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Suddle A, Reeves H, Hubner R, Marshall A, Rowe I, Tiniakos D, Hubscher S, Callaway M, Sharma D, See TC, Hawkins M, Ford-Dunn S, Selemani S, Meyer T. British Society of Gastroenterology guidelines for the management of hepatocellular carcinoma in adults. Gut 2024:gutjnl-2023-331695. [PMID: 38627031 DOI: 10.1136/gutjnl-2023-331695] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
Deaths from the majority of cancers are falling globally, but the incidence and mortality from hepatocellular carcinoma (HCC) is increasing in the United Kingdom and in other Western countries. HCC is a highly fatal cancer, often diagnosed late, with an incidence to mortality ratio that approaches 1. Despite there being a number of treatment options, including those associated with good medium to long-term survival, 5-year survival from HCC in the UK remains below 20%. Sex, ethnicity and deprivation are important demographics for the incidence of, and/or survival from, HCC. These clinical practice guidelines will provide evidence-based advice for the assessment and management of patients with HCC. The clinical and scientific data underpinning the recommendations we make are summarised in detail. Much of the content will have broad relevance, but the treatment algorithms are based on therapies that are available in the UK and have regulatory approval for use in the National Health Service.
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Affiliation(s)
- Abid Suddle
- King's College Hospital NHS Foundation Trust, London, UK
| | - Helen Reeves
- Newcastle University Translational and Clinical Research Institute, Newcastle upon Tyne, UK
| | - Richard Hubner
- Department of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | - Ian Rowe
- University of Leeds, Leeds, UK
- St James's University Hospital, Leeds, UK
| | - Dina Tiniakos
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Stefan Hubscher
- Department of Pathology, University of Birmingham, Birmingham, UK
| | - Mark Callaway
- Division of Diagnostics and Therapies, University Hospitals Bristol NHS Trust, Bristol, UK
| | | | - Teik Choon See
- Department of Radiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Maria Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | | | - Sarah Selemani
- King's College Hospital NHS Foundation Trust, London, UK
| | - Tim Meyer
- Department of Oncology, University College, London, UK
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Wojcieszynski AP, Chuong MD, Hawkins M, Jethwa KR, Kim H, Raldow A, Sanford NN, Olsen JR. Rectal Cancer Update: Which Treatment Effects Are the Least "Brutal"? Int J Radiat Oncol Biol Phys 2024; 118:1-7. [PMID: 38049215 DOI: 10.1016/j.ijrobp.2023.08.012] [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] [Received: 08/02/2023] [Revised: 08/04/2023] [Accepted: 08/06/2023] [Indexed: 12/06/2023]
Affiliation(s)
| | - Michael D Chuong
- Department of Radiation Oncology, Miami Cancer Institute, Miami, Florida
| | | | - Krishan R Jethwa
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Hyun Kim
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Ann Raldow
- Department of Radiation Oncology, University of California, Los Angeles, California
| | - Nina N Sanford
- Department of Radiation Oncology, UT Southwestern Medical Center, Dallas, Texas
| | - Jeffrey R Olsen
- Department of Radiation Oncology, University of Colorado, Denver, Colorado.
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Rushbrook SM, Kendall TJ, Zen Y, Albazaz R, Manoharan P, Pereira SP, Sturgess R, Davidson BR, Malik HZ, Manas D, Heaton N, Prasad KR, Bridgewater J, Valle JW, Goody R, Hawkins M, Prentice W, Morement H, Walmsley M, Khan SA. British Society of Gastroenterology guidelines for the diagnosis and management of cholangiocarcinoma. Gut 2023; 73:16-46. [PMID: 37770126 PMCID: PMC10715509 DOI: 10.1136/gutjnl-2023-330029] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023]
Abstract
These guidelines for the diagnosis and management of cholangiocarcinoma (CCA) were commissioned by the British Society of Gastroenterology liver section. The guideline writing committee included a multidisciplinary team of experts from various specialties involved in the management of CCA, as well as patient/public representatives from AMMF (the Cholangiocarcinoma Charity) and PSC Support. Quality of evidence is presented using the Appraisal of Guidelines for Research and Evaluation (AGREE II) format. The recommendations arising are to be used as guidance rather than as a strict protocol-based reference, as the management of patients with CCA is often complex and always requires individual patient-centred considerations.
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Affiliation(s)
- Simon M Rushbrook
- Department of Hepatology, Norfolk and Norwich University Hospitals NHS Trust, Norwich, UK
| | - Timothy James Kendall
- Division of Pathology, University of Edinburgh, Edinburgh, UK
- University of Edinburgh MRC Centre for Inflammation Research, Edinburgh, UK
| | - Yoh Zen
- Department of Pathology, King's College London, London, UK
| | - Raneem Albazaz
- Department of Radiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | - Richard Sturgess
- Digestive Diseases Unit, Aintree University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Brian R Davidson
- Department of Surgery, Royal Free Campus, UCL Medical School, London, UK
| | - Hassan Z Malik
- Department of Surgery, University Hospital Aintree, Liverpool, UK
| | - Derek Manas
- Department of Surgery, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Nigel Heaton
- Department of Hepatobiliary and Pancreatic Surgery, King's College London, London, UK
| | - K Raj Prasad
- John Goligher Colorectal Unit, St. James University Hospital, Leeds, UK
| | - John Bridgewater
- Department of Oncology, UCL Cancer Institute, University College London, London, UK
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust/University of Manchester, Manchester, UK
| | - Rebecca Goody
- Department of Oncology, St James's University Hospital, Leeds, UK
| | - Maria Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Wendy Prentice
- King's College Hospital NHS Foundation Trust, London, UK
| | | | | | - Shahid A Khan
- Hepatology and Gastroenterology Section, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
- Imperial College Healthcare NHS Trust, London, UK
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Weiner AA, Amos A, Marks LB, McGurk R, Dance MJ, Mazur L, Chera BS, Person T, Pineiro B, Hawkins M, Couch A, Risgaard S. The Need for Patience When Making Operational Changes to Address Quality. Int J Radiat Oncol Biol Phys 2023; 117:e449. [PMID: 37785447 DOI: 10.1016/j.ijrobp.2023.06.1633] [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) There is increasing recognition in the value of systematically addressing operational issues to improve quality. However, the time necessary for these initiatives has not been well described. Here we report the time necessary to implement meaningful operational changes based on our institutional incident reporting system. MATERIALS/METHODS Our department has a robust quality improvement/assurance program where all team members are encouraged to report operational challenges through our "Good Catch Program". A multidisciplinary committee composed of MDs, physicists, dosimetrists, RTTs, RNs, administrators, and industrial engineers meets weekly to review new Good Catches and prior unresolved Good Catches. Each Good Catch was assigned a "Champion" to oversee responses and lead subsequent initiatives. The software tracked when a Good Catch is submitted, each time a note is added (reflecting an individual's comment or summary of group discussion), and when it is "closed". Good Catch closure occurred upon implementation of a change in workflow, development of a new policy, or decision to take no action. In cases where a change in workflow or policy was the consensus decision of the committee, the Good Catch was kept open and re-reviewed at subsequent weekly meetings until a new workflow was in place and relevant teams were onboarded. RESULTS From Jan 2015 - Dec 2022, 2748 Good Catches were reported (see Table). Most Good Catches were discussed at only one weekly multidisciplinary committee meeting and closed within 7 days of reporting (69%). For the 854 Good Catches that took >1 week to close, the median time to closure was 16 days (range 7-588 days). In general, the number of notes was higher for Good Catches that took longer to close; however, some Good Catches that closed rapidly had more than 10 notes in a short period of time and other Good Catches with lengthy time to closure had minimal resulting documentation (see Table). Most Good Catches were assigned a Champion who was an MD, Physicist, or RTT, and there was no significant difference in Champion assignments for those good catches that closed quickly (< 8 days) and those that had a longer duration to closure. CONCLUSION The majority of operational Good Catches are resolved quickly; speaking to the value of regular weekly multidisciplinary meetings. However, many operational issues require multiple discussion over many weeks and emphasizes that such efforts are challenging and require patience, dedication, and commitment to implement changes in workflow.
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Affiliation(s)
- A A Weiner
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - A Amos
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - L B Marks
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - R McGurk
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - M J Dance
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - L Mazur
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC
| | - B S Chera
- Medical University of South Carolina, Charleston, SC
| | - T Person
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - B Pineiro
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - M Hawkins
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - A Couch
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - S Risgaard
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Mukherjee S, Hurt CN, Adams R, Bateman A, Bradley KM, Bridges S, Falk S, Griffiths G, Gwynne S, Jones CM, Markham PJ, Maughan T, Nixon LS, Radhakrishna G, Roy R, Schoenbuchner S, Sheikh H, Spezi E, Hawkins M, Crosby TD. Efficacy of early PET-CT directed switch to carboplatin and paclitaxel based definitive chemoradiotherapy in patients with oesophageal cancer who have a poor early response to induction cisplatin and capecitabine in the UK: a multi-centre randomised controlled phase II trial. EClinicalMedicine 2023; 61:102059. [PMID: 37409323 PMCID: PMC10318451 DOI: 10.1016/j.eclinm.2023.102059] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023] Open
Abstract
Background The utility of early metabolic response assessment to guide selection of the systemic component of definitive chemoradiotherapy (dCRT) for oesophageal cancer is uncertain. Methods In this multi-centre, randomised, open-label, phase II substudy of the radiotherapy dose-escalation SCOPE2 trial we evaluated the role of 18F-Fluorodeoxyglucose positron emission tomography (PET) at day 14 of cycle 1 of three-weekly induction cis/cap (cisplatin (60 mg/m2)/capecitabine (625 mg/m2 days 1-21)) in patients with oesophageal squamous cell carcinoma (OSCC) or adenocarcinoma (OAC). Non-responders, who had a less than 35% reduction in maximum standardised uptake value (SUVmax) from pre-treatment baseline, were randomly assigned to continue cis/cap or switch to car/pac (carboplatin AUC 5/paclitaxel 175 mg/m2) for a further induction cycle, then concurrently with radiotherapy over 25 fractions. Responders continued cis/cap for the duration of treatment. All patients (including responders) were randomised to standard (50Gy) or high (60Gy) dose radiation as part of the main study. Primary endpoint for the substudy was treatment failure-free survival (TFFS) at week 24. The trial was registered with International Standard Randomized Controlled Trial Number 97125464 and ClinicalTrials.govNCT02741856. Findings This substudy was closed on 1st August 2021 by the Independent Data Monitoring Committee on the grounds of futility and possible harm. To this point from 22nd November 2016, 103 patients from 16 UK centres had participated in the PET-CT substudy; 63 (61.2%; 52/83 OSCC, 11/20 OAC) of whom were non-responders. Of these, 31 were randomised to car/pac and 32 to remain on cis/cap. All patients were followed up until at least 24 weeks, at which point in OSCC both TFFS (25/27 (92.6%) vs 17/25 (68%); p = 0.028) and overall survival (42.5 vs. 20.4 months, adjusted HR 0.36; p = 0.018) favoured cis/cap over car/pac. There was a trend towards worse survival in OSCC + OAC cis/cap responders (33.6 months; 95%CI 23.1-nr) vs. non-responders (42.5 (95%CI 27.0-nr) months; HR = 1.43; 95%CI 0.67-3.08; p = 0.35). Interpretation In OSCC, early metabolic response assessment is not prognostic for TFFS or overall survival and should not be used to personalise systemic therapy in patients receiving dCRT. Funding Cancer Research UK.
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Affiliation(s)
- Somnath Mukherjee
- Oxford Cancer Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher N. Hurt
- Centre for Trials Research, Cardiff University, Cardiff, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Richard Adams
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Andrew Bateman
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kevin M. Bradley
- Wales Research and Diagnostic Positron Emission Tomography Centre (PETIC), Cardiff University, Cardiff, UK
| | - Sarah Bridges
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Stephen Falk
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Gareth Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Sarah Gwynne
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea, UK
| | | | | | - Tim Maughan
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | | | - Ganesh Radhakrishna
- The Christie Hospital, The Christie Hospitals NHS Foundation Trust, Manchester, UK
| | - Rajarshi Roy
- Queen's Centre for Oncology, Hull University Teaching Hospitals NHS Trust, UK
| | | | - Hamid Sheikh
- The Christie Hospital, The Christie Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Maria Hawkins
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
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Malik M, Bulman J, Lindquester W, Hawkins M, Liu R, Sarwar A. Abstract No. 234 Systematic Review and Update on Economic Research in Interventional Radiology. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.296] [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: 02/26/2023] Open
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Lindquester W, Hawkins M, Dhangana R. Abstract No. 584 Common Interventional Radiology Procedures Performed by Physician Assistants and Nurse Practitioners: Medicare Trends from 2010 to 2018. J Vasc Interv Radiol 2023. [DOI: 10.1016/j.jvir.2022.12.442] [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: 02/26/2023] Open
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Lee CL, Hawkins M, Brand D, Blackman G, Richards T. Single institution outcomes of conventional (1.8–2 Gy/Fr) and hypofractionated (2.5–3 Gy/Fr) RT in OG/GOJ cancers during COVID-19. Clin Oncol (R Coll Radiol) 2022. [PMCID: PMC9634425 DOI: 10.1016/j.clon.2022.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bridges S, Thomas B, Radhakrishna G, Hawkins M, Holborow A, Hurt C, Mukherjee S, Nixon L, Crosby T, Gwynne S. SCOPE 2 - Still Answering the Unanswered Questions in Oesophageal Radiotherapy? SCOPE 2: a Randomised Phase II/III Trial to Study Radiotherapy Dose Escalation in Patients with Oesophageal Cancer Treated with Definitive Chemoradiation with an Embedded Phase II Trial for Patients with a Poor Early Response using Positron Emission Tomography/Computed Tomography. Clin Oncol (R Coll Radiol) 2022; 34:e269-e280. [PMID: 35466013 DOI: 10.1016/j.clon.2022.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/12/2021] [Revised: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 12/18/2022]
Abstract
The SCOPE 2 trial of definitive chemoradiotherapy in oesophageal cancer investigates the benefits of radiotherapy dose escalation and systemic therapy optimisation. The trial opened in 2016. The landscape of oesophageal cancer treatment over the lifetime of this trial has changed significantly and the protocol has evolved to reflect this. However, with the recent results of the Dutch phase III ART DECO study showing no improvement in local control or overall survival with radiotherapy dose escalation in a similar patient group, we sought to determine if the SCOPE 2 trial is still answering the key unanswered questions for oesophageal radiotherapy. Here we discuss the rationale behind the SCOPE 2 trial, outline the trial schema and review current data on dose escalation and outline recommendations for future areas of research.
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Affiliation(s)
- S Bridges
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - B Thomas
- Velindre University NHS Trust, Cardiff, UK.
| | | | - M Hawkins
- University College London, Medical Physics and Biomedical Engineering, London, UK
| | - A Holborow
- South West Wales Cancer Centre, Swansea, UK
| | - C Hurt
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - S Mukherjee
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - L Nixon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - T Crosby
- Velindre University NHS Trust, Cardiff, UK
| | - S Gwynne
- South West Wales Cancer Centre, Swansea, UK; Swansea University Medical School, Swansea, UK
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Ahmad R, Baer E, Pile K, Collins-Fekete C, Gulliford S, Wickers S, Hawkins M. PO-1731 Investigating proton therapy as a treatment option for pregnant breast cancer patients. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03695-7] [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: 11/25/2022]
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Hudson EM, Noutch S, Brown S, Adapala R, Bach SP, Burnett C, Burrage A, Gilbert A, Hawkins M, Howard D, Jefford M, Kochhar R, Saunders M, Seligmann J, Smith A, Teo M, Webb EJ, Webster A, West N, Sebag-Montefiore D, Gollins S, Appelt AL. A Phase II trial of Higher RadiOtherapy Dose In The Eradication of early rectal cancer (APHRODITE): protocol for a multicentre, open-label randomised controlled trial. BMJ Open 2022; 12:e049119. [PMID: 35487526 PMCID: PMC9052059 DOI: 10.1136/bmjopen-2021-049119] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/18/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The standard of care for patients with localised rectal cancer is radical surgery, often combined with preoperative neoadjuvant (chemo)radiotherapy. While oncologically effective, this treatment strategy is associated with operative mortality risks, significant morbidity and stoma formation. An alternative approach is chemoradiotherapy to try to achieve a sustained clinical complete response (cCR). This non-surgical management can be attractive, particularly for patients at high risk of surgical complications. Modern radiotherapy techniques allow increased treatment conformality, enabling increased radiation dose to the tumour while reducing dose to normal tissue. The objective of this trial is to assess if radiotherapy dose escalation increases the cCR rate, with acceptable toxicity, for treatment of patients with early rectal cancer unsuitable for radical surgery. METHODS AND ANALYSIS APHRODITE (A Phase II trial of Higher RadiOtherapy Dose In The Eradication of early rectal cancer) is a multicentre, open-label randomised controlled phase II trial aiming to recruit 104 participants from 10 to 12 UK sites. Participants will be allocated with a 2:1 ratio of intervention:control. The intervention is escalated dose radiotherapy (62 Gy to primary tumour, 50.4 Gy to surrounding mesorectum in 28 fractions) using simultaneous integrated boost. The control arm will receive 50.4 Gy to the primary tumour and surrounding mesorectum. Both arms will use intensity-modulated radiotherapy and daily image guidance, combined with concurrent chemotherapy (capecitabine, 5-fluorouracil/leucovorin or omitted). The primary endpoint is the proportion of participants with cCR at 6 months after start of treatment. Secondary outcomes include early and late toxicities, time to stoma formation, overall survival and patient-reported outcomes (European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires QLQ-C30 and QLQ-CR29, low anterior resection syndrome (LARS) questionnaire). ETHICS AND DISSEMINATION The trial obtained ethical approval from North West Greater Manchester East Research Ethics Committee (reference number 19/NW/0565) and is funded by Yorkshire Cancer Research. The final trial results will be published in peer-reviewed journals and adhere to International Committee of Medical Journal Editors guidelines. TRIAL REGISTRATION NUMBER ISRCTN16158514.
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Affiliation(s)
- Eleanor M Hudson
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Samantha Noutch
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Sarah Brown
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Ravi Adapala
- Department of Radiology, Wrexham Maelor Hospital, Wrexham, UK
| | - Simon P Bach
- Academic Department of Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Carole Burnett
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | | | - Alexandra Gilbert
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Maria Hawkins
- Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Debra Howard
- National Radiotherapy Trials QA (RTTQA) Group, Mount Vernon Cancer Centre, Northwood, UK
| | | | - Rohit Kochhar
- Department of Radiology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mark Saunders
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jenny Seligmann
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Alexandra Smith
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Mark Teo
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - Edward Jd Webb
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Amanda Webster
- National Radiotherapy Trials QA (RTTQA) Group, Mount Vernon Cancer Centre, Northwood, UK
| | - Nicholas West
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | | | - Simon Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Bodelwyddan, UK
| | - Ane L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
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Davidson ME, Hawkins M, Panzera A, Owens-Young J, Misra D. Perceived racism and preterm birth: Baltimore preterm birth cohort study. Ann Epidemiol 2021. [DOI: 10.1016/j.annepidem.2021.06.017] [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: 11/25/2022]
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Daly M, Moinuddin SA, Petkar S, Jani Z, McGeady K, Hawkins M. A decision tool for radiographer-led abdominal image-guided stereotactic ablative body radiotherapy - Experience from a single institution. Tech Innov Patient Support Radiat Oncol 2021; 19:33-36. [PMID: 34401538 PMCID: PMC8349902 DOI: 10.1016/j.tipsro.2021.07.004] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/13/2022] Open
Abstract
A CBCT decision tool was developed for radiographer-led IGRT for abdominal SABR. This tool increased the confidence of radiographers undertaking online CBCT IGRT. Median online review time was reduced by 1m 8s.
A decision tool for radiographer-led image-guided radiotherapy (IGRT) using cone-beam CT (CBCT) for abdominal stereotactic radiotherapy was developed and successfully implemented in a single department. The confidence of 7 therapeutic radiographers when undertaking online CBCT review increased, and the pooled median online match time was reduced by 1 m 8 s. While this may be advantageous for abdominal SABR, further evaluation of this work in a larger cohort is required to validate these results.
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Affiliation(s)
- Mairead Daly
- University College London Hospitals NHS Trust, United Kingdom
| | | | - Shabnam Petkar
- University College London Hospitals NHS Trust, United Kingdom
| | - Zankhana Jani
- University College London Hospitals NHS Trust, United Kingdom
| | - Kathryn McGeady
- University College London Hospitals NHS Trust, United Kingdom
| | - Maria Hawkins
- University College London Hospitals NHS Trust, United Kingdom.,University College London, United Kingdom
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Robinson M, Muirhead R, Chu K, Jacobs C, Ng S, Hawkins M. PO-1276 Differential Response of FDG Uptake in Pelvic Bone Marrow to Concurrent Chemoradiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07727-6] [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: 10/20/2022]
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Colori A, Hawkins M, Mitchell A, Hiley C, Dubash S, Johnson U, Fenwick J, Mendes R, Carnell D, Wilson J. PO-1199 Cardiac disease and tumour below T7 confer poorer prognosis following radical radiotherapy for NSCLC. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07650-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Mukherjee S, O'Connor H, Harman R, O'Donovan M, Debiram-Beecham I, Alias B, Bailey A, Bateman A, de Caestecker J, Crosby T, Falk S, Gollins S, Hawkins M, Levy S, Radhakrishna G, Roy R, Sripadam R, Fitzgerald R. P-109 CYTOFLOC: Evaluation of a non-endoscopic immunocytological device (Cytosponge™) for post-chemo-radiotherapy surveillance in patients with oesophageal cancer – a feasibility study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Guckenberger M, Mantel F, Sweeney RA, Hawkins M, Belderbos J, Ahmed M, Andratschke N, Madani I, Flentje M. Long-Term Results of Dose-Intensified Fractionated Stereotactic Body Radiation Therapy (SBRT) for Painful Spinal Metastases. Int J Radiat Oncol Biol Phys 2021; 110:348-357. [PMID: 33412262 DOI: 10.1016/j.ijrobp.2020.12.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To report long-term outcome of fractionated stereotactic body radiation therapy (SBRT) for painful spinal metastases. METHODS AND MATERIALS This prospective, single-arm, multicenter phase 2 clinical trial enrolled 57 patients with 63 painful, unirradiated spinal metastases between March 2012 and July 2015. Patients were treated with 48.5 Gy in 10 SBRT fractions (long life expectancy [Mizumoto score ≤4]) or 35 Gy in 5 SBRT fractions (intermediate life expectancy [Mizumoto score 5-9]). Pain response was defined as pain improvement of a minimum of 2 points on a visual analog scale, and net pain relief was defined as the sum of time with pain response (complete and partial) divided by the overall follow-up time. RESULTS All 57 patients received treatment per protocol; 32 and 25 patients were treated with 10- and 5-fraction SBRT, respectively. The median follow-up of living patients was 60 months (range, 33-74 months). Of evaluable patients, 82% had complete or partial pain response (responders) at 3 months' follow-up (primary endpoint), and pain response remained stable over 5 years. Net pain relief was 74% (95% CI, 65%-80%). Overall survival rates of 1, 3, and 5 years were 59.6% (95% CI, 47%-72%), 33.3% (95% CI, 21%-46%), and 21% (95% CI, 10%-32%), respectively. Freedom from local spinal-metastasis progression was 82% at the last imaging follow-up. Late grade-3 toxicity was limited to pain in 2 patients (nonresponders). There were no cases of myelopathy. SBRT resulted in long-term improvements of all dimensions of the 5-level EuroQol 5-Dimension Questionnaire except anxiety/depression. CONCLUSIONS Fractionated SBRT achieved durable pain response and improved quality of life at minimum late toxicity.
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Affiliation(s)
- Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany.
| | - Frederick Mantel
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Reinhart A Sweeney
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, Schweinfurt, Germany
| | - Maria Hawkins
- Medical Physics and Biomedical Engineering, University College London, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - José Belderbos
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Merina Ahmed
- Department of Radiation Therapy, Royal Marsden NHS Foundation Trust/Institute of Cancer Research, Sutton, United Kingdom
| | - Nicolaus Andratschke
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Indira Madani
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Michael Flentje
- Department of Radiation Oncology, University Hospital Wuerzburg, Wuerzburg, Germany
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Zavaletta V, Wittling M, Shah J, Gill A, Hawkins M. Abstract No. 81 Bleomycin-soaked bio-resorbable particle embolization of benign vascular anomalies. J Vasc Interv Radiol 2021. [DOI: 10.1016/j.jvir.2021.03.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Jones CM, Hawkins M, Mukherjee S, Radhakrishna G, Crosby T. Corrigendum to "Considerations for the Treatment of Oesophageal Cancer with Radiotherapy During the COVID-19 Pandemic" [Clin Oncol 32 (2020) 354-357]. Clin Oncol (R Coll Radiol) 2021; 33:e362. [PMID: 33795184 PMCID: PMC8436418 DOI: 10.1016/j.clon.2021.03.010] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- C M Jones
- School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Hawkins
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - G Radhakrishna
- Christie Hospital, The Christie NHS Foundation Trust, Manchester, UK
| | - T Crosby
- Velindre Cancer Centre, Cardiff, UK.
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Slevin F, Beasley M, Speight R, Lilley J, Murray L, Hawkins M, Radhakrishna G, Henry A. Evaluation of Clinician Contouring for Pancreatic Stereotactic Ablative Radiotherapy During a Contouring Workshop Organised by the Royal College of Radiologists. Clin Oncol (R Coll Radiol) 2021; 33:e196-e197. [PMID: 33129654 DOI: 10.1016/j.clon.2020.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/19/2020] [Indexed: 11/22/2022]
Affiliation(s)
| | - M Beasley
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Speight
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Lilley
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - M Hawkins
- Medical Physics and Biochemical Engineering, University College London, London, UK
| | | | - A Henry
- University of Leeds, Leeds, UK
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Nicholas O, Radhakrishna G, Banner R, Mukherjee S, Hawkins M, Crosby T, Gwynne S. PO-1037: A new nodal delineation protocol for upper third oesophageal cancers in the SCOPE 2 trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01054-9] [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: 10/22/2022]
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O'Cathail S, Muirhead R, Sebag-Montefiore D, Hawkins M. PH-0161: Elective clinical target volumes for rectal IMRT delivery – moving towards a UK wide consensus. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00185-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Hawkins M. SP-0263: What is the optimal dose and fractionation? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00287-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Patel R, McGinty P, Cuthill V, Hawkins M, Moorghen M, Clark SK, Latchford A. MUTYH-associated polyposis - colorectal phenotype and management. Colorectal Dis 2020; 22:1271-1278. [PMID: 32307808 DOI: 10.1111/codi.15078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 03/11/2020] [Indexed: 12/13/2022]
Abstract
AIM The aim was to determine the presentation, management and outcomes of MUTYH-associated polyposis (MAP). METHOD A prospectively maintained database was used to identify patients with MAP. Demographic data and data on germline mutation, surgical management, histopathology of tumours and endoscopic surveillance were collected. RESULTS In all, 134 patients with MAP were identified. The majority presented symptomatically (n = 83). Sixty-eight patients developed cancer (seven synchronous, 12 metachronous). The median age at diagnosis of first colorectal cancer was 47 years (range 33-74 years). Cancers occurred in the context of a few adenomas (< 10). The majority of patients (n = 108) had surgery as the first line management. One patient received palliative care. Twenty-five patients had endoscopic surveillance as first line management; no cancers occurred in this group. Patients who had segmental resection and postoperative surveillance still appeared to be at risk of metachronous cancer (5/30, 17%). CONCLUSIONS MUTYH testing should be considered even in the context of cancers occurring with fewer than 10 adenomas. In cases of primary colorectal cancers, extended surgery should be considered if patients do not have access to high quality endoscopic surveillance postoperatively. For some patients, endoscopic therapy is an appropriate and safe option in expert hands.
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Affiliation(s)
- R Patel
- Polyposis Registry, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - P McGinty
- Polyposis Registry, St Mark's Hospital, Harrow, UK
| | - V Cuthill
- Polyposis Registry, St Mark's Hospital, Harrow, UK
| | - M Hawkins
- Polyposis Registry, St Mark's Hospital, Harrow, UK
| | - M Moorghen
- Polyposis Registry, St Mark's Hospital, Harrow, UK
| | - S K Clark
- Polyposis Registry, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Latchford
- Polyposis Registry, St Mark's Hospital, Harrow, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Jin H, Chalkidou A, Hawkins M, Summers J, Eddy S, Peacock JL, Coker B, Kartha MR, Good J, Pennington M. Cost-Effectiveness Analysis of Stereotactic Ablative Body Radiation Therapy Compared With Surgery and Radiofrequency Ablation in Two Patient Cohorts: Metastatic Liver Cancer and Hepatocellular Carcinoma. Clin Oncol (R Coll Radiol) 2020; 33:e143-e154. [PMID: 32951952 DOI: 10.1016/j.clon.2020.08.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/10/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023]
Abstract
AIMS To compare the cost-effectiveness of stereotactic ablative body radiation therapy (SABR) with radiofrequency ablation and surgery in adult patients with metastatic liver cancer and hepatocellular carcinoma (HCC). MATERIALS AND METHODS Two patient cohorts were assessed: liver oligometastases and HCC. For each patient cohort, a decision analytic model was constructed to assess the cost-effectiveness of interventions over a 5-year horizon. A Markov process was embedded in the decision model to simulate the possible prognosis of cancer. Data on transition probabilities, survival, side-effects, quality of life and costs were obtained from published sources and the SABR Commissioning through Evaluation (CtE) scheme. The primary outcome was the incremental cost-effectiveness ratio with respect to quality-adjusted life-years. The robustness of the results was examined in a sensitivity analysis. Analyses were conducted from a National Health Service and Personal Social Services perspective. RESULTS In the base case analysis, which assumed that all three interventions were associated with the same cancer progression rates and mortality rates, SABR was the most cost-effective intervention for both patient cohorts. This conclusion was sensitive to the cancer progression rate, mortality rate and cost of interventions. Assuming a willingness-to-pay threshold of £20 000 per quality-adjusted life-year, the probability that SABR is cost-effective was 57% and 50% in liver oligometastases and HCC, respectively. CONCLUSIONS Our results indicate a potential for SABR to be cost-effective for patients with liver oligometastases and HCC. This finding supports further investigation in clinical trials directly comparing SABR with surgery and radiofrequency ablation.
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Affiliation(s)
- H Jin
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK.
| | - A Chalkidou
- King's Technology Evaluation Centre (KiTEC), London, UK
| | - M Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - J Summers
- School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - S Eddy
- School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - J L Peacock
- School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - B Coker
- School of Population Health and Environmental Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - M R Kartha
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK; King's Technology Evaluation Centre (KiTEC), London, UK
| | - J Good
- Queen Elizabeth Hospital, Birmingham, UK
| | - M Pennington
- King's Health Economics (KHE), Institute of Psychiatry, Psychology & Neuroscience at King's College London, London, UK
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van Werkhoven E, Hinsley S, Frangou E, Holmes J, de Haan R, Hawkins M, Brown S, Love SB. Practicalities in running early-phase trials using the time-to-event continual reassessment method (TiTE-CRM) for interventions with long toxicity periods using two radiotherapy oncology trials as examples. BMC Med Res Methodol 2020; 20:162. [PMID: 32571298 PMCID: PMC7477911 DOI: 10.1186/s12874-020-01012-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 10/01/2019] [Accepted: 05/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Awareness of model-based designs for dose-finding studies such as the Continual Reassessment Method (CRM) is now becoming more commonplace amongst clinicians, statisticians and trial management staff. In some settings toxicities can occur a long time after treatment has finished, resulting in extremely long, interrupted, CRM design trials. The Time-to-Event CRM (TiTE-CRM), a modification to the original CRM, accounts for the timing of late-onset toxicities and results in shorter trial duration. In this article, we discuss how to design and deliver a trial using this method, from the grant application stage through to dissemination, using two radiotherapy trials as examples. METHODS The TiTE-CRM encapsulates the dose-toxicity relationship with a statistical model. The model incorporates observed toxicities and uses a weight to account for the proportion of completed follow-up of participants without toxicity. This model uses all available data to determine the next participant's dose and subsequently declare the maximum tolerated dose. We focus on two trials designed by the authors to illustrate practical issues when designing, setting up, and running such studies. RESULTS In setting up a TiTE-CRM trial, model parameters need to be defined and the time element involved might cause complications, therefore looking at operating characteristics through simulations is essential. At the grant application stage, we suggest resources to fund statisticians' time before funding is awarded and make recommendations for the level of detail to include in funding applications. While running the trial, close contact of all involved staff is required as a dose decision is made each time a participant is recruited. We suggest ways of capturing data in a timely manner and give example code in R for design and delivery of the trial. Finally, we touch upon dissemination issues while the trial is running and upon completion. CONCLUSION Model-based designs can be complex. We hope this paper will help clinical trial teams to demystify the conduct of TiTE-CRM trials and be a starting point for using this methodology in practice.
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Affiliation(s)
| | - Samantha Hinsley
- Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | | | - Jane Holmes
- Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | | | - Maria Hawkins
- CRUK MRC Oxford Institute for Radiation Oncology, Gray Laboratories, University of Oxford, Oxford, UK
| | - Sarah Brown
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
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Aitken K, Good J, Hawkins M, Grose D, Mukherjee S, Harrison M, Radhakrishna G. Liver Stereotactic Ablative Radiotherapy: an Effective and Feasible Alternative to Surgery during the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 32:477. [PMID: 32387045 PMCID: PMC7252179 DOI: 10.1016/j.clon.2020.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 01/08/2023]
Affiliation(s)
- K Aitken
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J Good
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Hawkins
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - D Grose
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - M Harrison
- Mount Vernon Cancer Centre, Northwood, UK
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Jones CM, Hawkins M, Mukherjee S, Radhakrishna G, Crosby T. Considerations for the Treatment of Oesophageal Cancer With Radiotherapy During the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 32:354-357. [PMID: 32299723 PMCID: PMC7144663 DOI: 10.1016/j.clon.2020.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Affiliation(s)
- C M Jones
- School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Hawkins
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - G Radhakrishna
- Christie Hospital, The Christie NHS Foundation Trust, Manchester, UK
| | - T Crosby
- Velindre Cancer Centre, Cardiff, UK.
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Hawkins M. A 10-year history of using of 5-Hydroxytryptophan for severe insomnia in a 15-year-old with autism, seizures, and sleep apnea; cause for concern? Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Robinson M, Muirhead R, Jacobs C, Cooke R, Chu KY, Van den Heuvel F, Ng S, Virdee P, Strauss V, Hawkins M. Response of FDG avid pelvic bone marrow to concurrent chemoradiation for anal cancer. Radiother Oncol 2019; 143:19-23. [PMID: 31506182 PMCID: PMC7077746 DOI: 10.1016/j.radonc.2019.08.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [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: 04/10/2019] [Revised: 08/15/2019] [Accepted: 08/19/2019] [Indexed: 11/16/2022]
Abstract
Chemoradiation suppression of active bone marrow shown in on-treatment FDG-PET. No suppression shown in un-irradiation bone marrow. Volumes of active bone marrow receiving 20 Gy are associated with blood count nadirs.
Background and purpose To determine if suppression of active bone marrow, as defined on FDG PETCT, is seen in on-treatment imaging of anal cancer patients receiving concurrent chemoradiation. Methods and materials Scans from 26 patients participating in the ART trial (full title: Anal squamous cell carcinoma: Investigation of functional imaging during chemoRadioTherapy), a single center observational study with FDG PETCT prior to radiotherapy and at fraction 8–10 of concurrent chemoradiation were analysed. Active bone marrow was contoured in both the pelvis and un-irradiated thoracic spine. SUV and volume of active bone marrow after 8–10 fractions of treatment were compared to baseline. Dose metrics to pelvic active bone marrow were extracted and compared to reduction in SUV/active bone marrow volume and to blood count nadir using linear regression. Results Suppression of active bone marrow is seen in the pelvis by a reduction in mean SUV and volume of active bone marrow after 8–10 fractions of treatment. Suppression is not seen in un-irradiated thoracic spine. Dose metrics were associated with reduced SUV and reduced volume of active bone marrow. Volume of active bone marrow receiving <20 Gy was associated with WCC/ANC nadir. 20 Gy was identified as the most likely clinically meaningful dose threshold for toxicity. Volume of active bone marrow receiving <20 Gy correlated to WCC and ANC with an increase of 100 cc being associated with an increase of 0.4 and 0.3 respectively. Conclusion The effect of concurrent chemoradiation in suppression of active bone marrow is seen in on-treatment FDG PETCT scans. Chemotherapy appears well tolerated after 2 weeks of treatment.
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Affiliation(s)
- Maxwell Robinson
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK
| | - Rebecca Muirhead
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK
| | - Clare Jacobs
- Department of Oncology, Oxford University Hospitals NHS Trust, UK
| | - Rosie Cooke
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK
| | - Kwun-Ye Chu
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK
| | | | - Stasya Ng
- Oncology Clinical Trials Office, University of Oxford, UK
| | - Pradeep Virdee
- Centre for Statistics in Medicine, University of Oxford, UK
| | | | - Maria Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, UK.
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Levy S, Moschandreas J, Debiram-Beecham I, O’Donovan M, Brooks C, Bailey A, Hawkins M, Kadri S, de Caestecker J, Crosby T, Fitzgerald R, Mukherjee S. Cytosponge™ for post‐chemoradiation surveillance of oesophageal cancer: a feasibility study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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32
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Babatunde O, O’Cathail S, Cooke R, George B, Robinson M, Van den Heuvel F, Hawkins M. PO-1121 Characterizing Dosimetric Uncertainties to Tumour Volume and Organs at Risk in Rectal Cancer. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31541-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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O'Cathail S, Smith T, Tsang Y, Harrison M, Hawkins M. EP-1461 SBRT Pelvic re-irradiation: 2cm "rind" around PTV and small bowel dosimetry of rectal recurrences. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31881-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: 11/24/2022]
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Strauss VY, Shaw R, Virdee PS, Hurt CN, Ward E, Tranter B, Patel N, Bridgewater J, Parsons P, Radhakrishna G, O’Neill E, Sebag-Montefiore D, Hawkins M, Corrie PG, Maughan T, Mukherjee S. Study protocol: a multi-centre randomised study of induction chemotherapy followed by capecitabine ± nelfinavir with high- or standard-dose radiotherapy for locally advanced pancreatic cancer (SCALOP-2). BMC Cancer 2019; 19:121. [PMID: 30717707 PMCID: PMC6360784 DOI: 10.1186/s12885-019-5307-z] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/16/2019] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Induction chemotherapy followed by chemoradiation is a treatment option for patients with locally advanced pancreatic cancer (LAPC). However, overall survival is comparable to chemotherapy alone and local progression occurs in nearly half of all patients, suggesting chemoradiation strategies should be optimised. SCALOP-2 is a randomised phase II trial testing the role of radiotherapy dose escalation and/or the addition of the radiosensitiser nelfinavir, following induction chemotherapy of gemcitabine and nab-paclitaxel (GEMABX). A safety run-in phase (stage 1) established the nelfinavir dose to administer with chemoradiation in the randomised phase (stage 2). METHODS Patients with locally advanced, inoperable, non-metastatic pancreatic adenocarcinoma receive three cycles of induction GEMABX chemotherapy prior to radiological assessment. Those with stable/responding disease are eligible for further trial treatment. In Stage 1, participants received one further cycle of GEMABX followed by capecitabine-chemoradiation with escalating doses of nelfinavir in a rolling-six design. Stage 2 aims to register 262 and randomise 170 patients with responding/stable disease to one of five arms: capecitabine with high- (arms C + D) or standard-dose (arms A + B) radiotherapy with (arms A + C) or without (arms B + D) nelfinavir, or three more cycles of GEMABX (arm E). Participants allocated to the chemoradiation arms receive another cycle of GEMABX before chemoradiation begins. Co-primary outcomes are 12-month overall survival (radiotherapy dose-escalation question) and progression-free survival (nelfinavir question). Secondary outcomes include toxicity, quality of life, disease response rate, resection rate, treatment compliance, and CA19-9 response. SCALOP-2 incorporates a detailed radiotherapy quality assurance programme. DISCUSSION SCALOP-2 aims to optimise chemoradiation in LAPC and incorporates a modern induction regimen. TRIAL REGISTRATION Eudract No: 2013-004968-56; ClinicalTrials.gov : NCT02024009.
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Affiliation(s)
| | - Rachel Shaw
- Oncology Clinical Trials Office, University of Oxford, Oxford, UK
| | | | | | - Elizabeth Ward
- Clinical Trials and Evaluation Unit, Bristol Royal Infirmary, Bristol, UK
| | - Bethan Tranter
- Pharmacy Department, Velindre Cancer Centre, Velindre NHS University Trust, Cardiff, UK
| | - Neel Patel
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - John Bridgewater
- Department of Oncology, University College London Hospitals, London, UK
| | - Philip Parsons
- Cardiff NCRI RTTQA group, Department of Medical Physics, Velindre Cancer Centre, Cardiff, UK
| | - Ganesh Radhakrishna
- Oncology Department, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK
| | - Eric O’Neill
- Department of Oncology, University of Oxford, CRUK MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | | | - Maria Hawkins
- Department of Oncology, University of Oxford, CRUK MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Pippa G. Corrie
- Cambridge Cancer Centre, Addenbrooke’s Hospital, Cambridge, UK
| | - Timothy Maughan
- Department of Oncology, University of Oxford, CRUK MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Somnath Mukherjee
- Department of Oncology, University of Oxford, CRUK MRC Oxford Institute for Radiation Oncology, Oxford, UK
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Gwynne S, Higgins E, Poon King A, Radhakrishna G, Wills L, Mukherjee S, Hawkins M, Jones G, Staffurth J, Crosby T. Driving developments in UK oesophageal radiotherapy through the SCOPE trials. Radiat Oncol 2019; 14:26. [PMID: 30717810 PMCID: PMC6360789 DOI: 10.1186/s13014-019-1225-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SCOPE trials (SCOPE 1, NeoSCOPE and SCOPE 2) have been the backbone of oesophageal RT trials in the UK. Many changes in oesophageal RT techniques have taken place in this time. The SCOPE trials have, in addition to adopting these new techniques, been influential in aiding centres with their implementation. We discuss the progress made through the SCOPE trials and include details of a questionnaire sent to participating centres. to establish the role that trial participation played in RT changes in their centre. METHODS Questionnaires were sent to 47 centres, 27 were returned. RESULTS 100% of centres stated their departmental protocol for TVD was based on the relevant SCOPE trial protocol. 4DCT use has increased from 42 to 71%. Type B planning algorithms, mandated in the NeoSCOPE trial, were used in 79.9% pre NeoSCOPE and now in 83.3%. 12.5% of centres were using a stomach filling protocol pre NeoSCOPE, now risen to 50%. CBCT was mandated for IGRT in the NeoSCOPE trial. 66.7% used this routinely pre NeoSCOPE/SCOPE 2 which has risen to 87.5% in the survey. CONCLUSION The results of the questionnaires show how participation in national oesophageal RT trials has led to the adoption of newer RT techniques in UK centres, leading to better patient care.
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Affiliation(s)
- S. Gwynne
- South West Wales Cancer Centre, Swansea, UK
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - E. Higgins
- South West Wales Cancer Centre, Swansea, UK
| | | | | | - L. Wills
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - S. Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Maria Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - G. Jones
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - J. Staffurth
- NIHR Cardiff RTTQA Group, Cardiff, UK
- Cardiff University, Cardiff, UK
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Mukherjee S, Virdee P, Shaw R, Bridgewater J, Radhakrishna G, Falk S, Scott-Brown M, Strauss V, Brooks C, Gillmore R, Patel N, Tranter B, Parsons P, Sebag-Montefiore D, Hawkins M, Corrie P, Maughan T. SCALOP-2: A multi-centre randomised trial of induction chemotherapy followed by capecitabine +/-nelfinavir with high or standard dose radiotherapy for locally advanced pancreatic cancer (LAPC): Results of stage 1 - the non-randomised dose-finding component. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Snelling A, Irvine Belson S, Hawkins M, Watts E, Albershardt R, Kaur G. Healthy Schoolhouse 2.0: A Research Project to Increase Nutrition Literacy. J Acad Nutr Diet 2018. [DOI: 10.1016/j.jand.2018.06.160] [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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Jones CM, Adams R, Downing A, Glynne-Jones R, Harrison M, Hawkins M, Sebag-Montefiore D, Gilbert DC, Muirhead R. Toxicity, Tolerability, and Compliance of Concurrent Capecitabine or 5-Fluorouracil in Radical Management of Anal Cancer With Single-dose Mitomycin-C and Intensity Modulated Radiation Therapy: Evaluation of a National Cohort. Int J Radiat Oncol Biol Phys 2018; 101:1202-1211. [PMID: 29859793 DOI: 10.1016/j.ijrobp.2018.04.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [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: 09/16/2017] [Revised: 04/03/2018] [Accepted: 04/11/2018] [Indexed: 01/29/2023]
Abstract
PURPOSE Chemoradiation therapy (CRT) with mitomycin C (MMC) and 5-fluorouracil (5-FU) is established as the standard of care for the radical treatment of patients with anal squamous cell carcinoma (ASCC). The use of the oral fluoropyrimidine-derivative capecitabine is emerging as an alternative to 5-FU despite limited evidence of its tolerability and toxicity. METHODS AND MATERIALS A national cohort evaluation of ASCC management within the United Kingdom National Health Service was undertaken from February to July 2015. The toxicity rates were prospectively recorded. For the present analysis, we report data from ASCC patients who underwent intensity modulated RT and a single dose of MMC with either 5-FU (5-FU/MMC) or capecitabine (capecitabine/MMC). All were treated with radical intent and intensity modulated radiation therapy (IMRT) was delivered in accordance with UK guidance. RESULTS Of the 242 patients received from 40 centers across the United Kingdom, 147 met the inclusion criteria; 52 of whom were treated with capecitabine/MMC and 95 with 5-FU/MMC. No treatment-related deaths and no overall difference were found in the proportion of patients experiencing any grade ≥3 toxicity between the capecitabine and 5-FU groups (45% vs 55%; P = .35). However, significantly fewer patients in the capecitabine/MMC group experienced grade 3 hematologic toxicity (4% vs 27%; P = .001). A lower proportion of patients completed their planned chemotherapy course in the capecitabine cohort, although this did not reach statistical significance (81% vs 90%; P = .21). The median RT duration was 38 days (interquartile range 38-39) for both groups. No difference was found in the 1-year oncologic outcomes. CONCLUSIONS Capecitabine/MMC resulted in similar levels of grade 3/4 toxicity overall compared with 5-FU/MMC as CRT for ASCC, although differences were found in the patterns of observed toxicities, with less hematologic toxicity with capecitabine. Further studies of capecitabine/MMC are required to understand the acute toxicity profile and long-term oncologic outcomes of this combination with intensity modulated RT for ASCC.
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Affiliation(s)
- Christopher M Jones
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom; Radiotherapy Research Group, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Richard Adams
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom; Velindre Hospital, Cardiff, United Kingdom
| | - Amy Downing
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom
| | - Rob Glynne-Jones
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
| | - Mark Harrison
- Mount Vernon Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, United Kingdom
| | - Maria Hawkins
- CRUK MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, United Kingdom
| | - David Sebag-Montefiore
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, United Kingdom; Radiotherapy Research Group, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Duncan C Gilbert
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - Rebecca Muirhead
- Oxford Cancer and Haematology Centre, Oxford University Hospitals, Oxford, United Kingdom.
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Peacock I, Hawkins M, Heptinstall S. Platelet Behaviour in Non-Insulin-Dependent Diabetes -Influence of Vascular Complications, Treatment and Metabolic Control. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1661564] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryPlatelet-rich plasma was prepared from 47 patients with noninsulin-dependent diabetes treated with glibenclamide and metformin, and 21 controls. The release of radio-labelled 5-hydroxy-tryptamine in response to aggregating agents (adenosine diphosphate, adrenaline and sodium arachidonate), and the effects on release of a selective thromboxane inhibitor (UK-34787) were investigated. Subsequently, 20 of the diabetic subjects were chosen at random for treatment with insulin; the remainder continued to take tablets. Platelet studies were then repeated, in all patients, after 4 and 6 months.The results showed an association between platelet behaviour and the presence of vascular complications, and were consistent with previous observations of reduced platelet reactivity in patients taking sulphonylureas. There was no correlation of platelet reactivity with blood glucose, glycosylated haemoglobin or lipid levels.
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Affiliation(s)
- I Peacock
- The Department of Medicine, University Hospital, Nottingham, UK
| | - M Hawkins
- The Department of Medicine, University Hospital, Nottingham, UK
| | - S Heptinstall
- The Department of Medicine, University Hospital, Nottingham, UK
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Holyoake D, Robinson M, Grose D, McIntosh D, Radhakrishna G, Sebag-Montefiore D, Hawkins M. Analysis of On-trial Quality Assurance for the SPARC Clinical Trial using Novel Peer-review Methodology. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Khoo V, Hawkins M, Ahmed M, Kirby A, van As N, McDonald F, Franks K, Syndikus I, Jain S, Tree A, Patel R, Hall E. A Randomised Trial of Conventional Care versus Radioablation (Stereotactic Body Radiotherapy) for Extracranial Oligometastases. Clin Oncol (R Coll Radiol) 2018. [DOI: 10.1016/j.clon.2018.02.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Patel A, Chang G, Wale A, Chong I, Rutten H, Nicholls J, Hawkins M, Steele RJC, Marks J, Brown G. Session 3: Intra-operative radiotherapy - creating new surgical boundaries. Colorectal Dis 2018; 20 Suppl 1:65-75. [PMID: 29878668 DOI: 10.1111/codi.14083] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In patients with advanced and recurrent colorectal cancer, surgical resection with clear margins is the greatest challenge and is limited by known anatomical constraints. Preoperative or intra-operative assessment of the limits of surgical dissection may help to explore the possibility of improving resectability through either targeted external beam radiotherapy or intra-operative radiotherapy. Professor Chang reviews the evidence base and potential advantages and disadvantages of this approach, whilst the expert panel agree a consensus on the evidence for assessment and therapy of such patients.
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Affiliation(s)
- A Patel
- The Royal Marsden NHS Foundation Trust, London, UK
| | - G Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - A Wale
- The Royal Marsden NHS Foundation Trust, London, UK
| | - I Chong
- The Royal Marsden NHS Foundation Trust, London, UK
| | - H Rutten
- Surgical Oncology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - J Nicholls
- Colorectal Surgery, Imperial College London, London, UK
| | - M Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | | | - J Marks
- Lankenau Hospital, Wynnewood, Pennsylvania, USA
| | - G Brown
- The Royal Marsden NHS Foundation Trust, London, UK.,Gastrointestinal Cancer Imaging, Imperial College London, London, UK
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Patel A, Holm T, Wale A, Rutten H, Nicholls J, Hawkins M, Steele RJC, Marks J, Brown G. Session 3: Beyond the boundaries of Total Mesorectal Excision - where surgeons fear to tread. Colorectal Dis 2018; 20 Suppl 1:61-64. [PMID: 29878672 DOI: 10.1111/codi.14082] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 02/08/2023]
Abstract
Approximately 10-15% of patients present with an advanced rectal cancer that extends beyond the conventional total mesorectal excision (TME) planes. In such cases extending the surgery to ensure resection with clear margins (R0 resection) is essential in order to achieve long-term cure. Professor Holm describes the techniques of beyond-TME exenterative surgery, the methods of patient selection and outcomes.
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Affiliation(s)
- A Patel
- The Royal Marsden NHS Foundation Trust, London, UK
| | - T Holm
- Division of Coloproctology, Center of Digestive Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - A Wale
- The Royal Marsden NHS Foundation Trust, London, UK
| | - H Rutten
- Surgical Oncology, Catharina Ziekenhuis, Eindhoven, The Netherlands
| | - J Nicholls
- Colorectal Surgery, Imperial College London, London, UK
| | - M Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | | | - J Marks
- Lankenau Hospital, Wynnewood, Pennsylvania, USA
| | - G Brown
- The Royal Marsden NHS Foundation Trust, London, UK.,Gastrointestinal Cancer Imaging, Imperial College London, London, UK
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Cox S, Jones G, Radhakrishna G, Mukherjee S, Hawkins M, Crosby T, Gwynne S. PO-1080: 4DCT oesophageal tumour delineation in SCOPE2 – how is radiotherapy quality assurance beneficial? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Holyoake D, Partridge M, Hawkins M. PO-1039: Meta-analysis of toxicity and small-bowel radiotherapy dose-volume: “omnibus consequentia”. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31349-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Guckenberger M, Sweeney R, Hawkins M, Belderbos J, Andratschke N, Ahmed M, Madani I, Mantel F, Steigerwald S, Flentje M. PV-0475: Stereotactic Body Radiation Therapy For Painful Spinal Metastases - Results Of A Phase 2 Study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30785-0] [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: 11/15/2022]
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Evans E, Jones G, Rackley T, Maggs R, Radhakrishna G, Mukherjee S, Hawkins M, Crosby T, Gwynne S. PO-0769: NeoSCOPE RTTQA: pre-accrual and on-trial review of all patients in a UK oesophageal RT trial. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31079-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: 11/25/2022]
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Guckenberger M, Sweeney RA, Hawkins M, Belderbos J, Andratschke N, Ahmed M, Madani I, Mantel F, Steigerwald S, Flentje M. Dose-intensified hypofractionated stereotactic body radiation therapy for painful spinal metastases: Results of a phase 2 study. Cancer 2018; 124:2001-2009. [DOI: 10.1002/cncr.31294] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/11/2017] [Accepted: 01/05/2018] [Indexed: 11/11/2022]
Affiliation(s)
| | - Reinhart A. Sweeney
- Department of Radiation Oncology; Leopoldina Hospital Schweinfurt; Schweinfurt Germany
| | - Maria Hawkins
- Cancer Research UK/Medical Research Council Oxford Institute for Radiation Oncology, Gray Laboratories; University of Oxford; Oxford United Kingdom
| | - Jose Belderbos
- Department of Radiation Oncology; Netherlands Cancer Institute; Amsterdam the Netherlands
| | - Nicolaus Andratschke
- Department of Radiation Oncology; University Hospital Zurich; Zurich Switzerland
| | - Merina Ahmed
- Department of Radiotherapy; Royal Marsden NHS Foundation Trust/Institute of Cancer Research; Sutton United Kingdom
| | - Indira Madani
- Department of Radiation Oncology; University Hospital Zurich; Zurich Switzerland
| | - Frederick Mantel
- Department of Radiation Oncology; University Hospital Würzburg; Würzburg Germany
| | - Sabrina Steigerwald
- Department of Radiation Oncology; University Hospital Würzburg; Würzburg Germany
| | - Michael Flentje
- Department of Radiation Oncology; University Hospital Würzburg; Würzburg Germany
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Vivekanandan S, Landau D, Counsell N, Warren D, Farrelly L, Ngai Y, Hawkins M, Fenwick J. Clinical and dosimetric factors impacting radiation pneumonitis in isotoxically dose-escalated NSCLC. Eur J Surg Oncol 2018. [DOI: 10.1016/j.ejso.2018.01.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Brown S, Van Herk M, Chuter R, Falk S, Kirkby K, Mackay R, Harrington K, Cosgrove V, Gray A, Hall E, Hawkins M, Hawkes D, Henry A, Maughan T, Nutting C, Oelfke U, Royle G, Sebag-Montefiore D, Sharma R, Van Den Heuvel F, Faivre-Finn C. Advanced Radiotherapy Technologies Network in the UK (ART-NET) – focus on lung cancer. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30166-1] [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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