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Abbott RA, Cordaro A, Lloyd B, Cannings-John R, Wootton M, Kirby N, Pickles T, McQueen A, Westmoreland M, Ziaj S, Martin-Clavijo A, Wernham A, Matin R, Thomas-Jones E. Observational study to estimate the proportion of surgical site infection following excision of ulcerated skin tumours (OASIS study). Clin Exp Dermatol 2022; 47:882-888. [PMID: 34855996 DOI: 10.1111/ced.15037] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Ulceration is a recognized risk factor for surgical site infection (SSI); however, the proportion of patients developing SSI after excision of an ulcerated skin cancer is unknown. AIM To determine the proportion of participants with SSI after surgical excision of an ulcerated skin cancer. A secondary aim was to assess feasibility outcomes to inform the design of a randomized controlled trial to investigate the benefits and harms of perioperative antibiotics following excision of ulcerated tumours. METHODS This was a multicentre, prospective, observational study of patients undergoing excision of an ulcerated skin cancer between March 2019 and March 2020. Prior to surgical excision, surface swabs of the ulcerated tumours of participants recruited from one centre were undertaken to determine organism growth. At 4 weeks after surgery, all participants were e-mailed or posted the Wound Healing Questionnaire (WHQ) to determine whether they had developed SSI. RESULTS In total, 148 participants were recruited 105 (70.9%) males; mean ± SD age 77.1 ± 12.3 years. Primary outcome data were available for 116 (78.4%) participants, of whom 35 (30.2%) were identified as having an SSI using the WHQ with a cutoff score of 8, and 47 (40.5%) were identified with a cutoff score of 6. Using the modified WHQ in participants with wounds left to heal by secondary intention, 33 (28.4%) and 43 (37.1%) were identified to have SSI respectively. CONCLUSION This prospective evaluation of SSI identified with the WHQ following excision of ulcerated skin cancers demonstrated a high proportion with SSI. The WHQ was acceptable to patients; however, further evaluation is required to ensure validity in assessing skin wounds.
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Affiliation(s)
- R A Abbott
- Department of Dermatology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - A Cordaro
- Department of Dermatology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - B Lloyd
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - M Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, Cardiff, UK
| | - N Kirby
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - T Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - A McQueen
- Department of Dermatology, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - M Westmoreland
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Ziaj
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Martin-Clavijo
- Department of Dermatology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Wernham
- Department of Dermatology, Manor Hospital, Walsall Healthcare NHS Trust, Wallsall, UK
- Department of Dermatology, Leicester Royal Infirmary, Leicester University Hospitals NHS Trust, Leicester, UK
| | - R Matin
- Department of Dermatology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - E Thomas-Jones
- Centre for Trials Research, Cardiff University, Cardiff, UK
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Holloway CL, Pickles T, Croteau NS, Wai ES. Treatment Outcomes of Low-grade Lymphoma of the Orbit. Clin Oncol (R Coll Radiol) 2022; 34:e298-e304. [PMID: 35210133 DOI: 10.1016/j.clon.2022.01.042] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 02/08/2023]
Abstract
AIMS Radiation therapy can be used with curative intent in patients with low-grade orbital non-Hodgkin's lymphoma (NHL) stages IE and IVE (limited to the bilateral orbits). This study evaluated local control and survival outcomes of patients with unilateral or bilateral orbital lymphoma treated in a provincial population. MATERIALS AND METHODS The study subjects were 176 patients with low-grade orbital or conjunctival lymphoma referred for management from 1980 to 2016. Demographic, tumour and treatment characteristics were abstracted by chart review. Recurrence-free survival (RFS) and overall survival were assessed with competing risks analysis and Gray's test. RESULTS The median follow-up was 8.5 years (range 0.4-29.5 years). The median age at diagnosis was 65 years (range 20-97 years). The most common histological subtype was mucosa-associated lymphoid tissue (MALT) (73%). Stage IVE accounted for 20.5% of the cohort. Orbital radiation therapy was used in 122 patients with stage IE (87%) and 12 patients with stage IVE (28%). The median dose was 25 Gy (range 2-35 Gy). Other treatments were antibiotics (seven patients), chemotherapy (10 patients), radioimmunotherapy (six patients), surgery (three patients) and observation (16 patients). Within the group treated with orbital external beam radiation therapy (EBRT) there were no local recurrences. Among those with stage IE NHL, EBRT was associated with improved local RFS (P ≤ 0.001) but did not have an impact on contralateral or distant RFS. In patients with stage IVE NHL limited to the bilateral orbit, bilateral EBRT was associated with improved RFS (P = 0.012) but did not affect distant recurrences or overall survival. CONCLUSION There were no local recurrences after EBRT for stage IE and IVE orbital low-grade NHL. The treatments offered over the study period varied, but only EBRT for stage IVE disease improved RFS. This supports EBRT as the preferred primary treatment for patients with localised orbital low-grade lymphoma, including those with bilateral disease.
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Affiliation(s)
- C L Holloway
- Radiation Oncology, University of British Columbia, BC Cancer, Victoria, British Columbia, Canada.
| | - T Pickles
- Radiation Oncology, University of British Columbia, BC Cancer, Vancouver, British Columbia, Canada
| | - N S Croteau
- Department of Mathematics and Statistics, University of Victoria, Victoria, British Columbia, Canada
| | - E S Wai
- Radiation Oncology, University of British Columbia, BC Cancer, Victoria, British Columbia, Canada
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Urban R, Chow R, Pickles T, Chan M, Livergant J, Gerrie A, Freeman C, Sehn L, Scott D, Villa D, Savage K, Slack G, Lo A. The Impact of Surveillance Imaging After Curative Intent Radiotherapy for Limited Stage Follicular Lymphoma. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.244] [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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Chahal M, Jiang A, Hayden A, Savage K, Villa D, Scott D, Gerrie A, Lo A, Chan M, Pickles T, Connors J, Sehn L, Freeman C. OUTCOMES AFTER INITIAL REFUSAL OF CURATIVE TREATMENT IN PATIENTS WITH HODGKIN LYMPHOMA IN BRITISH COLUMBIA. Hematol Oncol 2021. [DOI: 10.1002/hon.112_2880] [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: 11/06/2022]
Affiliation(s)
- M. Chahal
- BC Cancer, Medical Oncology Vancouver Canada
| | - A. Jiang
- British Columbia Cancer Research Centre Biostatistics Vancouver Canada
| | - A. Hayden
- BC Cancer Medical Oncology Surrey Canada
| | - K. Savage
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - D. Villa
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - D. Scott
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - A. Gerrie
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - A. Lo
- BC Cancer Division of Radiation Oncology Vancouver Canada
| | - M. Chan
- BC Cancer Division of Radiation Oncology Vancouver Canada
| | - T. Pickles
- BC Cancer Division of Radiation Oncology Vancouver Canada
| | - J. Connors
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - L. Sehn
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
| | - C. Freeman
- BC Cancer Centre for Lymphoid Cancer and Division of Medical Oncology Vancouver Canada
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Parimi S, Bondy S, Aparicio M, Sunderland K, Cho J, Bachand F, Nguyen Chi K, Pickles T, Tyldesley S. Presenting stage and risk group in men dying of prostate cancer. Curr Oncol 2020; 27:e547-e551. [PMID: 33380869 PMCID: PMC7755438 DOI: 10.3747/co.27.6385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 12/31/2022] Open
Abstract
Introduction Prostate cancer remains the 3rd leading cause of cancer-related mortality in Canadian men, and yet screening for prostate cancer continues to be controversial because the majority of men diagnosed with prostate cancer do not die of the disease. It also remains uncertain whether treatment of cases that can be treated with curative intent alters the mortality rate. There are very few studies describing the presenting stage, risk groups, and survival after diagnosis for men dying of prostate cancer in the literature. In this study, we explored these characteristics for all men who died of prostate cancer in British Columbia between 2013 and 2015. Methods The population-based BC Cancer databases were used to identify all patients diagnosed between January 2013 and December 2015 who died of prostate cancer. Patient, tumour, and treatment characteristics were collected, and the risk grouping for each tumour was determined. The proportion of cases in each risk group at the time of diagnosis was determined. Survival time from diagnosis to death was calculated for all patients and for each risk group using the Kaplan-Meier method. Results A total of 1256 patients died of prostate cancer. Of patients who presented with metastatic disease, 57.2% presented with a Gleason score of 8 or more, compared with only 35.7% of patients who presented with nonmetastatic disease (p < 0.0001). The presenting stage and risk group of those dying of prostate cancer were as follows: 32% metastatic disease, 3% regional (defined as node-positive), 39% localized high risk, 9% localized intermediate risk, 4% localized low risk, 6% localized not otherwise specified, and 7% unknown. Therefore, 80.3% of those with a known risk group presented with either localized high-risk, regional, or metastatic disease at diagnosis. The median survival times from diagnosis to death were 12 years for localized low-risk, 10 years for localized intermediate-risk, 6.5 years for localized high-risk, 4 years for regional, and 1.7 years for metastatic disease at diagnosis. Conclusions This population-based analysis demonstrates that patients with localized high-risk, regional, or metastatic disease at diagnosis constitute the overwhelming majority of patients who die of prostate cancer in British Columbia. Unless these disease states can reliably be identified at an earlier low- or intermediate-risk localized state in the future, it is unlikely that treatment of localized low- and intermediate-risk cancer will have an impact on survival. Furthermore, patients with de novo metastatic disease had identifiable risk factors of a higher prostate-specific antigen and Gleason score. Further studies are required to confirm these results.
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Affiliation(s)
- S Parimi
- Medical Oncology, BC Cancer, Vancouver, BC
| | - S Bondy
- Genitourinary Cancer Outcomes Unit, BC Cancer, Vancouver, BC
| | - M Aparicio
- Genitourinary Cancer Outcomes Unit, BC Cancer, Vancouver, BC
| | - K Sunderland
- Genitourinary Cancer Outcomes Unit, BC Cancer, Vancouver, BC
| | - J Cho
- Radiation Oncology, BC Cancer, Vancouver, BC
| | - F Bachand
- Radiation Oncology, BC Cancer, Vancouver, BC
| | | | - T Pickles
- Radiation Oncology, BC Cancer, Vancouver, BC
| | - S Tyldesley
- Radiation Oncology, BC Cancer, Vancouver, BC
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Bisson JI, van Deursen R, Hannigan B, Kitchiner N, Barawi K, Jones K, Pickles T, Skipper J, Young C, Abbott LR, van Gelderen M, Nijdam MJ, Vermetten E. Randomized controlled trial of multi-modular motion-assisted memory desensitization and reconsolidation (3MDR) for male military veterans with treatment-resistant post-traumatic stress disorder. Acta Psychiatr Scand 2020; 142:141-151. [PMID: 32495381 DOI: 10.1111/acps.13200] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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] [Accepted: 05/28/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To explore the potential efficacy of multi-modular motion-assisted memory desensitization and reprocessing (3MDR) in British military veterans with treatment-resistant service-related PTSD. METHODS Exploratory single-blind, randomized, parallel arm, cross-over controlled trial with nested process evaluation to assess fidelity, adherence and factors that influence outcome. RESULTS A total of 42 participants (all male) were randomized with 83% retention at 12 weeks and 86% at 26 weeks. The difference in mean Clinician-Administered PTSD Scale for DSM-5 scores between the immediate and delayed 3MDR arms was -9.38 (95% CI -17.33 to -1.44, P = 0.021) at 12 weeks and -3.59 (-14.39 to 7.20, P = 0.513) at 26 weeks when both groups had received 3MDR. The likely effect size of 3MDR was found to be 0.65. Improvements were maintained at 26-week follow-up. 3MDR was found to be acceptable to most, but not all, participants. Several factors that may impact efficacy and acceptability of 3MDR were identified. CONCLUSION 3MDR is a promising new intervention for treatment-resistant PTSD with emerging evidence of effect.
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Affiliation(s)
- J I Bisson
- School of Medicine, Cardiff University, Cardiff, UK
| | - R van Deursen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - B Hannigan
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - N Kitchiner
- Veterans' NHS Wales, Cardiff and Vale University Health Board, Cardiff, UK
| | - K Barawi
- School of Medicine, Cardiff University, Cardiff, UK
| | - K Jones
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - T Pickles
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - J Skipper
- School of Medicine, Cardiff University, Cardiff, UK
| | - C Young
- Cardiff and Vale University Health Board, Cardiff, UK
| | - L R Abbott
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - M van Gelderen
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - M J Nijdam
- ARQ Centrum'45, ARQ National Psychotrauma Centre, Diemen, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - E Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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Stampalija T, Thornton J, Marlow N, Napolitano R, Bhide A, Pickles T, Bilardo CM, Gordijn SJ, Gyselaers W, Valensise H, Hecher K, Sande RK, Lindgren P, Bergman E, Arabin B, Breeze AC, Wee L, Ganzevoort W, Richter J, Berger A, Brodszki J, Derks J, Mecacci F, Maruotti GM, Myklestad K, Lobmaier SM, Prefumo F, Klaritsch P, Calda P, Ebbing C, Frusca T, Raio L, Visser GHA, Krofta L, Cetin I, Ferrazzi E, Cesari E, Wolf H, Lees CC. Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2020; 56:173-181. [PMID: 32557921 DOI: 10.1002/uog.22125] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - T Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | | | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - G H A Visser
- Department of Obstetrics, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - C C Lees
- Imperial College School of Medicine, Imperial College London and Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust, London, UK
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Hayden A, Tonseth P, Villa D, Gerrie A, Scott D, Freeman C, Slack G, Parsons C, Pickles T, Wilson D, Connors J, Sehn L, Savage K. OUTCOME OF PRIMARY MEDIASTINAL LARGE B-CELL LYMPHOMA IN THE RITUXIMAB ERA: IMPACT OF A PET-GUIDED APPROACH. Hematol Oncol 2019. [DOI: 10.1002/hon.113_2629] [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: 11/05/2022]
Affiliation(s)
- A. Hayden
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - P. Tonseth
- Division of Radiology; BC Cancer; Vancouver Canada
| | - D. Villa
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - A.S. Gerrie
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - D.W. Scott
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - C.L. Freeman
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - G.W. Slack
- Centre for Lymphoid Cancer and Division of Pathology; BC Cancer; Vancouver Canada
| | - C. Parsons
- Division of Radiation Oncology; BC Cancer; Vancouver Canada
| | - T. Pickles
- Division of Radiation Oncology; BC Cancer; Vancouver Canada
| | - D. Wilson
- Division of Radiology; BC Cancer; Vancouver Canada
| | - J.M. Connors
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - L.H. Sehn
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
| | - K.J. Savage
- Centre for Lymphoid Cancer and Division of Medical Oncology; BC Cancer; Vancouver Canada
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Joshi H, Pickles T, Pietropaolo A, Matenhelia M, Somani B, Phillip J, Biyani S. Health related quality of life impact of renal and ureteric stones - do these differ? ACTA ACUST UNITED AC 2019. [DOI: 10.1016/s1569-9056(19)31453-8] [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: 11/24/2022]
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Morgan-Trimmer S, Chadwick BL, Hutchings S, Scoble C, Lisles C, Drew CJ, Murphy S, Pickles T, Hood K, Chestnutt IG. The acceptability of fluoride varnish and fissure sealant treatments in children aged 6-9 delivered in a school setting. Community Dent Health 2019; 36:33-38. [PMID: 30667189 DOI: 10.1922/cdh_4263morgan-trimmer06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the acceptability of fluoride varnish and fissure sealant treatments for children. To investigate the acceptability of delivering this treatment in a school setting for children, parents, clinicians and school staff. BASIC RESEARCH DESIGN Semi-structured interviews (with children, parents, clinicians and school staff) and a questionnaire (for school staff) as part of a two-arm, randomised clinical trial. PARTICIPANTS Children aged 6-9, their parents, clinical staff and school staff. INTERVENTIONS Fluoride varnish or fissure sealant was delivered to children from the ages of 6 to 9 years for 36 months, by a community dental service in a school setting. Fluoride varnish was re-applied every 6 months; fissure sealant was applied once to first permanent molars and re-applied as required. RESULTS Interviews with children a few days after treatment indicated little difference in preference; acceptability at this point was driven by factors such as finding it fun to visit 'the van' (i.e. mobile dental unit) and receiving a "sticker" rather than specific treatment received. Interviews with parents, clinicians and school staff indicated high acceptability of delivering this type of intervention in a school setting; this may have been partly due to the service being delivered by a well-established, child-oriented community dental service which delivered the clinical trial. CONCLUSIONS Preventive fluoride varnish and fissure sealant treatments in a school setting has high overall acceptability.
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Affiliation(s)
- S Morgan-Trimmer
- Institute of Health Research, College of Medicine and Health, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU
| | - B L Chadwick
- Applied Clinical Research and Public Health, Cardiff University School of Dentistry, Heath Park, Cardiff. CF14 4XY, UK
| | - S Hutchings
- Simbec-Orion Group Ltd, Simbec House, Merthyr Tydfil Industrial Park, Pentrebach, Merthyr Tydfil, Mid Glamorgan,CF48 4DR
| | - C Scoble
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff. CF14 4YS, UK
| | - C Lisles
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff. CF14 4YS, UK
| | - C J Drew
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff. CF14 4YS, UK
| | - S Murphy
- DECIPHer, School of Social Sciences, Cardiff University, 1 - 3 Museum Place, Cardiff. CF10 3BD
| | - T Pickles
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff. CF14 4YS, UK
| | - K Hood
- South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff. CF14 4YS, UK
| | - I G Chestnutt
- Applied Clinical Research and Public Health, Cardiff University School of Dentistry, Heath Park, Cardiff. CF14 4XY, UK
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11
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Wong J, Pickles T, Connors J, Aquino-Parsons C, Sehn L, Freeman C, Lo A. Efficacy of Palliative Radiation Therapy (RT) for Diffuse Large B-Cell Lymphoma: A Population-Based Retrospective Review. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1094] [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: 11/15/2022]
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12
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Loblaw D, Bassett J, D'Este C, Pond G, Cheung P, Frydenberg M, King M, Lukka H, Malone S, Millar J, Milne R, Pickles T, Smith R, Stockler M, Turner S, Tai K, Woo H, Duchesne G. Timing of Androgen Deprivation Therapy for Prostate Cancer Patients after Radiation: Planned Combined Analysis of Two Randomized Phase 3 Trials. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.06.358] [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: 10/28/2022]
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13
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Ingram JR, Cawley S, Coulman E, Gregory C, Thomas‐Jones E, Pickles T, Cannings‐John R, Francis NA, Harding K, Hood K, Piguet V. Levels of wound calprotectin and other inflammatory biomarkers aid in deciding which patients with a diabetic foot ulcer need antibiotic therapy (INDUCE study). Diabet Med 2018; 35:255-261. [PMID: 28734103 PMCID: PMC5811820 DOI: 10.1111/dme.13431] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 11/29/2022]
Abstract
AIMS Deciding if a diabetic foot ulcer is infected in a community setting is challenging without validated point-of-care tests. Four inflammatory biomarkers were investigated to develop a composite algorithm for mildly infected diabetic foot ulcers: venous white cell count, C-reactive protein (CRP) and procalcitonin, and a novel wound exudate calprotectin assay. Calprotectin is a marker of neutrophilic inflammation. METHODS In a prospective study, people with uninfected or mildly infected diabetic foot ulcers who had not received oral antibiotics in the preceding 2 weeks were recruited from community podiatry clinics for measurement of inflammatory biomarkers. Antibiotic prescribing decisions were based on clinicians' baseline assessments and participants were reviewed 1 week later; ulcer infection was defined by clinicians' overall impression from their two assessments. RESULTS Some 363 potential participants were screened, of whom 67 were recruited, 29 with mildly infected diabetic foot ulcers and 38 with no infection. One participant withdrew early in each group. Ulcer area was 1.32 cm2 [interquartile range (IQR) 0.32-3.61 cm2 ] in infected ulcers and 0.22 cm2 (IQR 0.09-1.46 cm2 ) in uninfected ulcers. Baseline CRP for mild infection was 9.00 mg/ml and 6.00 mg/ml for uninfected ulcers; most procalcitonin levels were undetectable. Median calprotectin level in infected diabetic foot ulcers was 1437 ng/ml and 879 ng/ml in uninfected diabetic foot ulcers. Area under the receiver operating characteristic curve for a composite algorithm incorporating calprotectin, CRP, white cell count and ulcer area was 0.68 (95% confidence intervals 0.52-0.82), sensitivity 0.64, specificity 0.81. CONCLUSIONS A composite algorithm including CRP, calprotectin, white cell count and ulcer area may help to distinguish uninfected from mildly infected diabetic foot ulcers. Venous procalcitonin is unhelpful for mild diabetic foot ulcer infection.
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Affiliation(s)
- J. R. Ingram
- Division of Infection and ImmunityCardiff UniversityCardiffUK
| | - S. Cawley
- Podiatry DepartmentCardiff and Vale University Health BoardCardiffUK
| | - E. Coulman
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - C. Gregory
- Division of Population MedicineCardiff UniversityCardiffUK
| | - E. Thomas‐Jones
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - T. Pickles
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - R. Cannings‐John
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - N. A. Francis
- Division of Population MedicineCardiff UniversityCardiffUK
| | - K. Harding
- Division of Population MedicineCardiff UniversityCardiffUK
| | - K. Hood
- Centre for Trials ResearchCollege of Biomedical and Life SciencesCardiffUK
| | - V. Piguet
- Division of Infection and ImmunityCardiff UniversityCardiffUK
- Division of DermatologyWomen's College HospitalTorontoCanada
- Department of MedicineUniversity of TorontoTorontoCanada
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14
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Chestnutt IG, Playle R, Hutchings S, Morgan-Trimmer S, Fitzsimmons D, Aawar N, Angel L, Derrick S, Drew C, Hoddell C, Hood K, Humphreys I, Kirby N, Lau TMM, Lisles C, Morgan MZ, Murphy S, Nuttall J, Onishchenko K, Phillips C, Pickles T, Scoble C, Townson J, Withers B, Chadwick BL. Fissure Seal or Fluoride Varnish? A Randomized Trial of Relative Effectiveness. J Dent Res 2017; 96:754-761. [PMID: 28394709 DOI: 10.1177/0022034517702094] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Fissure sealant (FS) and fluoride varnish (FV) are effective in preventing dental caries when compared with a no-treatment control. However, the relative clinical effectiveness of these interventions is uncertain. The objective of the study was to compare the clinical effectiveness of FS and FV in preventing dental caries in first permanent molars (FPMs) in 6- to 7-y-olds. The study design was a randomized clinical trial, with 2 parallel arms. The setting was a targeted-population program that used mobile dental clinics in schools located within areas of high social and economic deprivation in South Wales. A total of 1,016 children were randomized 1:1 to receive either FS or FV. Resin-based FS was applied to caries-free FPMs and maintained at 6-mo intervals. FV was applied at baseline and at 6-mo intervals for 3 y. The main outcome measures were the proportion of children developing caries into dentine (D4-6MFT) on any 1 of up to 4 treated FPMs after 36 mo. At 36 mo, 835 (82%) children remained: 417 in the FS arm and 418 in the FV arm. A smaller proportion of children who received FV ( n = 73, 17.5%) versus FS ( n = 82, 19.6%) developed caries into dentine on at least 1 FPM (odds ratio [OR] = 0.84; 95% CI, 0.59 to 1.21; P = 0.35), a nonstatistically significant difference between FS and FV treatments. The results were similar when the number of newly decayed teeth (OR = 0.86; 95% CI, 0.60 to 1.22) and tooth surfaces (OR = 0.85; 95% CI, 0.59 to 1.21) were examined. In a community oral health program, semiannual application of FV resulted in caries prevention that was not significantly different from that obtained by applying and maintaining FS after 36 mo (EudraCT: 2010-023476-23; ISRCTN: ISRCTN17029222).
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Affiliation(s)
- I G Chestnutt
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - R Playle
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK.,2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Hutchings
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Morgan-Trimmer
- 3 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - D Fitzsimmons
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - N Aawar
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - L Angel
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - S Derrick
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - C Drew
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Hoddell
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - K Hood
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - I Humphreys
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - N Kirby
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - T M M Lau
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Lisles
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - M Z Morgan
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
| | - S Murphy
- 3 DECIPHer, School of Social Sciences, Cardiff University, Cardiff, UK
| | - J Nuttall
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - K Onishchenko
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - C Phillips
- 4 Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - T Pickles
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - C Scoble
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - J Townson
- 2 South East Wales Trials Unit, Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Cardiff, UK
| | - B Withers
- 5 Community Dental Service, Cardiff and Vale University Health Board, Whitchurch Hospital, Cardiff, UK
| | - B L Chadwick
- 1 Applied Clinical Research and Public Health, School of Dentistry, Cardiff University, Cardiff, UK
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15
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Loblaw A, Pickles T, Crook J, Martin AG, Vigneault E, Souhami L, Cury F, Morris J, Catton C, Lukka H, Cheung P, Sethukavalan P, Warner A, Yang Y, Rodrigues G. Stereotactic Ablative Radiotherapy Versus Low Dose Rate Brachytherapy or External Beam Radiotherapy: Propensity Score Matched Analyses of Canadian Data. Clin Oncol (R Coll Radiol) 2017; 29:161-170. [DOI: 10.1016/j.clon.2016.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 08/25/2016] [Accepted: 09/22/2016] [Indexed: 02/05/2023]
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16
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Clarke N, De Santis M, Costello A, Chang YH, Pickles T, Pompeo A, Bazarbashi S, Haas G, Cooperberg M. Global treatment patterns for late-stage prostate cancer: Updated results from ASPIRE-PCa. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw372.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Atwan A, Ingram JR, Abbott R, Kelson MJ, Pickles T, Bauer A, Piguet V. Oral fumaric acid esters for psoriasis: abridged Cochrane systematic review including GRADE assessments. Br J Dermatol 2016; 175:873-881. [PMID: 27087044 PMCID: PMC5095877 DOI: 10.1111/bjd.14676] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 01/09/2023]
Abstract
Fumaric acid esters (FAEs) are licensed for the treatment of moderate‐to‐severe psoriasis in Germany but are also used off‐label in many other countries. We conducted this systematic review to synthesize the highest‐quality evidence for the benefits and risks of FAEs for psoriasis. Our primary outcomes were change in Psoriasis Area and Severity Index score and dropout rates due to adverse effects. Randomized controlled trials (RCTs) of FAEs or dimethylfumarate were included, with no restriction on age or psoriasis subtype. We searched the Cochrane Skin Group Specialised Register, CENTRAL in the Cochrane Library, Medline, Embase, LILACS and five trials registers, and hand searched six conference proceedings. Six RCTs with a total of 544 participants were included, four of which were published only as abstracts or brief reports, limiting study reporting. Five RCTs compared FAEs with placebo, and all demonstrated benefit in favour of FAEs. However, meta‐analysis was possible only for PASI 50 response after 12–16 weeks, which was achieved by 64% of participants on FAEs compared with 14% on placebo: risk ratio (RR) 4·55, 95% confidence interval (CI) 2·80–7·40; two studies; 247 participants; low‐quality evidence). There was no difference in dropout rates due to adverse effects (RR 5·36, 95% CI 0·28–102·12; one study; 27 participants; very low‐quality evidence and wide CI). More participants experienced nuisance adverse effects with FAEs (76%) than with placebo (16%) (RR 4·72, 95% CI 2·45–9·08; one study; 99 participants; moderate‐quality evidence), mainly abdominal pain, diarrhoea and flushing. One head‐to‐head study of very low‐quality evidence comparing FAEs with methotrexate reported comparable efficacy and dropout rates, although FAEs caused more flushing. The evidence in this review was limited and must be interpreted with caution; studies with better design and outcome reporting are needed. What's already known about this topic? Fumaric acid esters (FAEs) are licensed for the treatment of moderate‐to‐severe psoriasis in Germany, and are used off‐label in many other countries. Non‐Cochrane systematic reviews previously examined the effect of FAEs in psoriasis, but have not rigorously assessed the quality of the evidence.
What does this study add? Six randomized controlled trials with 544 participants were included, four of which were published only as abstracts or brief reports, resulting in low‐ or very low‐quality evidence. Results suggest that FAEs are superior to placebo, but their efficacy in comparison with methotrexate is uncertain due to very low‐quality evidence. The relative risk of nuisance adverse effects with FAEs is about five times greater than with placebo; however, there is insufficient evidence available to give an accurate figure for dropout rates due to adverse effects.
Linked Comment:Egeberg. Br J Dermatol 2016; 175:857. Audio Commentary
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Affiliation(s)
- A Atwan
- Department of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity, Cardiff University, 3rd Floor Glamorgan House, Heath Park, Cardiff, CF14 4XN, U.K
| | - J R Ingram
- Department of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity, Cardiff University, 3rd Floor Glamorgan House, Heath Park, Cardiff, CF14 4XN, U.K..
| | - R Abbott
- Welsh Institute of Dermatology, University Hospital of Wales, Cardiff, U.K
| | - M J Kelson
- South East Wales Trials Unit, Institute of Translation, Innovation, Methodology and Engagement, Cardiff University, Cardiff, U.K
| | - T Pickles
- South East Wales Trials Unit, Institute of Translation, Innovation, Methodology and Engagement, Cardiff University, Cardiff, U.K
| | - A Bauer
- Department of Dermatology, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - V Piguet
- Department of Dermatology & Wound Healing, Cardiff Institute of Infection & Immunity, Cardiff University, 3rd Floor Glamorgan House, Heath Park, Cardiff, CF14 4XN, U.K
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18
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Rodrigues G, Wang T, Warner A, Pickles T, Crook J, Martin A, Vigneault E, Cury F, Souhami L, Morris W, Catton C, Lukka H. Post–Biochemical Failure Risk Stratification to Predict Survival in Prostate Cancer: A Recursive Partitioning Analysis. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.1039] [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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19
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Conway J, Connors J, Pickles T. A Population-Based Analysis of Secondary Breast Cancer Risk According to Radiation Volume in Women With Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.191] [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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20
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De Santis M, Costello A, Chang Y, Clarke N, Pickles T, Bellm L, Haas G, Pompeo A, Bazarbashi S, Cooperberg M. 2525 ASPIRE-PCa: Initial findings from a prospective, global observational study of men with late-stage prostate cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31344-2] [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: 10/22/2022]
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21
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Weber B, Paton K, Ma R, Pickles T. PO-0812: Long-term outcomes and toxicity after proton beam radiotherapy of large non-peripapillary choroidal melanoma. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40804-7] [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: 10/23/2022]
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22
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Hamilton S, Tyldesley S, Hamm J, Keyes M, Pickles T, Lapointe V, Kahnamelli A, McKenzie M, Miller S, Morris W. The Incidence of Second Malignancies Following Low-Dose-Rate Brachytherapy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1344] [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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23
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Loblaw D, Pickles T, Crook J, Martin A, Vigneault E, Catton C, Lukka H, Cheung P, Sethukavalan P, Warner A, Yang Y, Rodrigues G. Stereotactic Ablative Radiation Therapy Versus Low-Dose-Rate Brachytherapy: A Propensity Matched Analysis of Canadian Data. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1343] [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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24
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De Santis M, Cooperberg M, Chang Y, Clarke N, Costello A, Pickles T, Curiel R, Pompeo A. A Prospective, Multinational Observational Study of Men with Later-Stage Prostate Cancer, a New Global Study to Examine Patterns of Care and Outcomes. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.54] [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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25
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Pickles T, Morris W, Tyldesley S. PO-0725: Neoadjuvant PSA kinetics in prostate cancer with LHRH agonists: The importance of full testosterone suppression. Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30843-4] [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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26
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Rajala J, Tyldesley S, Pickles T, Virani S. The Prevalence of Cardiac Risk Factors in Men With Localized Prostate Cancer Undergoing Androgren Deprivation Therapy in British Columbia, Canada. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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27
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Bains P, Al Tourah A, Campbell BA, Pickles T, Gascoyne RD, Connors JM, Savage KJ. Incidence of transformation to aggressive lymphoma in limited-stage follicular lymphoma treated with radiotherapy. Ann Oncol 2013; 24:428-432. [PMID: 23035152 DOI: 10.1093/annonc/mds433] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The established treatment of limited-stage follicular lymphoma is radiotherapy (RT). There is an inherent risk of transformation of follicular lymphoma to aggressive lymphoma; however, the frequency and impact on the outcome are unknown in limited-stage patients. MATERIALS AND METHODS We identified 237 patients with limited-stage follicular lymphoma treated with curative intent RT. Cases were reviewed to determine the frequency of transformation and subsequent survival. RESULTS With a median follow-up of 7.4 years, the 10-year risk of transformation was 18.5%. With a median follow-up after transformation of 4.7 years, the 3-year post-transformation progression-free survival (PFS) and overall survival (OS) were 42% and 44%, respectively. The addition of rituximab improved the 3-year post-transformation PFS and OS compared with combination chemotherapy alone (78% versus 15%, P < 0.00001) and (87% versus 38.5%, P < 0.00001), respectively. In multivariate analysis, only rituximab was associated with OS [HR 0.07 (95% CI 0.015-0.312, P = 0.001)] and PFS [HR 0.19 (95% CI 0.55-0.626, P = 0.007)] following transformation. CONCLUSIONS There is a moderate risk of transformation in limited-stage follicular lymphoma treated with curative intent RT, and it substantially impacts outcome in these patients. Treatment with rituximab at the time of transformation appears to improve survival in this otherwise poor-risk population.
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MESH Headings
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal, Murine-Derived/adverse effects
- Antibodies, Monoclonal, Murine-Derived/therapeutic use
- Cell Transformation, Neoplastic
- Combined Modality Therapy
- Disease-Free Survival
- Female
- Humans
- Lymphoma, Follicular/drug therapy
- Lymphoma, Follicular/mortality
- Lymphoma, Follicular/pathology
- Lymphoma, Follicular/radiotherapy
- Male
- Middle Aged
- Rituximab
- Survival
- Treatment Outcome
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Affiliation(s)
- P Bains
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver; Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - A Al Tourah
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver; Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - B A Campbell
- Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - T Pickles
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver
| | - R D Gascoyne
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver; Department of Pathology and the Centre for Lymphoid Cancer, British Columbia Cancer Agency Vancouver, Canada
| | - J M Connors
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - K J Savage
- Centre for Lymphoid Cancer, British Columbia Cancer Agency, Vancouver; Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada.
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28
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Rodrigues G, Gonzalez-Maldonado S, Lukka H, Warde P, Brundage M, Souhami L, Crook J, Catton C, Martin A, Pickles T. The Prostate Cancer Risk Stratification (ProCaRS) Project: Database Construction and Outcome Analysis. Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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29
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Tyldesley S, Tran E, Paquette M, Jay J, Liu M, Hamm J, Duncan G, Pickles T. OC-0049 THE IMPACT OF COMORBIDITIES ON THE BENEFITS OF PROLONGED ANDROGEN ABLATION IN PATIENTS WITH T3-4 PROSTATE CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70388-2] [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: 10/28/2022]
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30
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Chan E, Keyes M, Pickles T, Lapointe V, Spadinger I, McKenzie M, Morris W. PD-123 DECLINE IN ACUTE URINARY TOXICITY: A LONG TERM STUDY IN 2011 PATIENTS WITH PROSTATE BRACHYTHERAPY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)72090-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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31
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Gregory J, Robling M, Bennert K, Channon S, Cohen D, Crowne E, Hambly H, Hawthorne K, Hood K, Longo M, Lowes L, McNamara R, Pickles T, Playle R, Rollnick S, Thomas-Jones E. Development and evaluation by a cluster randomised trial of a psychosocial intervention in children and teenagers experiencing diabetes: the DEPICTED study. Health Technol Assess 2011; 15:1-202. [PMID: 21851764 DOI: 10.3310/hta15290] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To develop and evaluate a health-care communication training programme to help diabetes health-care professionals (HCPs) counsel their patients more skilfully, particularly in relation to behaviour change. DESIGN The HCP training was assessed using a pragmatic, cluster randomised controlled trial. The primary and secondary analyses were intention-to-treat comparisons of outcomes using multilevel modelling to allow for cluster (service) and individual effects, and involved two-level linear models. SETTING Twenty-six UK paediatric diabetes services. PARTICIPANTS The training was delivered to HCPs (doctors, nurses, dietitians and psychologists) working in paediatric diabetes services and the effectiveness of this training was measured in 693 children aged 4-15 years and families after 1 year (95.3% follow-up). INTERVENTIONS A blended learning programme was informed by a systematic review of the literature, telephone and questionnaire surveys of professional practice, focus groups with children and parents, experimental consultations and three developmental workshops involving a stakeholder group. The programme focused on agenda-setting, flexible styles of communication (particularly guiding) and a menu of strategies using web-based training and practical workshops. MAIN OUTCOME MEASURES The primary trial outcome was a change in glycosylated haemoglobin (HbA1c) levels between the start and finish of a 12-month study period. Secondary trial outcomes included change in quality of life, other clinical [including body mass index (BMI)] and psychosocial measures (assessed at participant level as listed above) and cost (assessed at service level). In addition, patient details (HbA1c levels, height, weight, BMI, insulin regimen), health service contacts and patient-borne costs were recorded at each clinic visit, along with details of who patients consulted with, for how long, and whether or not patients consulted on their own at each visit. Patients and carers were also asked to complete an interim questionnaire assessing patient enablement (or feelings towards clinic visit for younger patients aged 7-10 years) at their first clinic visit following the start of the trial. The cost of the intervention included the cost of training intervention teams. RESULTS Trained staff showed better skills than control subjects in agenda-setting and consultation strategies, which waned from 4 to 12 months. There was no effect on HbA1c levels (p = 0.5). Patients in intervention clinics experienced a loss of confidence in their ability to manage diabetes, whereas controls showed surprisingly reduced barriers (p = 0.03) and improved adherence (p = 0.05). Patients in intervention clinics reported short-term increased ability (p = 0.04) to cope with diabetes. Parents in the intervention arm experienced greater excitement (p = 0.03) about clinic visits and improved continuity of care (p = 0.01) without the adverse effects seen in their offspring. The mean cost of training was £13,145 per site or £2163 per trainee. There was no significant difference in total NHS costs (including training) between groups (p = 0.1). CONCLUSIONS Diabetes HCPs can be trained to improve consultation skills, but these skills need reinforcing. Over 1 year, no benefits were seen in children, unlike parents, who may be better placed to support their offspring. Further modification of this training is required to improve outcomes that may need to be measured over a longer time to see effects. TRIAL REGISTRATION Current Controlled Trials ISRCTN61568050. FUNDING This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 15, No. 29. See the HTA programme website for further project information.
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Affiliation(s)
- Jw Gregory
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, UK
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Tran E, Tyldesley S, Paquette M, Hamm J, Liu M, Lim J, Keyes M, Kwan W, Pickles T. Population-based Validation of the Bolla Study in T3-4 Prostate Cancer in British Columbia. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Caon J, Paquette M, Pickles T. Statin and ASA Use in Regards to Comorbidity and Outcome in Men with Prostate Cancer Treated with Curative Intent Radiation Therapy. Int J Radiat Oncol Biol Phys 2011. [DOI: 10.1016/j.ijrobp.2011.06.687] [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: 10/15/2022]
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Abstract
External-beam radiotherapy and brachytherapy, widely utilized as curative treatment modalities for prostate cancer, have undergone significant clinical and technological advances in recent decades. Contemporary radiotherapy treatment algorithms use pretreatment prognostic factors to stratify patients into low-, intermediate-, and high-risk groups that correlate with both pathologic stage of disease and risk of recurrence after treatment. The use of risk groups and additional prognostic factors guide selection of the optimal treatment modalities for individual patients. Here, the roles of external-beam radiotherapy, brachytherapy, and neoadjuvant or adjuvant androgen deprivation therapy are discussed in that context. Additional prognostic factors for recurrence in the post-prostatectomy setting and the role of adjuvant and salvage radiation therapy are also reviewed. The risk-adaptive approach in radiotherapy for prostate cancer aims to optimize cancer control outcomes while minimizing the morbidity of treatment.
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Affiliation(s)
- A J Hayden
- Radiation Oncology Program, BC Cancer Agency, Vancouver, BC
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Savage KJ, Connors JM, Klasa RJ, Hoskins P, Shenkier TN, Gascoyne RD, Bhimji S, Pickles T, Benard F, Wilson D, Sehn LH. The use of FDG-PET to guide consolidative radiotherapy in patients with advanced-stage Hodgkin lymphoma with residual abnormalities on CT scan following ABVD chemotherapy. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.8034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Foo M, Lavieri M, Pickles T. Impact of Neo-adjuvant PSA Kinetics on Biochemical Failure and Prostate cancer Mortality: Results from a Prospective Patient Database. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.789] [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: 10/19/2022]
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Morris W, Spadinger I, Keyes M, McKenzie M, Pickles T. CT Based Dosimetry Following Low Dose Rate (LDR) Prostate Brachytherapy in 2787 Consecutive Cases over 11 Years. Int J Radiat Oncol Biol Phys 2010. [DOI: 10.1016/j.ijrobp.2010.07.855] [Citation(s) in RCA: 2] [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: 11/26/2022]
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Campbell BA, Connors JM, Gascoyne RD, Pickles T, Morris WJ, Sehn LH. Limited-stage diffuse large B-cell lymphoma (DLBCL) treated with abbreviated systemic therapy and consolidation radiotherapy: Involved field radiotherapy (IFRT) versus involved nodal radiotherapy (INRT≤5cm). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bains P, Al-Tourah AJ, Campbell BA, Pickles T, Gascoyne RD, Connors JM, Savage KJ. Incidence of transformation to aggressive lymphoma in limited-stage follicular lymphoma (FL) treated with radiotherapy. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kim JO, Vaid M, Tyldesley S, Woods R, Pickles T. A population-based study of cardiovascular (CV) mortality among patients with prostate cancer (PCa) treated with radical external beam radiation therapy (EBRT) with and without adjuvant androgen deprivation therapy (ADT) at a provincial cancer agency. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.4656] [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: 11/20/2022] Open
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Buyyounouski M, Pickles T, Kestin L, Allison R, Williams S. Validating the Interval to Biochemical Failure for the Identification of Potentially Lethal Prostate Cancer. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.252] [Citation(s) in RCA: 3] [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: 11/27/2022]
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Stokes E, Tyldesley S, Pickles T. 7001 Oncologist case load volume and disease outcomes after definitive external beam radiotherapy for localized prostate cancer. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71379-5] [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: 10/20/2022] Open
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Pickles T, Morris W, Kattan M, Yu C, Keyes M. 111 PROSTATE BRACHYTHERAPY: NOMOGRAM COMPARISON WITH SURGICAL OUTCOME. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72498-2] [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: 10/27/2022]
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Shaffer R, Pickles T, Lee R, Moiseenko V. 7026 Deriving prostate alpha-beta ratio using carefully matched groups, long follow-up and the Phoenix definition of biochemical failure. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71404-1] [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: 11/25/2022] Open
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Danielson B, Pearcey R, Bass B, Pickles T, Owen J, Brundgae M, Mackillop W. 198 A FRAMEWORK FOR MEASURING QUALITY OF CARE: AN ILLUSTRATION IN PROSTATE CANCER. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72585-9] [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: 11/30/2022]
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Pickles T, Hoegler D, Morris J, Parsons C. 19 CHANGING UTILIZATION OF RADIATION THERAPY IN LYMPHOID MALIGNANCIES. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72406-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shaffer R, Pickles T, Lee R, Moiseenko V. 170 DERIVING PROSTATE ALPHA-BETA RATIO USING CAREFULLY MATCHED GROUPS, LONG FOLLOW UP AND THE PHOENIX DEFINITION OF BIOCHEMICAL FAILURE. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72557-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Palma D, Pickles T, Keyes M, Morris W. Reply. Urology 2009. [DOI: 10.1016/j.urology.2008.08.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Shaffer R, Morris WJ, Moiseenko V, Welsh M, Crumley C, Nakano S, Schmuland M, Pickles T, Otto K. Volumetric modulated Arc therapy and conventional intensity-modulated radiotherapy for simultaneous maximal intraprostatic boost: a planning comparison study. Clin Oncol (R Coll Radiol) 2009; 21:401-7. [PMID: 19268554 DOI: 10.1016/j.clon.2009.01.014] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 12/30/2008] [Accepted: 01/22/2009] [Indexed: 10/21/2022]
Abstract
AIMS Volumetric modulated arc therapy (VMAT) is a novel extension of intensity-modulated radiotherapy (IMRT) where an optimised three-dimensional dose distribution may be delivered in a single gantry rotation. This optimisation algorithm is the predecessor to Varian's RapidArc. The aim of this study was to compare the ability of conventional static nine-field IMRT (cIMRT) and VMAT to boost as much of the clinical target volume (CTV) as possible to 88.8Gy without exceeding organ at risk (OAR) dose-volume constraints. MATERIALS AND METHODS Optimal cIMRT and VMAT radiotherapy plans were produced for 10 patients with localised prostate cancer using common planning objectives: (1) Treat >or=98% of the planning target volume (PTV) to >or=95% of the prescription dose (74Gy in 37 fractions); (2) keep OAR doses within predefined limits; (3) treat as much of prostate CTV (minus urethra) as possible to >or=120% of prescription dose (=88.8Gy); (4) keep within maximum dose limits in and out of target volumes; (5) conformality index (volume of 95% isodose/volume of PTV)<or=1.2. RESULTS VMAT and cIMRT boosted an average of 68.8 and 63.5% of the CTV to >or=120% of the prescription dose (P=0.002). All dose constraints were kept within predefined limits. VMAT and cIMRT required an average of 949 and 1819 monitor units and 3.7 and 9.6min, respectively, to deliver a single radiation fraction. CONCLUSIONS VMAT is able to boost more of the CTV to >or=120% than cIMRT without contravening OAR dose constraints, and uses 48% fewer monitor units. Treatment times were 61% less than with cIMRT.
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Affiliation(s)
- R Shaffer
- British Columbia Cancer Agency, 600 West 10th Avenue, Vancouver, British Columbia, Canada.
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Morris WJ, Keyes M, Palma D, Spadinger I, McKenzie MR, Agranovich A, Pickles T, Liu M, Kwan W, Wu J, Berthelet E, Pai H. Population-based study of biochemical and survival outcomes after permanent 125I brachytherapy for low- and intermediate-risk prostate cancer. Urology 2009; 73:860-5; discussion 865-7. [PMID: 19168203 DOI: 10.1016/j.urology.2008.07.064] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 07/01/2008] [Accepted: 07/07/2008] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To analyze the biochemical and survival outcomes after permanent low-dose-rate prostate brachytherapy in a large, consecutive, population-based cohort of patients. METHODS A total of 1006 consecutive implants were performed from July 20, 1998 to October 23, 2003 for men with low-risk and "low-tier" intermediate-risk prostate cancer. The prescribed minimal peripheral dose was 144 Gy, using 0.33 mCi (125)I sources and a preplan technique with a strong posterior-peripheral dose bias. Most patients (65%) had received 6 months of androgen deprivation therapy. Supplemental external beam radiotherapy was not used. The prognostic features, dose metrics, and follow-up data were prospectively collected. Kaplan-Meier and Cox regression analyses were used to assess the factors associated with freedom from biochemical recurrence and survival. RESULTS The median patient age at treatment was 66 years. The median follow-up was 54 months for biochemical outcomes and 66 months for survival. The actuarial freedom from biochemical recurrence rate was 95.6% +/- 1.6% at 5 years and 94.0% +/- 2.2% at 7 years. On multivariate analysis, the pretreatment prostate-specific antigen level (P = .03) and androgen deprivation therapy use (P = .04) were predictive of the freedom from biochemical recurrence. The actuarial rates of distant metastasis and disease-specific death at 5 years were both <1%. The overall survival rate at 5 years was 95.2% +/- 1.4% and was 93.4% +/- 1.8% at 7 years. On multivariate analysis, only age was predictive of overall survival (P = .011). CONCLUSIONS When consistently planned and delivered, low-dose-rate brachytherapy, without supplemental external beam radiotherapy or intraoperative planning, can produce cancer-specific outcomes for men with low- and "low-tier" intermediate-risk prostate cancer at least equal to that produced by dose-escalated external beam radiotherapy or surgical prostatectomy.
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Affiliation(s)
- W J Morris
- British Columbia Cancer Centre, Vancouver, British Columbia, Canada.
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