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Treasure T. Observations on local interventions for colorectal cancer metastases to liver and lung. Ir J Med Sci 2023; 192:2661-2662. [PMID: 37022599 DOI: 10.1007/s11845-023-03358-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 03/28/2023] [Indexed: 04/07/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK.
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Macbeth F, Williams N, Ahmad I, Treasure T. Lung surveillance following colorectal cancer pulmonary metastasectomy: Utilization of clinicopathologic risk factors to guide strategy. J Thorac Cardiovasc Surg 2023:S0022-5223(23)00990-X. [PMID: 37952137 DOI: 10.1016/j.jtcvs.2023.10.033] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 10/14/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Norman Williams
- Surgical and Interventional Trials Unit, University College London, London, United Kingdom
| | - Irfan Ahmad
- Department of Radiation Oncology, Rajiv Gandhi Cancer Institute & Research Centre, New Delhi, India
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom
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Macbeth F, Fallowfield L, Treasure E, Ahmad I, Zheng Y, Treasure T. Removal or ablation of asymptomatic lung metastases should be reconsidered. BMJ 2023; 383:e073042. [PMID: 37945005 DOI: 10.1136/bmj-2022-073042] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, University of Sussex, Sussex, UK
| | - Elizabeth Treasure
- Patient author, Oxford University Counselling Service, University of Oxford, Oxford, UK
| | - Irfan Ahmad
- Radiation Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Yan Zheng
- Department of Thoracic Surgery, Affiliated Cancer Hospital of ZhengZhou University/Henan Cancer Hospital, People's Republic of China
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Macbeth F, Treasure T. Local Treatments of Oligometastatic and Oligoprogressive NSCLC Should Not Become the Standard of Care. J Thorac Oncol 2023; 18:981-985. [PMID: 37479328 DOI: 10.1016/j.jtho.2022.09.227] [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] [Received: 09/09/2022] [Revised: 09/22/2022] [Accepted: 09/25/2022] [Indexed: 07/23/2023]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom.
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Treasure T, Macbeth F, Williams NR. Letter to the editor in response to Andreas Gkikas et al: Preoperative prognostic factors for 5-year survival following pulmonary metastasectomy from colorectal cancer: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2023:7179794. [PMID: 37228033 DOI: 10.1093/ejcts/ezad211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/24/2023] [Indexed: 05/27/2023] Open
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
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Austin C, Golesworthy T, Izgi C, Mohiaddin R, Pepper J, Treasure T. Correspondence on "Has personalised surgery made another advancement in aortic root surgery?" by Zhu and Woo. Heart 2023; 109:886. [PMID: 37080765 DOI: 10.1136/heartjnl-2023-322642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Affiliation(s)
- Conal Austin
- Cardiac Surgery, Guys and St Thomas' Hospital, London, UK
| | | | - Cemil Izgi
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Raad Mohiaddin
- Cardiovascular Magnetic Resonance Unit, Royal Brompton and Harefield Hospitals, Guy's and St Thomas' NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
| | - John Pepper
- Cardiac Surgery, Royal Brompton Hospital and NIHR Imperial Biomedical Research Centre, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Treasure T, Macbeth F. Finding that outcomes after imaging-guided thermal ablation and surgery for colorectal lung metastases are similar does not prove a survival benefit from either. J Surg Oncol 2023; 127:510-512. [PMID: 36394433 DOI: 10.1002/jso.27145] [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] [Received: 10/26/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Tom Treasure
- Department of Mathematics, Clinical Operational Research Unit, University College London, London, UK
| | - Fergus Macbeth
- Center for Trials Research, Cardiff University, Cardiff, UK
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Van Hoof L, Lamberigts M, Noé D, El-Hamamsy I, Lansac E, Kluin J, de Kerchove L, Pepper J, Treasure T, Meuris B, Rega F, Verbrugghe P. Matched comparison between external aortic root support and valve-sparing root replacement. Heart 2023; 109:832-838. [PMID: 36650042 DOI: 10.1136/heartjnl-2022-321840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Differences in indication and technique make a randomised comparison between valve-sparing root replacement (VSRR) and personalised external aortic root support (PEARS) challenging. We performed a propensity score (PS)-matched comparison of PEARS and VSRR for syndromic root aneurysm. METHODS Patients in the PEARS 200 Database and Aortic Valve Insufficiency and ascending aorta Aneurysm InternATiOnal Registry (undergoing VSRR) with connective tissue disease operated electively for root aneurysm <60 mm with aortic regurgitation (AR) <1/4 were included. Using a PS analysis, 80 patients in each cohort were matched. Survival, freedom from reintervention and from AR ≥2/4 were estimated using a Kaplan-Meier analysis. RESULTS Median follow-up was 25 and 55 months for 159 PEARS and 142 VSRR patients. Seven (4.4%) patients undergoing PEARS required an intervention for coronary injury or impingement, resulting in one death (0.6%). After VSRR, there were no early deaths, 10 (7%) reinterventions for bleeding and 1 coronary intervention. Survival for matched cohorts at 5 years was similar (PEARS 98% vs VSRR 99%, p=0.99). There was no difference in freedom from valve or ascending aortic/arch reintervention between matched groups. Freedom from AR ≥2/4 at 5 years in the matched cohorts was 97% for PEARS vs 92% for VSRR (p=0.55). There were no type A dissections. CONCLUSIONS VSRR and PEARS offer favourable mid-term survival, freedom from reintervention and preservation of valve function. Both treatments deserve their place in the surgical repertoire, depending on a patient's disease stage. This study is limited by its retrospective nature and different follow-ups in both cohorts.
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Affiliation(s)
- Lucas Van Hoof
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Marie Lamberigts
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Dries Noé
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Ismail El-Hamamsy
- Cardiovascular Surgery, Mount Sinai Hospital, New York, New York, USA
| | - Emmanuel Lansac
- Cardiothoracic Surgery, University Hospital Pitié Salpêtrière, Paris, France
| | - Jolanda Kluin
- Cardiothoracic Surgery, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
| | - Laurent de Kerchove
- Cardiovascular Surgery, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - John Pepper
- Cardiac Surgery, Royal Brompton and Harefield NHS Trust, London, UK.,Cardiovascular Biomedical Research Unit (BRU), NIHR Imperial Biomedical Research Centre, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Bart Meuris
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Peter Verbrugghe
- Cardiac Surgery, KU Leuven University Hospitals Leuven, Leuven, Belgium
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Macbeth F, Williams NR, Treasure T. Comment on: A Systematic Review and Meta-analysis of Patient Survival and Disease Recurrence Following Percutaneous Ablation of Pulmonary Metastasis. Cardiovasc Intervent Radiol 2022; 45:1114-1116. [DOI: 10.1007/s00270-022-03172-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/02/2022]
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10
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Treasure T, Williams NR, Macbeth F. The cohort data in the full pulmonary metastasectomy in colorectal cancer study: Comment on Engstrand et al. Eur J Surg Oncol 2022; 48:1869-1870. [PMID: 35525726 DOI: 10.1016/j.ejso.2022.04.014] [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] [Received: 03/20/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, UK.
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardif University, Cardiff, UK
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11
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Macbeth F, Treasure T, Williams NR. Letter in Response to 'Approach to Oligometastatic Cancer in the Elderly Patient'. Curr Oncol Rep 2022; 24:1091-1093. [PMID: 35451687 DOI: 10.1007/s11912-022-01236-w] [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] [Accepted: 02/10/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK.
| | - Norman R Williams
- Surgical and Interventional Trial Unit, University College London, London, UK
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12
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Treasure T, Macbeth F, Younes R. The Pulmonary Metastasectomy in Colorectal Cancer study calls for reconsideration of the clinical effectiveness of this widespread practice. Rev Assoc Med Bras (1992) 2022; 68:296-298. [PMID: 35442350 DOI: 10.1590/1806-9282.20211094] [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] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 12/24/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Tom Treasure
- University College London, Clinical Operational Research Unit - London, United Kingdom
| | - Fergus Macbeth
- Cardiff University, Centre for Trials Research - Cardiff, United Kingdom
| | - Riad Younes
- Hospital Alemão Oswaldo Cruz, Cancer Center - São Paulo (SP), Brazil
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Williams NR, Patrick H, Fiorentino F, Allen A, Sharma M, Milošević M, Macbeth F, Treasure T. Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) randomised controlled trial: a systematic review of published responses. Eur J Cardiothorac Surg 2022; 62:6567629. [PMID: 35415756 PMCID: PMC9257793 DOI: 10.1093/ejcts/ezac253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/15/2022] [Accepted: 04/09/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this review was to assess the nature and tone of the published responses to the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) randomized controlled trial. METHODS Published articles that cited the PulMiCC trial were identified from Clarivate Web of Science (©. Duplicates and self-citations were excluded and relevant text extracted. Four independent researchers rated the extracts independently using agreed scales for the representativeness of trial data and the textual tone. The ratings were aggregated and summarized. Two PulMiCC authors carried out a thematic analysis of the extracts. RESULTS Sixty-four citations were identified and relevant text was extracted and examined. The consensus rating for data inclusion was a median of 0.25 out of 6 (range 0 to 5.25, IQR 0-1.5) and for textual tone the median rating was 1.87 out of 6 (range 0 to 5.75, IQR 1-3.5). The majority of citations did not provide adequate representation of the PulMiCC data and the overall the textual tone was dismissive. Although some were supportive, many discounted the findings because the trial closed early and was underpowered to show non-inferiority. Two misinterpreted the authors' conclusions but there was acceptance that five-year survival was much higher than widely assumed. CONCLUSIONS Published comments reveal a widespread reluctance to consider seriously the results of a carefully conducted randomized trial. This may be because the results challenge accepted practice because of 'motivated reasoning'. But there is a widespread misunderstanding of the fact that though PulMiCC with 93 patients was underpowered to test non-inferiority, it still provides reliable evidence to undermine the widespread belief in a major survival benefit from metastasectomy.
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Affiliation(s)
- Norman R Williams
- Surgical and Interventional Trials Unit, University College London, UK
| | | | - Francesca Fiorentino
- Nightingale-Saunders Clinical Trials & Epidemiology Unit, King's Clinical Trials Unit, Kings College London, UK
| | | | - Manuj Sharma
- Research Department of Primary Care and Population Health, University College, London, UK
| | - Mišel Milošević
- Thoracic Surgery Clinic, Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
| | | | - Tom Treasure
- Clinical Operational Research Unit, University College London, UK
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Milošević M, Treasure T, Fiorentino F. A well-balanced randomized controlled trial in 93 patients is more trustworthy than attempted propensity matching in 38 patients: comments on Schlachtenberger et al. Eur J Cardiothorac Surg 2022; 62:6566324. [PMID: 35403670 DOI: 10.1093/ejcts/ezac234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 04/01/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mišel Milošević
- Thoracic Surgery Clinic, Institute for Lung Diseases of Vojvodina, Sremska, Kamenica, Serbia
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Francesca Fiorentino
- Nightingale-Saunders Clinical Trials & Epidemiology Unit, King's Clinical Trials Unit, King's College London, London, UK
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Treasure T, Dunning J, Williams NR, Macbeth F. Lung metastasectomy for colorectal cancer: The impression of benefit from uncontrolled studies was not supported in a randomized controlled trial. J Thorac Cardiovasc Surg 2022; 163:486-490. [PMID: 33840470 DOI: 10.1016/j.jtcvs.2021.01.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 11/19/2020] [Accepted: 01/02/2021] [Indexed: 01/19/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom.
| | - Joel Dunning
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, United Kingdom
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, United Kingdom
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Macbeth F, Williams N, Treasure T. Stereotactic radiotherapy needs more evidence before it can be used routinely to treat metastases: a comment on the paper by Nicosia et al. Radiother Oncol 2022; 169:159-160. [DOI: 10.1016/j.radonc.2022.02.005] [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] [Received: 01/11/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
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Macbeth F, Treasure T. Stereotactic Ablative Radiotherapy for Oligometastatic Disease: Great Enthusiasm but Scant Evidence. Clin Oncol (R Coll Radiol) 2022; 34:313-317. [DOI: 10.1016/j.clon.2022.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/26/2022] [Accepted: 02/10/2022] [Indexed: 12/25/2022]
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Treasure T, Williams NR, Macbeth F. The full cohort of 512 patients and the nested controlled trial in 93 patients in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) study raise doubts about the effective size at present claimed. J Cardiothorac Surg 2022; 17:9. [PMID: 35034630 PMCID: PMC8762936 DOI: 10.1186/s13019-022-01757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 01/08/2022] [Indexed: 11/23/2022] Open
Abstract
A comparison of the relative merits of video-assisted pulmonary metastasectomy versus thoracotomy is predicated on the assumption that removal of asymptomatic lung metastases favourably influences survival and that it does so by a large degree. Recently published but long-awaited evidence from a prospective cohort study and a randomised trial of Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) challenges that assumption.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK.
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
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Williams NR, Macbeth F, Treasure T. Colorectal cancer-related pulmonary metastasectomy: Factors affecting survival time. Thorac Cancer 2021; 13:517-518. [PMID: 34951126 DOI: 10.1111/1759-7714.14240] [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] [Received: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tom Treasure
- Professor of Cardiothoracic Surgery, Clinical Operational Research Unit, University College London, London, UK
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London WC1H 0BT, UK
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21
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Macbeth F, Dunning J, Treasure T. Pulmonary metastasectomy in colorectal cancer: A letter in response to Antonoff and colleagues. JTCVS Open 2021; 8:612-613. [PMID: 36004202 PMCID: PMC9390400 DOI: 10.1016/j.xjon.2021.08.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Treasure T, Farewell V, Macbeth F, Batchelor T, Milosevic M, King J, Zheng Y, Leonard P, Williams NR, Brew-Graves C, Morris E, Fallowfield L. The Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) burden of care study: Analysis of local treatments for lung metastases and systemic chemotherapy in 220 patients in the PulMiCC cohort. Colorectal Dis 2021; 23:2911-2922. [PMID: 34310835 DOI: 10.1111/codi.15833] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 02/08/2023]
Abstract
AIM The aim of this work was to examine the burden of further treatments in patients with colorectal cancer following a decision about lung metastasectomy. METHOD Five teams participating in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) study provided details on subsequent local treatments for lung metastases, including the use of chemotherapy. For patients in three groups (no metastasectomy, one metastasectomy or multiple local interventions), baseline factors and selection criteria for additional treatments were examined. RESULTS The five teams recruited 220 patients between October 2010 and January 2017. No lung metastasectomy was performed in 51 patients, 114 patients had one metastasectomy and 55 patients had multiple local interventions. Selection for initial metastasectomy was associated with nonelevated carcinoembryonic antigen, fewer metastases and no prior liver metastasectomy. These patients also had better Eastern Cooperative Oncology Group scores and lung function at baseline. Four sites provided information on chemotherapy in 139 patients: 79 (57%) had one to five courses of chemotherapy, to a total of 179 courses. The patterns of survival after one or multiple metastasectomy interventions showed evidence of guarantee-time bias contributing to an impression of benefit over no metastasectomy. After repeated metastasectomy, a significantly higher risk of death was observed, with no apparent reduction in chemotherapy usage. CONCLUSION Repeated metastasectomy is associated with a higher risk of death without reducing the use of chemotherapy. Continued monitoring without surgery might reassure patients with indolent disease or allow response assessment during systemic treatment. Overall, the carefully collected information from the PulMICC study provides no indication of an important survival benefit from metastasectomy.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | | | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tim Batchelor
- Bristol Royal Infirmary, University Hospitals, Bristol, UK
| | - Misel Milosevic
- Institute for Lung Diseases of Vojvodina, Thoracic Surgery Clinic, Sremska Kamenica, Serbia
| | | | - Yan Zheng
- Department of Thoracic Surgery, The Affiliated Cancer Hospital of Zheng Zhou University/Henan Cancer Hospital, Zheng Zhou, Henan Province, China
| | - Pauline Leonard
- Barking, Havering and Redbridge University Hospitals, Romford, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit (SITU), University College London, London, UK
| | - Chris Brew-Graves
- Division of Medicine, National Cancer Imaging Accelerator (NCIA), University College London, London, UK
| | | | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), University of Sussex, Falmer, UK
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Brew-Graves C, Leonard P, Treasure T. Lung Metastasectomy in the Treatment of Rectal Cancer Gives Little if Any Benefit Compared With the Importance of Control at the Primary Cancer Site. Am J Clin Oncol 2021; 44:503-504. [PMID: 34432669 DOI: 10.1097/coc.0000000000000853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Chris Brew-Graves
- National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine
| | - Pauline Leonard
- Barking, Havering and Redbridge University Hospitals, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit University College London
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Williams NR, Treasure T, Macbeth F, Fallowfield L. The Prospective Observational Cohort and the Nested Randomized Controlled Trial in the Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC Study) Question the Reliance on Existing Evidence for the Magnitude of Benefit From Lung Metastasectomy. Am J Clin Oncol 2021; 44:502-503. [PMID: 34432668 PMCID: PMC7611601 DOI: 10.1097/coc.0000000000000847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Norman R Williams
- Surgical and Interventional Trials Unit, University College London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, UK
| | | | - Lesley Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), University of Sussex, Sussex, UK
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Van Hoof L, Rega F, Golesworthy T, Verbrugghe P, Austin C, Takkenberg JJM, Pepper JR, Treasure T. Personalised external aortic root support for elective treatment of aortic root dilation in 200 patients. Heart 2021; 107:1790-1795. [PMID: 34326135 DOI: 10.1136/heartjnl-2021-319300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/05/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In personalised external aortic root support (PEARS), a custom-made, macroporous mesh is used to stabilise a dilated aortic root and prevent dissection, primarily in patients with genetically driven aortopathies. Data are needed on the safety and postoperative incidence of aortic events. METHODS We present a multicentre cohort study evaluating the first 200 consecutive patients (median age 33 years) undergoing surgery with an intention to perform PEARS for aortic root dilatation in 23 centres between 2004 and 2019. Perioperative outcomes were collected prospectively while clinical follow-up was retrieved retrospectively. Median follow-up was 21.2 months. RESULTS The main indication was Marfan syndrome (73.5%) and the most frequent concomitant procedure was mitral valve repair (10%). An intervention for myocardial ischaemia or coronary injury was needed in 11 patients, 1 case resulting in perioperative death. No ascending aortic dissections were observed in 596 documented postoperative patient years. Late reoperation was performed in 3 patients for operator failure to achieve complete mesh coverage. Among patients with at least mild aortic regurgitation (AR) preoperatively, 68% had no or trivial AR at follow-up. CONCLUSIONS This study represents the clinical history of the first 200 patients to undergo PEARS. To date, aortic dissection has not been observed in the restrained part of the aorta, yet long-term follow-up is needed to confirm the potential of PEARS to prevent dissection. While operative mortality is low, the reported coronary complications reflect the learning curve of aortic root surgery in patients with connective tissue disease. PEARS may stabilise or reduce aortic regurgitation.
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Affiliation(s)
- Lucas Van Hoof
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | | | | | - Conal Austin
- Department of Paediatric Cardiology and Cardiothoracic Surgery, St Thomas' Hospital, London, UK
| | - Johanna J M Takkenberg
- Department of Cardio-Thoracic Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - John R Pepper
- Cardiothoracic Surgery, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Macbeth F, Treasure T. Early repeat resection of liver metastases from colorectal cancer may not be justified without controlled trial evidence. Cancer Epidemiol 2021; 74:101981. [PMID: 34272195 DOI: 10.1016/j.canep.2021.101981] [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] [Received: 06/20/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022]
Affiliation(s)
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, UK.
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Van Raemdonck D, Treasure T, Van Cutsem E, Macbeth F. Pulmonary Metastasectomy in Colorectal Cancer: has the randomized controlled trial brought enough reliable evidence to convince believers in metastasectomy to reconsider their oncological practice? Eur J Cardiothorac Surg 2021; 59:517-521. [PMID: 33332567 DOI: 10.1093/ejcts/ezaa450] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics and Physical Sciences, University College London, London, UK
| | - Eric Van Cutsem
- Department of Gastrointestinal and Liver Diseases, Digestive Oncology Unit, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
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Treasure T, Farewell V, Macbeth F, Batchelor T, Milošević M, King J, Zheng Y, Leonard P, Williams NR, Brew‐Graves C, Fallowfield L. The Pulmonary Metastasectomy in Colorectal Cancer cohort study: Analysis of case selection, risk factors and survival in a prospective observational study of 512 patients. Colorectal Dis 2021; 23:1793-1803. [PMID: 33783109 PMCID: PMC8496511 DOI: 10.1111/codi.15651] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/02/2021] [Accepted: 03/23/2021] [Indexed: 01/02/2023]
Abstract
AIM We wanted to examine survival in patients with resected colorectal cancer (CRC) whose lung metastases are or are not resected. METHODS Teams participating in the study of Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC) identified potential candidates for lung metastasectomy and invited their consent to join Stage 1. Baseline data related to CRC and fitness for surgery were collected. Eligible patients were invited to consent for randomization in the PulMiCC randomized controlled trial (Stage 2). Sites were provided with case report forms for non-randomized patients to record adverse events and death at any time. They were all reviewed at 1 year. Baseline and survival data were analysed for the full cohort. RESULTS Twenty-five clinical sites recruited 512 patients from October 2010 to January 2017. Data collection closed in October 2020. Before analysis, 28 patients with non-CRC lung lesions were excluded and three had withdrawn consent leaving 481. The date of death was known for 292 patients, 136 were alive in 2020 and 53 at earlier time points. Baseline factors and 5-year survival were analysed in three strata: 128 non-randomized patients did not have metastasectomy; 263 had elective metastasectomy; 90 were from the randomized trial. The proportions of solitary metastases for electively operated and non-operated patients were 69% and 35%. Their respective 5-year survivals were 47% and 22%. CONCLUSION Survival without metastasectomy was greater than widely presumed. Difference in survival appeared to be largely related to selection. No inference can be drawn about the effect of metastasectomy on survival in this observational study.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
| | | | | | - Tim Batchelor
- Bristol Royal InfirmaryUniversity HospitalsBristolUK
| | - Mišel Milošević
- Institute for Lung Diseases of VojvodinaThoracic Surgery ClinicSremska KamenicaSerbia
| | - Juliet King
- Thoracic SurgeryGuy's and St Thomas'HospitalLondonUK
| | - Yan Zheng
- Department of Thoracic SurgeryAffiliated Cancer Hospital of ZhengZhou University/Henan Cancer HospitalZheng ZhouChina
| | - Pauline Leonard
- Barking, Havering and Redbridge University HospitalsRomfordUK
| | - Norman R. Williams
- Surgical and Interventional Trials Unit (SITU)University College LondonLondonUK
| | - Chris Brew‐Graves
- National Cancer Imaging Accelerator (NCIA)Division of MedicineUniversity College LondonLondonUK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE‐C)University of SussexFalmerUK
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29
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Treasure T, Macbeth F. The evidence for surgical interventions: Lung metastasectomy outcomes in the PulMiCC trial, an observational cohort study, and big data analysis. Colorectal Dis 2021; 23:1932-1933. [PMID: 33894024 DOI: 10.1111/codi.15686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 12/12/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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30
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Treasure T. Pulmonarymetastasectomy in colorectal cancer: a nested randomized trial casting doubt ona large survival benefit. ANZ J Surg 2021; 91:1319-1320. [PMID: 34121281 DOI: 10.1111/ans.16915] [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] [Accepted: 04/21/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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31
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Fiorentino F, Milošević M, Treasure T. What have we learned in the process of setting up and running the PulMiCC (Pulmonary Metastasectomy in Colorectal Cancer) randomised controlled trial? Video-assist Thorac Surg 2021. [DOI: 10.21037/vats-2020-lm-08] [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: 11/06/2022]
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32
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Fenton HM, Finan PJ, Milton R, Shackcloth M, Taylor JC, Treasure T, Morris EJA. National variation in pulmonary metastasectomy for colorectal cancer. Colorectal Dis 2021; 23:1306-1316. [PMID: 33368958 PMCID: PMC8614123 DOI: 10.1111/codi.15506] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
Abstract
AIM Evidence on patterns of use of pulmonary metastasectomy in colorectal cancer patients is limited. This population-based study aims to investigate the use of pulmonary metastasectomy in the colorectal cancer population across the English National Health Service (NHS) and quantify the extent of any variations in practice and outcome. METHODS All adults who underwent a major resection for colorectal cancer in an NHS hospital between 2005 and 2013 were identified in the COloRECTal cancer data Repository (CORECT-R). All inpatient episodes corresponding to pulmonary metastasectomy, occurring within 3 years of the initial colorectal resection, were identified. Multi-level logistic regression was used to determine patient and organizational factors associated with the use of pulmonary metastasectomy for colorectal cancer, and Kaplan-Meier and Cox models were used to assess survival following pulmonary metastasectomy. RESULTS In all, 173 354 individuals had a major colorectal resection over the study period, with 3434 (2.0%) undergoing pulmonary resection within 3 years. The frequency of pulmonary metastasectomy increased from 1.2% of patients undergoing major colorectal resection in 2005 to 2.3% in 2013. Significant variation was observed across hospital providers in the risk-adjusted rates of pulmonary metastasectomy (0.0%-6.8% of patients). Overall 5-year survival following pulmonary resection was 50.8%, with 30-day and 90-day mortality of 0.6% and 1.2% respectively. CONCLUSIONS This study shows significant variation in the rates of pulmonary metastasectomy for colorectal cancer across the English NHS.
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Affiliation(s)
- Hayley M. Fenton
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Paul J. Finan
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Richard Milton
- Department of Thoracic SurgerySt James’s University HospitalLeedsUK
| | - Michael Shackcloth
- Department of Thoracic SurgeryLiverpool Heart and Chest HospitalLiverpoolUK
| | - John C. Taylor
- Cancer Epidemiology GroupLeeds Institute for Data AnalyticsUniversity of LeedsLeedsUK
| | - Tom Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
| | - Eva J. A. Morris
- Nuffield Department of Population HealthBig Data InstituteUniversity of OxfordOxfordUK
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33
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Macbeth F, Williams NR, Treasure T. Pulmonary metastasectomy in colorectal cancer: a randomized controlled trial. ANZ J Surg 2021; 91:473. [PMID: 33740304 DOI: 10.1111/ans.16658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/01/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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Affiliation(s)
- Lucas Van Hoof
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, United Kingdom
| | - John Pepper
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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35
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Treasure T. Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC). Assumed benefits are not confirmed by new study findings. Pathol Res Pract 2021; 222:153442. [PMID: 33862562 DOI: 10.1016/j.prp.2021.153442] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/03/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, UK.
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36
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Abstract
Lung metastases are a common site of spread for many malignant tumours. Pulmonary metastasectomy has been practiced for many years for sarcomas and is now becoming increasingly frequently advocated for patients with many other tumours, especially colorectal cancer. In this article we argue that this procedure is one framed by therapeutic opportunity and not supported by strong evidence. It is potentially harmful and may not be effective. Our argument is based on several important issues: (I) the vagueness of the concept of “oligometastases” and its biological implausibility; (II) the flaws in the often-cited observational evidence, especially selection bias; (III) the lack of any reliable randomised trial evidence of improved survival but evidence of harm; (IV) the failure of strategies to detect metastases earlier to influence overall survival. The introduction of stereotactic radiotherapy and image-guided thermal ablation have made the urge to treat lung metastases stronger but without any good evidence to justify their use. We acknowledge the problems of carrying out randomised trials when there is a clear lack of equipoise in the clinical teams involved but believe that there is an ethical need to do so. Many patients are probably being given false hope of cure or prolonged survival but are at risk of harm from pulmonary metastasectomy or ablation. It is possible that a few patients may benefit but without better evidence we do not know which, if any, do.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
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37
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Treasure T, Williams NR. Lung metastasectomy for colorectal cancer in the PulMiCC randomised controlled trial. Lancet Reg Health Eur 2021; 3:100080. [PMID: 34557807 PMCID: PMC8454816 DOI: 10.1016/j.lanepe.2021.100080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
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38
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Austin C, Thompson P, Fittipaldi M, Treasure T. The consequences of incomplete covering of the critical part of the aortic root in Personalized External Aortic Root Support. Eur J Cardiothorac Surg 2021; 59:1095. [DOI: 10.1093/ejcts/ezab118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | | | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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39
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Batchelor T, Hasan J, Macbeth F, Shackcloth M, Treasure T. Randomised Controlled Trial Evidence Questions the Assumption that Pulmonary Metastasectomy Benefits Patients with Colorectal Cancer. Ann Surg Oncol 2021; 28:4066-4067. [PMID: 33590363 DOI: 10.1245/s10434-020-09521-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 11/18/2022]
Abstract
Pulmonary metastasectomy for sarcoma is surgery without proven benefit, and in the light of a randomized controlled trial examining pulmonary metastasectomy in colorectal cancer, it should be questioned.
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Affiliation(s)
| | | | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Tom Treasure
- Clinical Operational Research Unit, University College, London, UK.
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40
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Treasure T, Macbeth F, Farewell V, Williams NR, Fallowfield L. The fallacy of large survival gains from lung metastasectomy in colorectal cancer. Lancet 2021; 397:97-98. [PMID: 33422259 DOI: 10.1016/s0140-6736(20)32760-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/27/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London WC1E 6BT, UK.
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London WC1E 6BT, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer, University of Sussex, Falmer, UK
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41
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Brew-Graves C, Farewell V, Monson K, Milošević M, Williams NR, Morris E, Macbeth F, Treasure T, Fallowfield L. Pulmonary metastasectomy in colorectal cancer: health utility scores by EQ-5D-3L in a randomized controlled trial show no benefit from lung metastasectomy. Colorectal Dis 2021; 23:200-205. [PMID: 33002305 PMCID: PMC7612179 DOI: 10.1111/codi.15386] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 02/08/2023]
Abstract
AIM The aim was to assess the health utility of lung metastasectomy in the treatment of patients with colorectal cancer (CRC) using the EQ-5D-3L questionnaire. METHODS Multidisciplinary CRC teams at 14 sites recruited patients to a two-arm randomized controlled trial-Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC). Remote randomization was used, stratified by site and with minimization for seven known confounders. Participants completed the EQ-5D-3L questionnaire together with other patient reported outcome measures at randomization and then again at 3, 6, 12 and 24 months. These were returned by post to the coordinating centre. RESULTS Between December 2010 and December 2016, 93 participants were randomized, 91 of whom returned questionnaires. Survival and patient reported quality of life have been published previously, revealing no significant differences between the trial arms. Described here are patient reported data from the five dimensions of the EQ-5D-3L and the visual analogue scale (VAS) health state. No significant difference was seen at any time point. The estimated difference between control and metastasectomy patients was -0.23 (95% CI -0.113, 0.066) for the composite 0 to 1 index scale based on the descriptive system and 0.123 (95% CI -7.24, 7.49) for the 0 to 100 VAS scale. CONCLUSIONS Following lung metastasectomy for CRC, no benefit was demonstrated for health utility, which alongside a lack of a survival or quality of life benefit calls into question the widespread use of the procedure.
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Affiliation(s)
- Chris Brew-Graves
- National Cancer Imaging Translational Accelerator (NCITA), Division of Medicine, UCL, London, UK
| | - Vernon Farewell
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Kathryn Monson
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Mišel Milošević
- Thoracic Surgery Clinic, Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Norman R. Williams
- Surgical and Interventional Trials Unit (SITU), University College London, London, UK
| | - Eva Morris
- Nuffield Department of Population Health, Big Data Institute, University of Oxford, Oxford, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
| | - Lesley Fallowfield
- Sussex Health Outcomes Research and Education in Cancer (SHORE-C), Brighton and Sussex Medical School, University of Sussex, Falmer, UK
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42
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Fiorentino F, Treasure T. Sample size calculations for randomized controlled trials and for prediction models. Colorectal Dis 2021; 23:316-319. [PMID: 33320416 DOI: 10.1111/codi.15489] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 02/08/2023]
Affiliation(s)
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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43
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Williams NR, Macbeth F, Treasure T. Pulmonary metastasectomy in colorectal cancer: PulMiCC and future trials. Quant Imaging Med Surg 2020; 10:2215-2217. [PMID: 33140001 DOI: 10.21037/qims-20-774] [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)
- Norman R Williams
- Surgical and Interventional Trials Unit, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK
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44
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Williams NR, Treasure T, Macbeth F. Pulmonary Metastasectomy for Colorectal Cancer: Randomized Controlled Trial. Radiology 2020; 298:E54-E55. [PMID: 33107803 DOI: 10.1148/radiol.2020202862] [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: 11/11/2022]
Affiliation(s)
| | - Tom Treasure
- Clinical Operational Research Unit, University College London, Gower Street, London WC1E 6BT, England
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, Wales
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45
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Milosevic M, Treasure T, Macbeth F. PulMiCC and data from other randomized controlled trials challenge the usefulness of metastasectomy. Eur J Cardiothorac Surg 2020; 59:ezaa291. [PMID: 33006614 DOI: 10.1093/ejcts/ezaa291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/13/2020] [Indexed: 11/08/2023] Open
Affiliation(s)
- Misel Milosevic
- Thoracic Surgery Clinic, Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Tom Treasure
- Clinical Operational Research Unit, Department of Mathematics and Physical Sciences, University College London, London, UK
| | - Fergus Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
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46
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Treasure T, Leonard P, Milosevic M, Williams NR, Macbeth F, Farewell V. Pulmonary Metastasectomy in Colorectal Cancer: the PulMiCC randomised controlled trial. Br J Surg 2020; 107:e489-e490. [PMID: 32820820 DOI: 10.1002/bjs.11948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, Sremska Kamenica, Serbia
| | - Pauline Leonard
- Barking, Havering and Redbridge University Hospitals NHS Trust, Sremska Kamenica, Serbia
| | - Misel Milosevic
- Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
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47
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Milosevic M, Edwards J, Tsang D, Dunning J, Shackcloth M, Batchelor T, Coonar A, Hasan J, Davidson B, Marchbank A, Grumett S, Williams N, Macbeth F, Farewell V, Treasure T. Pulmonary Metastasectomy in Colorectal Cancer: updated analysis of 93 randomized patients - control survival is much better than previously assumed. Colorectal Dis 2020; 22:1314-1324. [PMID: 32388895 PMCID: PMC7611567 DOI: 10.1111/codi.15113] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 12/23/2022]
Abstract
AIM Lung metastases from colorectal cancer are resected in selected patients in the belief that this confers a significant survival advantage. It is generally assumed that the 5-year survival of these patients would be near zero without metastasectomy. We tested the clinical effectiveness of this practice in Pulmonary Metastasectomy in Colorectal Cancer (PulMiCC), a randomized, controlled noninferiority trial. METHOD Multidisciplinary teams in 14 hospitals recruited patients with resectable lung metastases into a two-arm trial. Randomization was remote and stratified according to site, with minimization for age, sex, primary cancer stage, interval since primary resection, prior liver involvement, number of metastases and carcinoembryonic antigen level. The trial management group was blind to patient allocation until after intention-to-treat analysis. RESULTS From 2010 to 2016, 93 participants were randomized. These patients were 35-86 years of age and had between one and six lung metastases at a median of 2.7 years after colorectal cancer resection; 29% had prior liver metastasectomy. The patient groups were well matched and the characteristics of these groups were similar to those of observational studies. The median survival after metastasectomy was 3.5 (95% CI: 3.1-6.6) years compared with 3.8 (95% CI: 3.1-4.6) years for controls. The estimated unadjusted hazard ratio for death within 5 years, comparing the metastasectomy group with the control group, was 0.93 (95% CI: 0.56-1.56). Use of chemotherapy or local ablation was infrequent and similar in each group. CONCLUSION Patients in the control group (who did not undergo lung metastasectomy) have better survival than is assumed. Survival in the metastasectomy group is comparable with the many single-arm follow-up studies. The groups were well matched with features similar to those reported in case series.
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Affiliation(s)
- M. Milosevic
- Institute for Lung Diseases of VojvodinaThoracic Surgery ClinicSremska KamenicaSerbia
| | - J. Edwards
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - D. Tsang
- Basildon and Thurrock University Hospitals NHS Foundation TrustBasildonUK
| | - J. Dunning
- South Tees Hospitals NHS Foundation TrustThe James Cook University HospitalMiddlesbroughUK
| | - M. Shackcloth
- Liverpool Heart And Chest Hospital NHS Foundation TrustLiverpoolUK
| | - T. Batchelor
- Bristol Royal InfirmaryUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - A. Coonar
- Royal Papworth Hospital NHS Foundation TrustCambridgeUK
| | - J. Hasan
- The Christie NHS Foundation TrustManchesterUK
| | - B. Davidson
- Division of SurgeryRoyal Free London NHS Foundation TrustUCLLondonUK
| | - A. Marchbank
- Derriford HospitalUniversity Hospitals Plymouth NHS TrustPlymouthUK
| | - S. Grumett
- The Royal Wolverhampton NHS TrustNew Cross HospitalWolverhamptonUK
| | - N.R. Williams
- Surgical & Interventional Trials Unit (SITU)University College LondonLondonUK
| | - F. Macbeth
- Centre for Trials ResearchCardiff UniversityCardiffUK
| | | | - T. Treasure
- Clinical Operational Research UnitUniversity College LondonLondonUK
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48
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Baum M, Fallowfield L, Farewell V, Macbeth F, Treasure T. NICE Guidelines: management of colorectal cancer metastases. Br J Surg 2020; 107:e357. [PMID: 32652538 DOI: 10.1002/bjs.11789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 01/16/2023]
Affiliation(s)
- M Baum
- University College, Sussex, UK
| | - L Fallowfield
- Sussex Health Outcomes Research & Education in Cancer (SHORE-C), University of Sussex, Sussex, UK
| | | | - F Macbeth
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - T Treasure
- Clinical Operational Research Unit, University College London, London, UK
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49
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Pepper J, Izgi C, Golesworthy TJ, Takkenberg JJM, Treasure T. Personalised external aortic root support (PEARS) to stabilise an aortic root aneurysm. Br J Cardiol 2020; 27:22. [PMID: 35747770 PMCID: PMC9205243 DOI: 10.5837/bjc.2020.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Patients with congenitally determined aortic root aneurysms are at risk of aortic valve regurgitation, aortic dissection, rupture and death. Personalised external aortic root support (PEARS) may provide an alternative to aortic root replacement. This was a multi-centre, prospective cohort of all consecutive patients who received ExoVasc mesh implants for a dilated aortic root between 2004 and 2017. Baseline and peri-operative characteristics, as well as early postoperative outcomes are described, and time-related survival and re-operation free survival are estimated using the Kaplan-Meier method. From 2004 through 2017, 117 consecutive patients have received ExoVasc mesh implants for aortic root aneurysm. The inclusion criteria were an aortic root/sinus of Valsalva and ascending aorta with asymptomatic dilatation of between 40 and 50 mm in diameter in patients aged 16 years or more. Patients with more than mild aortic regurgitation were excluded. There was one early death. The length of stay was within seven days in 75% of patients. In conclusion, the operation achieves the objectives of valve-sparing root replacement. PEARS may be seen as a low-risk conservative operation, which can be applied earlier on in the disease process, and which is complementary to more invasive procedures, such as valve-sparing root replacement or total root replacement.
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Affiliation(s)
- John Pepper
- Consultant Cardiac Surgeon, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP
| | - Cemil Izgi
- Consultant Cardiac Radiologist, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, SW3 6NP
| | - Tal J Golesworthy
- Chartered Energy Engineer, Extent Ltd., Theocsbury House, 18-20 Barton Street, Tewkesbury Gloucestershire
| | - Johanna J M Takkenberg
- Cardiac Epidemiologist, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam The Netherlands
| | - Tom Treasure
- Consultant Cardiothoracic Surgeon, Clinical Operational Research Unit, University College London, 4 Taviton Street, London WC1H 0BT
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50
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Milosevic M, Edwards J, Dunning J, Shackcloth M, Treasure T. Five-year survival of patients in control groups of randomized controlled trials is much higher than that assumed in observational study reports. Int J Colorectal Dis 2020; 35:941-942. [PMID: 32067060 DOI: 10.1007/s00384-020-03540-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Misel Milosevic
- Thoracic Surgery Clinic, Institute for Lung Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - John Edwards
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Joel Dunning
- The James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
| | | | - Tom Treasure
- Clinical Operational Research Unit, University College, London, UK.
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