knowledge in frontline practice and systems improvement.
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Affiliation(s)
- A Wales
- NHS Education for Scotland, Glasgow, Scotland, UK.
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Abstract
A growing number of studies suggest a potential link between obesity and altered iron metabolism. The purpose of this systematic review was to examine existing literature on iron status in obese populations. A comprehensive literature search was conducted. Included studies recruited participants ≥ 18 years with a body mass index ≥ 30 kg m(-2) and provided descriptive statistics for haemoglobin or ferritin at a minimum. There were 25 studies meeting all eligibility criteria, of these 10 examined iron status in free-living obese individuals and 15 reported baseline iron biomarkers from bariatric surgery candidates. Non-obese comparison groups were used by 10 (40%) articles. In these, seven obese groups reported higher mean haemoglobin concentration; six reported significantly higher ferritin concentration; and four significantly lower transferrin saturation. Due to insufficient data, it was not possible to make conclusions regarding mean differences for soluble transferrin receptor (sTfR), hepcidin or C-reactive protein. Existing evidence suggests a tendency for higher haemoglobin and ferritin concentration and lower transferrin saturation in obesity. Alternation of iron biomarkers in obese populations may be a result of obesity-related inflammation and/or related comorbidities. Further research incorporating measurement of inflammatory cytokines, sTfR and hepcidin is required to confirm the impact of obesity on iron status.
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Affiliation(s)
- H L Cheng
- Discipline of Exercise and Sport Science, Faculty of Health Sciences, The University of Sydney, Sydney, New South Wales, Australia.
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Rooney K, Vengalil S, Hanna G, Harney J, Eakin R, Young L, McAleese J. 176 Concurrent chemoradiation for lung cancer in routine practice. Lung Cancer 2012. [DOI: 10.1016/s0169-5002(12)70177-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Keating S, Machan E, Rooney K, O’Connor H, Caterson I, Johnson N. A novel exercise regime to reduce cardiometabolic risk in overweight sedentary individuals. J Sci Med Sport 2011. [DOI: 10.1016/j.jsams.2011.11.226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Rooney K, Cummins P. A service review of dietetic input for chronic obstructive pulmonary disease patients on long-term oral nutritional support. J Hum Nutr Diet 2011. [DOI: 10.1111/j.1365-277x.2011.01175_33.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ainge H, Thompson C, Ozanne S, Rooney K. A systematic review on animal models of maternal high fat feeding and offspring glycaemic control and adiposity. Obes Res Clin Pract 2010. [DOI: 10.1016/j.orcp.2010.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Norquay M, Walters M, Rooney K, Gillett D. Patterns of facial growth in Western Australian children and adolescents. HOMO 2010. [DOI: 10.1016/j.jchb.2010.01.028] [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: 11/29/2022]
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Affiliation(s)
- J S Michael
- University of Sydney, Exercise Health and Performance Research Group, Lidcombe, Australia.
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Khalafallah A, Vos LJ, Beamish M, Rooney K. Successful rituximab therapy in the treatment of refractory cold haemagglutinin disease with long-term disease control. Intern Med J 2010; 40:387-9. [DOI: 10.1111/j.1445-5994.2010.02173.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dixon LJ, Hughes SM, Rooney K, Madden A, Devine A, Leahey W, Henry W, Johnston GD, McVeigh GE. Increased superoxide production in hypertensive patients with diabetes mellitus: role of nitric oxide synthase. Am J Hypertens 2005; 18:839-43. [PMID: 15925745 DOI: 10.1016/j.amjhyper.2005.01.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Revised: 12/05/2004] [Accepted: 12/10/2004] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hypertension and diabetes are important independent risk factors for increased oxidative stress and increased cardiovascular risk. The combination of hypertension and diabetes results in a dramatic increase in cardiovascular risk. Enhanced oxidative stress in hypertension and diabetes is linked to decreased nitric oxide (NO) bioavailability because of its interaction with vascular superoxide (O(2)(*-)), derived predominantly from NAD(P)H-dependent oxidases. When uncoupled from essential cofactors, NO synthase III (NOS III) can also produce O(2)(*-). We studied platelet superoxide production in patients with hypertension alone and in patients with coexistent diabetes mellitus, investigating the contribution of NOS III uncoupling to platelet superoxide production. METHODS AND RESULTS Gel-filtered platelets were obtained and were stimulated with Phorbol 12-myristate 13-acetate, and O(2)(*-) production was detected using lucigenin-enhanced chemiluminescence. Superoxide production was significantly higher in patients with diabetes and hypertension (6.4 +/- 1.6 pmol/min/10(8) platelets) than in patients with hypertension (1.6 +/- 0.6 pmol/min/10(8) platelets) (P < .04). After incorporation of N(omega)-nitro-l-arginine methyl ester (L-NAME, 1 mmol/L), O(2)(*-) detection increased in 40% of patients with diabetes and hypertension and in 87% of patients with hypertension. This expected response results from L-NAME inhibition of NO production preventing NO scavenging of O(2)(*-). A reduction in O(2)(*-) production in response to L-NAME occurred in the remaining patients and indicates O(2)(*-) production by the uncoupled NOS III enzyme. CONCLUSIONS This study provides first published evidence that NOS III can reside in the uncoupled state in patients with hypertension and, to a greater extent, in patients with coexisting hypertension and diabetes, and that it contributes significantly to increased superoxide production in these disease states.
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Affiliation(s)
- Lana J Dixon
- Department of Therapeutics and Pharmacology, The Queen's University of Belfast, Belfast, Northern Ireland
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Affiliation(s)
- S M Murphy
- Department of Plastic and Reconstructive Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin 12, Ireland
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Rooney K, Bertram J, Austen C, Connelley G, Rose M, Williams O, Carter C. The effective use of automated apheresis of autologous red cells in elective orthopaedic and major urological surgery – a rural hospital experience. Transfus Apher Sci 2001. [DOI: 10.1016/s1473-0502(01)00013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Denney R, Feaster T, Hughes M, Estees S, McKay D, Mockenhaupt S, Rooney K, Whisman K. Recognition items on the WMS-III as a forced choice test of negative response bias. Arch Clin Neuropsychol 1999. [DOI: 10.1093/arclin/14.1.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Morton J, Taylor K, Bunce I, Eliadis P, Rentoul A, Moore D, Kelly C, Wright S, Bashford J, Rodwell R, Rooney K, Mulligan S, Firkin F, Dodds A, Parkin J, Lowenthal R, Kimber R, Frost T, Grigg A, Goldstein D, Stone J, Lee N. High response rates with short infusional 2-chlorodeoxyadenosine in de novo and relapsed low-grade lymphoma. Australian and New Zealand Lymphoma Study Group. Br J Haematol 1996; 95:110-5. [PMID: 8857946 DOI: 10.1046/j.1365-2141.1996.d01-1868.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: 02/02/2023]
Abstract
Thirty-five patients (eight de novo, 27 relapsed disease) with low-grade non-Hodgkin's lymphoma (diffuse small lymphocytic, follicular small cleaved cell, follicular mixed cell, and lymphoplasmacytoid) were treated with 2-chlorodeoxyadenosine (2CdA) at a daily dose of 0.14 mg/kg for 5d (2 h infusion) for an average of three cycles. Minor treatment delays, generally due to haematological toxicities, occurred in nine of 105 cycles. Major toxicities were lymphopenia, neutropenia and thrombocytopenia. Opportunistic infections occurred in seven patients. Overall response rate was 69% (five complete, 19 partial) reaching 88% for de novo patients (two complete, five partial). Elevated beta 2-microglobulin level was negatively predictive of response (P = 0.0014). Eight of 24 responders relapsed, with a median follow-up of 13 months. 2CdA administered as an intermittent infusion shows considerable single-agent activity in low-grade lymphomas achieving high response rates of prolonged duration. Consideration of schedules where 2CdA is alternatively administered with combination chemotherapy appears warranted.
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Affiliation(s)
- J Morton
- Mater Misericordiae Hospitals, South Brisbane, Australia
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Vander Salm TJ, Ansell JE, Okike ON, Marsicano TH, Lew R, Stephenson WP, Rooney K. The role of epsilon-aminocaproic acid in reducing bleeding after cardiac operation: a double-blind randomized study. J Thorac Cardiovasc Surg 1988; 95:538-40. [PMID: 3278170] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Sixty patients scheduled for elective coronary artery bypass graft operations were randomly assigned to receive epsilon-aminocaproic acid or placebo to test whether antifibrinolytic therapy would decrease postoperative bleeding. A small but significant decrease in bleeding was observed in the treated group without complications resulting from treatment with epsilon-aminocaproic acid.
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Affiliation(s)
- T J Vander Salm
- Department of Surgery, University of Massachusetts Medical Center, Worcester 01655
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Durham J, MacNeish A, Rooney PJ, Rooney K, Hart LE, Norman G. The M.D.R. index of function in rheumatoid arthritis. Clin Exp Rheumatol 1985; 3:297-302. [PMID: 4085160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The M.D.R. index is a new instrument which has been designed to give a measurement of physical function in inflammatory joint disease. It is very easy to apply and is not time-consuming. In preliminary assessment, the index has proven to be highly reliable. It has also been sufficiently sensitive to detect short-term changes in functional capacity which were unrelated to changes in the severity of joint inflammation. The application of the index is inexpensive and does not require extensive training of personnel for its accurate use. It is expected that the M.D.R. index will prove to be suitable for widespread use as a clinical assessment of physical function.
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