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Anderson S, Peters AL, Lumsden G, Alhasso A, Cartwright D, O'Brien O, Marashi H. Clinical Experience of Axillary Radiotherapy for Node-positive Breast Cancer. Clin Oncol (R Coll Radiol) 2024; 36:98-106. [PMID: 38057203 DOI: 10.1016/j.clon.2023.11.040] [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] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 09/11/2023] [Accepted: 11/23/2023] [Indexed: 12/08/2023]
Abstract
AIMS Patients with breast cancer who have positive lymph nodes are currently recommended axillary node clearance (ANC) or regional nodal irradiation (RNI). ANC is associated with complications such as lymphoedema, brachial plexopathy and shoulder stiffness. The AMAROS Group showed RNI to be non-inferior to ANC with regards to survival and recurrence, and with a better quality of life. We conducted a large real-world population study to show our centre's experience with the use of RNI and to contribute to the current discussion around the management of node-positive breast cancer. MATERIALS AND METHODS We evaluated patients who received RNI as opposed to ANC between 2006 and 2009 (n = 190). Patients had a range of cancer subtypes/grades. All had positive axillary disease, identified by axillary node sampling or sentinel lymph node biopsy. Systemic therapy was given as per standard protocol. Our data were compared with those of patients who had RNI (n = 681) in AMAROS. Patients were followed up retrospectively and overall survival, breast cancer-specific survival, distant metastasis-free survival, locoregional recurrence and toxicity were recorded, including lymphoedema, brachial plexopathy and shoulder stiffness. Survival analysis was performed on R via the Kaplan-Meier method. Univariate and multivariate analyses were also performed. Toxicity data were reported as percentages. Patients meeting POSNOC trial criteria (one to two positive sentinel lymph nodes, macrometastasis, receiving adjuvant chemotherapy) including if oestrogen receptor-positive (stratified POSNOC) were identified for subgroup analysis in the regression model. RESULTS Locoregional recurrence was 3.16% versus AMAROS RNI of 1.82%. Overall survival was slightly lower in our population, but cancer-specific survival was higher than AMAROS. Lymphoedema rates were 5.8% versus AMAROS 11% in RNI and 23% in ANC arms, respectively. Brachial plexopathy was 1.6% and arm/shoulder stiffness 7.4%. AMAROS conducted a quality of life survey pertaining to arm/shoulder stiffness, mobility and function, which seemed to affect about 18% in the RNI arm. Univariate analysis revealed POSNOC status, especially if also oestrogen receptor-positive, to be a low risk group with hazard ratio 0.42 (0.20-0.83, P = 0.015). Extracapsular extension of lymph node metastasis was a poor prognostic factor; hazard ratio 4.39 (1.45-14.0, P = 0.009). CONCLUSION We support the conclusion of the AMAROS trial with survival and recurrence following RNI being non-inferior to ANC, and with similarly favourable toxicity data. We support the continuing use of RNI as a treatment option for patients with node-positive breast cancer. Further research is required to answer the key questions regarding personalised management for node-positive breast cancer, with regards to de-escalation and also intensification for the patients exhibiting adverse tumour biology.
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Affiliation(s)
- S Anderson
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - A L Peters
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK.
| | - G Lumsden
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - A Alhasso
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - D Cartwright
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - O O'Brien
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - H Marashi
- Beatson West of Scotland Cancer Centre, Gartnavel Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
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O'Brien O, Allen S, Krützen M, Connor R. Alliance-specific habitat selection by male Indo-Pacific bottlenose dolphins in Shark Bay, Western Australia. Anim Behav 2020. [DOI: 10.1016/j.anbehav.2020.03.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Kelly D, Mc Sorley L, O'Shea E, Mc Carthy E, Bowe S, Brady C, Sui J, Dawod MA, O'Brien O, Graham D, McCarthy J, Burke L, Power D, O'Reilly S, Bambury RM, Mahony DO. A regional analysis of epidermal growth factor receptor (EGFR) mutated lung cancer for HSE South. Ir J Med Sci 2017; 186:855-857. [PMID: 28185061 DOI: 10.1007/s11845-017-1579-y] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 02/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND EGFR mutated lung cancer represents a subgroup with distinct clinical presentations, prognosis, and management requirements. We investigated the survival, prognostic factors, and real-world treatment of NSCLC patients with EGFR mutation in clinical practice. METHODS A retrospective review of all specimens sent for EGFR analysis from December 2009 to September 2015 was performed. Patient demographics, specimen type, EGFR mutation status/type, stage at diagnosis, treatment, response rate, and survival data were recorded. RESULTS 27/334 (8%) patient specimens sent for EGFR testing tested positive for a sensitising EGFR mutation. The median age was 65 years (40-85 years). Exon 19 deletion represented the most commonly detected alteration, accounting for 39% (n = 11). First-line treatment for those with Exon 18, 19, or 21 alterations (n = 24) was with an EGFR tyrosine kinase inhibitor (TKI) in 79% (n = 19). Objective response rate among these patients was 74% and median duration of response was 13 months (range 7-35 months). CONCLUSION The incidence of EGFR mutation in our cohort of NSCLC is 9% which is consistent with mutation incidence reported in other countries. The rate of EGFR mutation in our population is slightly below that reported internationally, but treatment outcomes are consistent with published data. Real-world patient data have important contributions to make with regard to quality measurement, incorporating patient experience into guidelines and identifying safety signals.
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Affiliation(s)
- D Kelly
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland.
| | - L Mc Sorley
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - E O'Shea
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - E Mc Carthy
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - S Bowe
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - C Brady
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - J Sui
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - M A Dawod
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - O O'Brien
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - D Graham
- Department of Respiratory Medicine, Cork University Hospital, Cork, Ireland
| | - J McCarthy
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - L Burke
- Department of Pathology, Cork University Hospital, Cork, Ireland
| | - D Power
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - S O'Reilly
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - R M Bambury
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
| | - D O Mahony
- Department of Medical Oncology, Cork University Hospital, Mercy University Hospital Cork, University Hospital Kerry, Tralee, County Kerry, Ireland
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Wekesa AL, Cross KS, O'Donovan O, Dowdall JF, O'Brien O, Doyle M, Byrne L, Phelan JP, Ross MD, Landers R, Harrison M. Predicting carotid artery disease and plaque instability from cell-derived microparticles. Eur J Vasc Endovasc Surg 2014; 48:489-95. [PMID: 25218652 DOI: 10.1016/j.ejvs.2014.08.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 08/01/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Cell-derived microparticles (MPs) are small plasma membrane-derived vesicles shed from circulating blood cells and may act as novel biomarkers of vascular disease. We investigated the potential of circulating MPs to predict (a) carotid plaque instability and (b) the presence of advanced carotid disease. METHODS This pilot study recruited carotid disease patients (aged 69.3 ± 1.2 years [mean ± SD], 69% male, 90% symptomatic) undergoing endarterectomy (n = 42) and age- and sex-matched controls (n = 73). Plaques were classified as stable (n = 25) or unstable (n = 16) post surgery using immunohistochemistry. Blood samples were analysed for MP subsets and molecular biomarkers. Odds ratios (OR) are expressed per standard deviation biomarker increase. RESULTS Endothelial MP (EMP) subsets, but not any vascular, inflammatory, or proteolytic molecular biomarker, were higher (p < .05) in the unstable than the stable plaque patients. The area under the receiver operator characteristic curve for CD31(+)41(-) EMP in discriminating an unstable plaque was 0.73 (0.56-0.90, p < .05). CD31(+)41(-) EMP predicted plaque instability (OR = 2.19, 1.08-4.46, p < .05) and remained significant in a multivariable model that included transient ischaemic attack symptom status. Annexin V(+) MP, platelet MP (PMP) subsets, and C-reactive protein were higher (p < .05) in cases than controls. Annexin V(+) MP (OR = 3.15, 1.49-6.68), soluble vascular cell adhesion molecule-1 (OR = 1.64, 1.03-2.59), and previous smoking history (OR = 3.82, 1.38-10.60) independently (p < .05) predicted the presence of carotid disease in a multivariable model. CONCLUSIONS EMP may have utility in predicting plaque instability in carotid patients and annexin V(+) MPs may predict the presence of advanced carotid disease in aging populations, independent of established biomarkers.
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Affiliation(s)
- A L Wekesa
- Biomedical Research Group, Schools of Health Science and Science, Waterford Institute of Technology, Waterford, Ireland
| | - K S Cross
- Departments of Vascular Surgery and Histopathology, Waterford Regional Hospital, Waterford, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | - O O'Donovan
- Biomedical Research Group, Schools of Health Science and Science, Waterford Institute of Technology, Waterford, Ireland
| | - J F Dowdall
- Departments of Vascular Surgery and Histopathology, Waterford Regional Hospital, Waterford, Ireland
| | - O O'Brien
- Departments of Vascular Surgery and Histopathology, Waterford Regional Hospital, Waterford, Ireland
| | - M Doyle
- Departments of Vascular Surgery and Histopathology, Waterford Regional Hospital, Waterford, Ireland
| | - L Byrne
- Departments of Vascular Surgery and Histopathology, Waterford Regional Hospital, Waterford, Ireland
| | - J P Phelan
- Biomedical Research Group, Schools of Health Science and Science, Waterford Institute of Technology, Waterford, Ireland
| | - M D Ross
- Biomedical Research Group, Schools of Health Science and Science, Waterford Institute of Technology, Waterford, Ireland
| | - R Landers
- Departments of Vascular Surgery and Histopathology, Waterford Regional Hospital, Waterford, Ireland
| | - M Harrison
- Biomedical Research Group, Schools of Health Science and Science, Waterford Institute of Technology, Waterford, Ireland.
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O'Leary DP, O'Brien O, Relihan N, McCarthy J, Ryan M, Barry J, Kelly LM, Redmond HP. Rapid on-site evaluation of axillary fine-needle aspiration cytology in breast cancer. Br J Surg 2012; 99:807-12. [PMID: 22473359 DOI: 10.1002/bjs.8738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND Axillary ultrasonography (AUS) and fine-needle aspiration cytology (FNAC) can establish axillary lymph node status before surgery, although this technique is hampered by poor adequacy rates. To achieve consistently high rates of FNAC adequacy, rapid on-site evaluation (ROSE) of FNAC samples was introduced. METHODS This single-centre, retrospective observational study of patients with newly diagnosed breast cancer undergoing preoperative AUS and FNAC between February 2008 and November 2010 examined the effect of the introduction of ROSE. RESULTS A total of 381 patients were included. AUS revealed 152 axillae with suspicious radiological features. FNAC was positive for malignant cells in 75 (49·3 per cent) of 152 samples. Sentinel lymph node mapping was avoided in 75 patients, representing 19·7 per cent of the entire study population. Adequacy rates increased from 78 per cent to 96 per cent following the introduction of ROSE (P = 0·001). The overall sensitivity and specificity of AUS and FNAC was 80·6 and 100 per cent respectively. A lymph node diameter equal to or larger than 10 mm and extranodal extension were significantly associated with positive FNAC (P < 0·001 and P = 0·012 respectively). Maximum lymph node diameter of at least 10 mm was an independent predictor of positive FNAC (odds ratio 11·2, 95 per cent confidence interval 3·32 to 37·76; P < 0·001). CONCLUSION AUS with FNAC provided accurate preoperative staging of the axilla for metastatic breast disease and avoided unnecessary sentinel lymph node mapping. The introduction of ROSE ensured the efficiency of AUS and FNAC.
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Affiliation(s)
- D P O'Leary
- Department of Surgery, Cork University Hospital, Cork, Ireland.
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Wong VV, O'Brien O, De Tavernier M. Bilateral malignant ovarian haemangiopericytoma. J OBSTET GYNAECOL 2011; 31:98-9. [PMID: 21281014 DOI: 10.3109/01443615.2010.515322] [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]
Affiliation(s)
- V V Wong
- Department of Gynaecology, Cork University Hospital, Wilton, Cork, Republic of Ireland.
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West J, O'Brien O, Ellis J, O'Brien C. In Vitro comparison of the performance of salmeterol/fluticasone propionate HFA Metered Dose Inhaler (MDI) with and without MDI counter. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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O'Brien O, Pickering TG, van Montfrans GA, Di Rienzo M, Fagard R. Blood Pressure Monitoring. Task force I: Methodological aspects. Blood Press Monit 1999; 4:279-93. [PMID: 10602533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- O O'Brien
- Blood Pressure Unit, Beamont Hospital, Dublin, Ireland
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Lindsay S, Ireland M, O'Brien O, Clayton-Smith J, Hurst JA, Mann J, Cole T, Sampson J, Slaney S, Schlessinger D, Burn J, Pilia G. Large scale deletions in the GPC3 gene may account for a minority of cases of Simpson-Golabi-Behmel syndrome. J Med Genet 1997; 34:480-3. [PMID: 9192268 PMCID: PMC1050971 DOI: 10.1136/jmg.34.6.480] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.0] [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] [Indexed: 02/04/2023]
Abstract
AIMS OF THE STUDY To identify the proportion and type of deletions present in the glypican 3 (GPC3) gene in a group of patients with Simpson-Golabi-Behmel syndrome (SGBS). SUBJECTS AND METHODS PCR analysis using primer pairs which amplify fragments from each of the eight exons of the GPC3 gene was carried out in a series of 18 families with SGBS (approximately half of reported cases). RESULTS Deletions were detected in only five families (one reported previously). We found deletions in all exons of the gene except exon 3. CONCLUSIONS Our results suggest that large scale deletions may be less common in SGBS than was originally thought. One patient, with an exon 4 and 5 deletion, lacked the characteristic facial dysmorphic features. This raises the possibility of involvement of GPC3 gene defects in a wider range of overgrowth disorders.
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Affiliation(s)
- S Lindsay
- Department of Human Genetics, University of Newcastle upon Tyne, UK
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Lindsay S, Splitt M, Edney S, Berney TP, Knight SJ, Davies KE, O'Brien O, Gale M, Burn J. PPM-X: a new X-linked mental retardation syndrome with psychosis, pyramidal signs, and macroorchidism maps to Xq28. Am J Hum Genet 1996; 58:1120-6. [PMID: 8651288 PMCID: PMC1915053] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We report a three-generation family manifesting a previously undescribed X-linked mental retardation syndrome. Four of the six moderately retarded males have had episodes of manic-depressive psychosis. The phenotype also includes pyramidal signs, Parkinsonian features, and macroorchidism, but there are no characteristic dysmorphic facial features. Affected males do not show fragile sites at distal Xq on cytogenetic analysis, nor do they have expansions of the CGG repeats at the FRAXA, FRAXE, or FRAXF loci. Linkage analyses were undertaken, and a maximal LOD score of 3.311 at theta = .0 was observed with the microsatellite marker DXS1123 in Xq28. A recombination was detected in one of the affected males with DXS1691 (Xq28), which gives the proximal boundary of the localization. No distal recombination has been detected at any of the loci tested.
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Affiliation(s)
- S Lindsay
- Department of Human Genetics, Newcastle upon Tyne, United Kingdom
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O'Brien O. Drugs in current use. Aust Nurses J 1971; 1:34. [PMID: 5211164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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O'Brien O. Drugs in current use. Aust Nurses J 1971; 1:33-4. [PMID: 5211232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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O'Brien O. Drugs in current use. Aust Nurses J 1971; 1:28. [PMID: 5211156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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