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Lukovic J, Moore AJ, Lee MT, Willis D, Ahmed S, Akra M, Hortobagyi E, Kron T, Lim Joon D, Liu A, Ryan J, Thomas M, Wall K, Ward I, Wiltshire KL, O'Callaghan CJ, Wong RKS, Ringash JG, Haustermans K, Leong T. The Feasibility of Quality Assurance in the TOPGEAR International Phase 3 Clinical Trial of Neoadjuvant Chemoradiation Therapy for Gastric Cancer (an Intergroup Trial of the AGITG/TROG/NHMRC CTC/EORTC/CCTG). Int J Radiat Oncol Biol Phys 2023; 117:1096-1106. [PMID: 37393022 DOI: 10.1016/j.ijrobp.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/12/2023] [Accepted: 06/14/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE The TOPGEAR phase 3 trial hypothesized that adding preoperative chemoradiation therapy (CRT) to perioperative chemotherapy will improve survival in patients with gastric cancer. Owing to the complexity of gastric irradiation, a comprehensive radiation therapy quality assurance (RTQA) program was implemented. Our objective is to describe the RTQA methods and outcomes. METHODS AND MATERIALS RTQA was undertaken in real time before treatment for the first 5 patients randomized to CRT from each center. Once acceptable quality was achieved, RTQA was completed for one-third of subsequent cases. RTQA consisted of evaluating (1) clinical target volume and organ-at-risk contouring and (2) radiation therapy planning parameters. Protocol violations between high- (20+ patients enrolled) and low-volume centers were compared using the Fisher exact test. RESULTS TOPGEAR enrolled 574 patients, of whom 286 were randomized to receive preoperative CRT and 203 (71%) were included for RTQA. Of these, 67 (33%) and 136 (67%) patients were from high- and low-volume centers, respectively. The initial RTQA pass rate was 72%. In total, 28% of cases required resubmission. In total, 200 of 203 cases (99%) passed RTQA before treatment. Cases from low-volume centers required resubmission more often (44/136 [33%] vs 13/67 [18%]; P = .078). There was no change in the proportion of cases requiring resubmission over time. Most cases requiring resubmission had multiple protocol violations. At least 1 aspect of the clinical target volume had to be adjusted in all cases. Inadequate coverage of the duodenum was most common (53% major violation, 25% minor violation). For the remaining cases, the resubmission process was triggered secondary to poor contour/plan quality. CONCLUSIONS In a large multicenter trial, RTQA is feasible and effective in achieving high-quality treatment plans. Ongoing education should be performed to ensure consistent quality during the entire study period.
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Affiliation(s)
- Jelena Lukovic
- Radiation Medicine Program, Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
| | - Alisha J Moore
- Trans-Tasman Radiation Oncology Group, University of Newcastle, Newcastle, New South Wales, Australia
| | - Mark T Lee
- Liverpool and Macarthur Cancer Therapy Centre, Sydney, New South Wales, Australia
| | - David Willis
- Cancer Care Services, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Shahida Ahmed
- Radiation Oncology, CancerCare Manitoba, Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Mohamed Akra
- Radiation Oncology, CancerCare Manitoba, Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Eszter Hortobagyi
- Department of Radiation Oncology, UZ Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Tomas Kron
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Daryl Lim Joon
- Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Melbourne, Victoria, Australia; Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - Amy Liu
- Radiation Medicine Program, Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - John Ryan
- Department of Medical Imaging and Radiation Sciences, Monash University, Melbourne, Victoria, Australia
| | - Melissa Thomas
- Department of Radiation Oncology, UZ Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Katelyn Wall
- Department of Radiation Oncology, North West Cancer Centre, Tamworth, New South Wales, Australia
| | - Iain Ward
- St. George's Cancer Care, Christchurch, New Zealand
| | - Kirsty L Wiltshire
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Rebecca K S Wong
- Radiation Medicine Program, Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Jolie G Ringash
- Radiation Medicine Program, Princess Margaret Cancer Centre and Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Karin Haustermans
- Department of Radiation Oncology, UZ Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Trevor Leong
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
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Day F, Sridharan S, Lynam J, Gedye C, Johnson C, Fraser A, Thompson SR, Michael M, Leong T, Roy A, Kumar M, van der Westhuizen A, Quah GT, Mandaliya H, Mallesara G, Sappiatzer J, Oldmeadow C, Martin J. Chemoradiotherapy with concurrent durvalumab for the palliative treatment of oligometastatic oesophageal and gastrooesophageal carcinoma with dysphagia: a single arm phase II clinical trial (PALEO, sponsored by the Australasian Gastro-Intestinal Trials Group). BMC Cancer 2022; 22:1324. [PMID: 36528772 PMCID: PMC9758808 DOI: 10.1186/s12885-022-10407-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Oesophageal and gastrooesophageal junction (GOJ) carcinoma frequently present with dysphagia and de novo metastatic disease. There is scope to improve treatment paradigms to both address symptoms and improve survival. One method is integrating immune checkpoint inhibition with novel treatment combinations. METHODS PALEO is a single arm, phase II clinical trial in patients with previously untreated, oligometastatic or locoregionally advanced oesophageal or GOJ carcinoma and dysphagia. PALEO is sponsored by the Australasian Gastro-Intestinal Trials Group (AGITG). Participants receive 2 weeks of therapy with concurrent hypofractionated radiotherapy of 30Gy in 10 fractions to the primary tumour, weekly carboplatin AUC2, weekly paclitaxel 50 mg/m2 and durvalumab 1500 mg q4 weekly, followed by durvalumab monotherapy continuing at 1500 mg q4weekly until disease progression, unacceptable toxicity or 24 months of therapy. A single metastasis is treated with stereotactic radiotherapy of 24Gy in 3 fractions in week 7. The trial primary endpoint is the progression free survival rate at 6 months. Secondary endpoints include duration of dysphagia relief, nutritional status change, quality of life, response rate, toxicity, progression free survival and overall survival. The tertiary endpoint is prediction of outcome based on biomarkers identified from patient serial blood samples collected pre- and post-radiotherapy. DISCUSSION This unique investigator-initiated clinical trial is designed to simultaneously address the clinically relevant problems of dysphagia and distant disease control. The overarching aims are to improve patient nutrition, quality of life and survival with low toxicity therapy. AGITG PALEO is a multidisciplinary collaboration and will add to the understanding of the relationship between radiotherapy and the anti-tumour immune response. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry: ACTRN12619001371189 , registered 8 October 2019.
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Affiliation(s)
- Fiona Day
- grid.413265.70000 0000 8762 9215Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Swetha Sridharan
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia ,grid.413265.70000 0000 8762 9215Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW Australia
| | - James Lynam
- grid.413265.70000 0000 8762 9215Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
| | - Craig Gedye
- grid.413265.70000 0000 8762 9215Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
| | - Catherine Johnson
- grid.413265.70000 0000 8762 9215Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Allison Fraser
- grid.413265.70000 0000 8762 9215Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW Australia ,grid.413265.70000 0000 8762 9215Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW Australia
| | - Stephen R. Thompson
- grid.1005.40000 0004 4902 0432Prince of Wales Clinical School, Faculty of Medicine, University of New South Wales, Sydney, NSW Australia
| | - Michael Michael
- grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC Australia
| | - Trevor Leong
- grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC Australia
| | - Amitesh Roy
- grid.414925.f0000 0000 9685 0624Flinders Medical Centre, Bedford Park, Adelaide, SA Australia
| | - Mahesh Kumar
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia ,grid.413265.70000 0000 8762 9215Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW Australia
| | - Andre van der Westhuizen
- grid.413265.70000 0000 8762 9215Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
| | - Gaik T. Quah
- grid.413265.70000 0000 8762 9215Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
| | - Hiren Mandaliya
- grid.413265.70000 0000 8762 9215Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
| | - Girish Mallesara
- grid.413265.70000 0000 8762 9215Department of Medical Oncology, Calvary Mater Newcastle, Waratah, NSW Australia ,grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia
| | - Joshua Sappiatzer
- grid.459526.90000 0004 0625 890XGenesisCare, Flinders Private Hospital, Bedford Park, Adelaide, SA Australia
| | - Christopher Oldmeadow
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia ,grid.413648.cHunter Medical Research Institute, New Lambton Heights, NSW Australia
| | - Jarad Martin
- grid.266842.c0000 0000 8831 109XSchool of Medicine and Public Health, University of Newcastle, Callaghan, NSW Australia ,grid.413265.70000 0000 8762 9215Department of Radiation Oncology, Calvary Mater Newcastle, Waratah, NSW Australia
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Obermannová R, Alsina M, Cervantes A, Leong T, Lordick F, Nilsson M, van Grieken NCT, Vogel A, Smyth EC. Oesophageal cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:992-1004. [PMID: 35914638 DOI: 10.1016/j.annonc.2022.07.003] [Citation(s) in RCA: 121] [Impact Index Per Article: 60.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- R Obermannová
- Department of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - M Alsina
- Department of Medical Oncology, Hospital Universitario de Navarra (HUN), Pamplona; Gastrointestinal Tumours Group, Vall d'Hebron Institute of Oncology, Barcelona
| | - A Cervantes
- Department of Medical Oncology, INCLIVA Biomedical Research Institute, University of Valencia, Valencia; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - T Leong
- The Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia
| | - F Lordick
- Department of Medicine II (Oncology, Gastroenterology, Hepatology, Pulmonology and Infectious Diseases), University Cancer Center Leipzig (UCCL), Leipzig University Medical Center, Leipzig, Germany
| | - M Nilsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - N C T van Grieken
- Department of Pathology, Amsterdam University Medical Centers, Cancer Center Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
| | - A Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Hannover, Germany
| | - E C Smyth
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Stirling R, Smith S, Brand M, Harden S, Briggs L, Leigh L, Brims F, Brooke M, Brunelli V, Chia C, Dawkins P, Lawrenson R, Duffy M, Evans S, Leong T, Marshall H, Patel D, Pavlakis N, Philip J, Rankin N, Singhal N, Stone E, Tay R, Vinod S, Windsor M, Wright G, Leong D, Zalcberg J. EP04.01-023 Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry (ANZLCR). J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Nilsson M, Olafsdottir H, Alexandersson von Döbeln G, Villegas F, Gagliardi G, Hellström M, Wang QL, Johansson H, Gebski V, Hedberg J, Klevebro F, Markar S, Smyth E, Lagergren P, Al-Haidari G, Rekstad LC, Aahlin EK, Wallner B, Edholm D, Johansson J, Szabo E, Reynolds JV, Pramesh CS, Mummudi N, Joshi A, Ferri L, Wong RKS, O’Callaghan C, Lukovic J, Chan KKW, Leong T, Barbour A, Smithers M, Li Y, Kang X, Kong FM, Chao YK, Crosby T, Bruns C, van Laarhoven H, van Berge Henegouwen M, van Hillegersberg R, Rosati R, Piessen G, de Manzoni G, Lordick F. Neoadjuvant Chemoradiotherapy and Surgery for Esophageal Squamous Cell Carcinoma Versus Definitive Chemoradiotherapy With Salvage Surgery as Needed: The Study Protocol for the Randomized Controlled NEEDS Trial. Front Oncol 2022; 12:917961. [PMID: 35912196 PMCID: PMC9326032 DOI: 10.3389/fonc.2022.917961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/08/2022] [Indexed: 12/24/2022] Open
Abstract
Background The globally dominant treatment with curative intent for locally advanced esophageal squamous cell carcinoma (ESCC) is neoadjuvant chemoradiotherapy (nCRT) with subsequent esophagectomy. This multimodal treatment leads to around 60% overall 5-year survival, yet with impaired post-surgical quality of life. Observational studies indicate that curatively intended chemoradiotherapy, so-called definitive chemoradiotherapy (dCRT) followed by surveillance of the primary tumor site and regional lymph node stations and surgery only when needed to ensure local tumor control, may lead to similar survival as nCRT with surgery, but with considerably less impairment of quality of life. This trial aims to demonstrate that dCRT, with selectively performed salvage esophagectomy only when needed to achieve locoregional tumor control, is non-inferior regarding overall survival, and superior regarding health-related quality of life (HRQOL), compared to nCRT followed by mandatory surgery, in patients with operable, locally advanced ESCC. Methods This is a pragmatic open-label, randomized controlled phase III, multicenter trial with non-inferiority design with regard to the primary endpoint overall survival and a superiority hypothesis for the experimental intervention dCRT with regard to the main secondary endpoint global HRQOL one year after randomization. The control intervention is nCRT followed by preplanned surgery and the experimental intervention is dCRT followed by surveillance and salvage esophagectomy only when needed to secure local tumor control. A target sample size of 1200 randomized patients is planned in order to reach 462 events (deaths) during follow-up. Clinical Trial Registration www.ClinicalTrials.gov, identifier: NCT04460352.
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Affiliation(s)
- Magnus Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
- *Correspondence: Magnus Nilsson,
| | - Halla Olafsdottir
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Thoracic Oncology Center, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Gabriella Alexandersson von Döbeln
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Thoracic Oncology Center, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Fernanda Villegas
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Giovanna Gagliardi
- Section of Radiotherapy Physics and Engineering, Department of Medical Radiation Physics and Nuclear Medicine, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Hellström
- Center for Clinical Cancer Studies, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Qiao-Li Wang
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Hemming Johansson
- Center for Clinical Cancer Studies, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW, Australia
| | - Jakob Hedberg
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Fredrik Klevebro
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Upper Abdominal Diseases, Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| | - Sheraz Markar
- Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeth Smyth
- Department of Oncology, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Pernilla Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | | | - Lars Cato Rekstad
- Department of Gastrointestinal Surgery, St. Olav’s Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Eirik Kjus Aahlin
- Department of GI and HPB Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Bengt Wallner
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - David Edholm
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
| | - Jan Johansson
- Department of Surgery, Skåne University Hospital, Lund, Sweden
| | - Eva Szabo
- Department of Surgery, University Hospital of Örebro, Örebro, Sweden
| | - John V. Reynolds
- Department of Surgery, Trinity St James’s Cancer Institute, Dublin, Ireland
| | - CS Pramesh
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Naveen Mummudi
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Amit Joshi
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Lorenzo Ferri
- Department of Thoracic Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - Rebecca KS Wong
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Jelena Lukovic
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Toronto, ON, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Kelvin KW Chan
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Trevor Leong
- Sir Peter MacCallum Department of Oncology, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Barbour
- Academy of Surgery, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Mark Smithers
- Academy of Surgery, University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Yin Li
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaozheng Kang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng-Ming Kong
- Thoracic Oncology Center, HKU Shenzhen Hospital, Hong Kong University Li Ka Shing Medical School, Shenzhen, China
| | - Yin-Kai Chao
- Department of thoracic surgery, Chang Gung Memorial Hospital-Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Tom Crosby
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, United Kingdom
| | - Christiane Bruns
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Hanneke van Laarhoven
- Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Mark van Berge Henegouwen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | | | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Rafaele Hospital, Vita Salute University, Milan, Italy
| | - Guillaume Piessen
- Univ. Lille, CNRS, Inserm, CHU Lille, UMR9020-U1277 - CANTHER – Cancer Heterogeneity Plasticity and Resistance to Therapies, F-59000 Lille, France
| | | | - Florian Lordick
- University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
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Maharaj AD, Evans SM, Ioannou LJ, Croagh D, Earnest A, Holland JF, Pilgrim CHC, Neale RE, Goldstein D, Kench JG, Merrett ND, White K, Burmeister EA, Evans PM, Hayes TM, Houli N, Knowles B, Leong T, Nikfarjam M, Philip J, Quinn M, Shapiro J, Smith MD, Spillane JB, Wong R, Zalcberg JR. The association between quality care and outcomes for a real-world population of Australian patients diagnosed with pancreatic cancer. HPB (Oxford) 2022; 24:950-962. [PMID: 34852933 DOI: 10.1016/j.hpb.2021.11.005] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/14/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study: (i) assessed compliance with a consensus set of quality indicators (QIs) in pancreatic cancer (PC); and (ii) evaluated the association between compliance with these QIs and survival. METHODS Four years of data were collected for patients diagnosed with PC. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). A multivariable analysis tested the relationship between significant patient and hospital characteristics, patient cluster effects within hospitals and survival. RESULTS 1061 patients were eligible for this study. Significant association with improved survival were: (i) in the potentially resectable group having adjuvant chemotherapy administered following surgery or a reason documented (HR, 0.29; 95 CI, 0.19-0.46); (ii) in the locally advanced group included having chemotherapy ± chemoradiation, or a reason documented for not undergoing treatment (HR, 0.38; 95 CI, 0.25-0.58); and (iii) in the metastatic disease group included having documented performance status at presentation (HR, 0.65; 95 CI, 0.47-0.89), being seen by an oncologist in the absence of treatment (HR, 0.48; 95 CI, 0.31-0.77), and disease management discussed at a multidisciplinary team meeting (HR, 0.79; 95 CI, 0.64-0.96). CONCLUSION Capture of a concise data set has enabled quality of care to be assessed.
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Affiliation(s)
- Ashika D Maharaj
- School of Public Health and Preventative Medicine, Monash University, Victoria, Australia
| | - Sue M Evans
- School of Public Health and Preventative Medicine, Monash University, Victoria, Australia
| | - Liane J Ioannou
- School of Public Health and Preventative Medicine, Monash University, Victoria, Australia
| | | | - Arul Earnest
- School of Public Health and Preventative Medicine, Monash University, Victoria, Australia
| | - Jennifer F Holland
- School of Public Health and Preventative Medicine, Monash University, Victoria, Australia
| | | | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Queensland, Australia
| | - David Goldstein
- Nelune Comprehensive Cancer Centre, New South Wales, Australia
| | - James G Kench
- Royal Prince Alfred Hospital, New South Wales, Australia
| | - Neil D Merrett
- School of Medicine, Western Sydney University, New South Wales, Australia
| | - Kate White
- Sydney Nursing School, University of Sydney, New South Wales, Australia
| | | | | | | | | | | | - Trevor Leong
- Peter MacCallum Cancer Centre, Victoria, Australia
| | | | | | - Maddy Quinn
- School of Public Health and Preventative Medicine, Monash University, Victoria, Australia
| | | | | | | | - Rachel Wong
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | - John R Zalcberg
- School of Public Health and Preventative Medicine, Monash University, Victoria, Australia; Alfred Health, Victoria, Australia.
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Marinelli B, Goldman D, Sharma H, Leong T, Bishay V, Garcia-Reyes K, Shilo D, Kim E, Nowakowski S, Fischman A, Lookstein R, Patel R. Abstract No. 187 Safety and feasibility of “gun-sight technique” for complex transjugular intrahepatic portosystemic shunt (TIPS) creation: single-center retrospective study of 98 interventions. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.268] [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: 11/29/2022] Open
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Wang J, Prabhakaran S, Larach T, Warrier SK, Bednarski BK, Ngan SY, Leong T, Rodriguez-Bigas M, Peacock O, Chang G, Heriot AG, Kong JCH. Treatment strategies for locally recurrent rectal cancer. Eur J Surg Oncol 2022; 48:2292-2298. [DOI: 10.1016/j.ejso.2022.05.011] [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: 10/19/2021] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022] Open
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Nguyen M, Segelov E, Goldstein D, Pavlakis N, Shapiro J, Price TJ, Nagrial A, Chantrill L, Leong T, Chen J, Burge M, Karapetis CS, Chau I, Lordick F, Renouf D, Tebbutt N, Roy AC. Update on optimal management for pancreatic cancer: expert perspectives from members of the Australasian Gastrointestinal Trials Group (AGITG) with invited international faculty. Expert Rev Anticancer Ther 2022; 22:39-51. [PMID: 34739362 DOI: 10.1080/14737140.2022.2002689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 10/28/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Pancreatic cancer remains a challenging malignancy due to the high proportion of patients diagnosed at advanced stages and the limited treatment options. This article discusses recent evidence in the management of both localized and advanced pancreatic cancer and offers an expert opinion on current best practice. AREAS COVERED For patients with localized disease, the evidence for adjuvant chemotherapy is discussed as well as emerging neoadjuvant approaches for resectable, borderline resectable, and locally advanced disease. Advances in metastatic disease are discussed including cytotoxic chemotherapy, targeted therapies, and the role of genomic testing to identify patients with molecular alterations. Reviewed literature included journal publications, abstracts presented at major international oncology meetings, and ongoing clinical trials databases. EXPERT OPINION Pancreatic cancer is a devastating diagnosis and despite recent advances has a very poor prognosis. Only a minority of patients, 20%, are diagnosed with potentially curable disease. The shifting paradigm toward neoadjuvant therapy may improve resectability and survival rates; however, robust evidence is required. Thus far, there has only been limited progress in advanced stage disease. Genomic testing may potentially identify more treatment targets although limited to small subgroups.
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Affiliation(s)
- Mike Nguyen
- Department of Medical Oncology, School of Clinical Sciences, Monash University and Monash Health, Melbourne, Australia
| | - Eva Segelov
- Department of Medical Oncology, School of Clinical Sciences, Monash University and Monash Health, Melbourne, Australia
| | - David Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, University of NSW, Sydney, Australia
| | - Nick Pavlakis
- Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, Sydney, Australia
| | | | - Timothy J Price
- Department of Haematology and Oncology, The Queen Elizabeth Hospital/University of Adelaide, Adelaide, Australia
| | - Adnan Nagrial
- Department of Medical Oncology, Westmead & Blacktown Hospitals, University of Sydney, Sydney, Australia
| | - Lorraine Chantrill
- Department Medical Oncology, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Australia
| | - Trevor Leong
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, The University of Melbourne, Melbourne, Australia
| | - John Chen
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Australia
| | - Matt Burge
- Department of Cancer Care Services, Royal Brisbane Hospital, University of Queensland, Herston, Australia
| | - Christos S Karapetis
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Australia
| | - Ian Chau
- Department of Medicine, Royal Marsden Hospital, Institute of Cancer Research, Surrey, London, UK
| | - Florian Lordick
- University Cancer Center Leipzig and Department of Oncology, Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Daniel Renouf
- Department of Medical Oncology, BC Cancer. Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Niall Tebbutt
- Department of Medical Oncology, Olivia Newton-John Cancer Wellness and Research Centre. Austin Health, Heidelberg, Australia
| | - Amitesh C Roy
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, Australia
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Ng SP, Ngan SY, Leong T. Current State of Neoadjuvant Radiotherapy for Rectal Cancer. Clin Colorectal Cancer 2021; 21:63-70. [PMID: 34852972 DOI: 10.1016/j.clcc.2021.10.008] [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] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 11/11/2022]
Abstract
Colorectal cancer is the third most commonly diagnosed cancer, with rectal cancer accounting for 30% of cases. The current standard of care curative treatment for locally advanced rectal cancer is (chemo)radiotherapy followed by surgery and adjuvant chemotherapy. Although neoadjuvant radiotherapy has reduced the risk of local recurrence to less than 10%, the risk of distant metastasis remained high at 30% affecting patient survival. In addition, there is a recognition that there is heterogeneity in tumor biology and treatment response with good responders potentially suitable for treatment de-escalation. Therefore, new treatment sequencing and regimens were investigated. Here, we reviewed the evidence for current neoadjuvant treatment options in patients with locally advanced rectal adenocarcinoma, and highlight the new challenges in this new treatment landscape.
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Affiliation(s)
- Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Australia; School of Molecular Sciences, La Trobe University, Melbourne, Australia; Department of Surgery, The University of Melbourne, Melbourne, Australia.
| | - Samuel Y Ngan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Trevor Leong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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11
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Lukovic J, Moore A, Lee M, Willis D, Ahmed S, Akra M, Hortobagyi E, Joon D, Kron T, Liu Z, Ryan J, Thomas M, Wall K, Ward I, Wiltshire K, O'Callaghan C, Wong R, Ringash J, Haustermans K, Leong T. The Feasibility of Quality Assurance in the TOPGEAR International Phase III Clinical Trial of Neoadjuvant Chemoradiotherapy for Gastric Cancer (An Intergroup Trial of the AGITG/TROG/EORTC/CCTG). Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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12
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Sia J, Mou W, Agas RA, Xie J, Burns M, Varghayee N, Chu J, Heriot A, Leong T, Ngan SY. Long-term Patterns of Failure and the Value of Blood Prognostic Markers in Anal Cancers Treated With Intensity-Modulated Radiation Therapy. Clin Colorectal Cancer 2021; 21:e102-e112. [PMID: 34799240 DOI: 10.1016/j.clcc.2021.10.005] [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] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/30/2021] [Accepted: 10/19/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND To analyze the long-term outcomes and prognostic value of hematological parameters in anal cancer patients receiving intensity-modulated radiation therapy (IMRT). MATERIALS Hospital records of consecutive patients with anal squamous cell carcinoma who received curative-intent IMRT according to a standardized contouring protocol between 2010 and 2020 were reviewed. Locoregional failure-free survival (LRFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) were estimated using the Kaplan-Meier method. Coverage of locoregional recurrences by the initial IMRT volumes were assessed. The prognostic value of pretreatment blood counts for PFS and OS were determined using Cox regression analysis. RESULTS A total of 166 patients were analyzed with a median follow-up of 3.3 years. Forty-six percent and 54% of patients had Stage I-II and IIIA-B cancers, respectively. The 5-year LRFS, DMFS, PFS and OS were 81%, 89%, 65% and 76% respectively. Grade ≥ 3 toxicity occurred in 5% of patients. Of all patients who relapsed, 70% had only locoregional recurrence as first site of failure. Ninety percent of locoregional recurrences were in-field. Hemoglobin, neutrophil and platelet counts were associated with PFS on univariable analysis, but only cancer stage and p16 status remained prognostic on multivariable analysis. Patients with more advanced cancer stages also had higher baseline neutrophil counts. Performance status and neutrophil counts were prognostic for OS on multivariable analysis. CONCLUSION This study affirms the long-term efficacy and safety of IMRT. Treatment resistance, rather than radiation geographic miss, is a major issue underpinning locoregional recurrences. Pretreatment blood counts were not validated to be independently prognostic for disease recurrence.
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Affiliation(s)
- Joseph Sia
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir PeterMacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
| | - Wei Mou
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir PeterMacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Ryan Anthony Agas
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jing Xie
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mark Burns
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nahal Varghayee
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Julie Chu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alexander Heriot
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir PeterMacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Trevor Leong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir PeterMacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Samuel Y Ngan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir PeterMacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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13
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Al-Wahaibi K, Khan I, McAdam B, Leong T. The association between novel ST2, BNP, atrial fibrillation and heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background/Introduction
ST2, a novel marker of fibrosis has been proposed as a novel biomarker for heart failure. There is paucity of data suggesting its association with Atrial Fibrillation (AF), in particular, with regards to the its independent effect after adjustment for clinical factors and traditional biomarkers such as BNP. There is increasing evidence that inflammation and fibrosis are important players in the pathogenesis of AF, the most common arrhythmia that is associated with considerable morbidity.
Purpose
We sought to examine the association of ST2 with AF and its possible incremental value in combination with traditional biomarkers already used in routine clinical practice such as BNP.
Methods
Unselected patients presenting to a Cardiology service who had BNP for clinical reasons, concomitantly had ST2 sent. These patients included those with heart failure, acute coronary syndromes and AF, as well as patients attending cardioversion and cardiac catheterisation. The association between ST2, BNP and clinical factors was examined. ST2 was examined in tertiles as its distribution was highly skewed. Raised BNP was defined as usual (≥100 pg/ml).
Results
Of the 619 patients, the mean age was 69 years and 66% were male. The prevalence of co-morbidities were: Coronary heart disease - CHD (41%), Atrial Fibrillation – AF (30%), Heart Failure - HF (20%), Chronic Kidney Disease – CKD (23%). The mean eGFR was 68 ml/h and the mean LV ejection fraction was 55%. Both ST2 and BNP levels were significantly higher in patients with heart failure, CKD and AF. Mean levels of ST2 were (in ng/ml): HF vs no HF (65 vs. 38, p=0.0001) and in CKD vs. no CKD (49 vs. 41, p=0.001), CAD vs no CAD (43 vs. 42, p=0.3). Mean levels of BNP were (in pg/ml): HF vs no HF (579 vs. 131, p=0.0001), CKD vs. no CKD (379 vs. 173, p=0.0001), CAD vs. no CAD (239 vs. 206, p=0.5).
In patients with AF, levels of both ST2 and BNP were higher, as were their mean ages and prevalence of co-morbidities (see Table 1). Both ST2 and BNP correlated with AF (Pearson r=0.2, p<0.0001 for ST2 and r=0.5, p<0.0001 for BNP). There was also a graded association of ST2 with AF (15%, 33% and 40% across tertiles of ST2, p=0.0001).
Both ST2 and raised BNP were significant associated with AF in both univariable and multi-variable regression models, and remained independent predictors when adjusted for HF, CHD, LV EF and eGFR (Table 2, Model 2 – Relative risk ratio of AF with ST2 across tertiles 1.5, p0.005, and Odds ratio of AF with raised BNP 7.4, p<0.001). However, ST2 loses significance when BNP is added to the model in combination (Table 2 – Model 3).
Conclusions
Both ST2 and BNP are independent predictors of AF even after adjustment for heart failure and other clinical factors. When ST2 is used in combination with BNP, raised BNP appears to be a stronger predictor of AF than ST2.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Al-Wahaibi
- Hermitage Medical Clinic, Cardiology, Dublin, Ireland
| | - I Khan
- Hermitage Medical Clinic, Cardiology, Dublin, Ireland
| | - B McAdam
- Hermitage Medical Clinic, Cardiology, Dublin, Ireland
| | - T Leong
- Hermitage Medical Clinic, Cardiology, Dublin, Ireland
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14
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Ireland-Jenkin K, Fuller P, Alexiadis M, Pendlebury A, Hyde S, Grant P, Lamont J, Leong T, Newman M. Utility of FOXL2 mutation testing in differential diagnosis of adult granulosa cell tumour. Pathology 2021. [DOI: 10.1016/j.pathol.2021.05.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Sia J, Hagekyriakou J, Chindris I, Albarakati H, Leong T, Schlenker R, Keam SP, Williams SG, Neeson PJ, Johnstone RW, Haynes NM. Regulatory T Cells Shape the Differential Impact of Radiation Dose-Fractionation Schedules on Host Innate and Adaptive Antitumor Immune Defenses. Int J Radiat Oncol Biol Phys 2021; 111:502-514. [PMID: 34023423 DOI: 10.1016/j.ijrobp.2021.05.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/04/2021] [Accepted: 05/13/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE We examined how radiation dose per fraction (DPF) and total dose, as represented by biological effective dose (BED), can independently and differentially affect the immunomodulatory capacity of radiation therapy (RT). METHODS AND MATERIALS AT3-OVA mammary and MC38 colorectal tumors in C57BL/6 mice were irradiated with rationally selected dose-fractionation schedules, alone or with immune-modulating or -depleting agents. Tumor growth was monitored as a readout of therapeutic response. Flow cytometry and RNA sequencing of mouse tumors and analysis of transcriptomic data sets from irradiated human cancers were used to examine the immunomodulatory effects of the different radiation schedules. RESULTS In AT3-OVA tumors, radiation DPF rather than BED determined the ability of RT to evoke local antitumor CD8+ T cell responses and synergize with anti-PD-1 therapy. Natural killer cell-mediated control of irradiated tumors was more sensitive to radiation BED. Radiation-induced regulatory T cell (Treg) responses, which were detected in both mouse and human tumors, were a major factor underlying the differential activation of adaptive immunity by radiation DPF and the activity of natural killer cells during the early phase of response to RT. Targeted inhibition of Treg responses within irradiated tumors rescued and enhanced local tumor control by RT and permitted the generation of abscopal and immunologic memory responses, irrespective of radiation schedule. MC38 tumors did not support the induction of an amplified Treg response to RT and were highly vulnerable to its immunoadjuvant effects. CONCLUSIONS Local radiation-induced Treg responses are influenced by radiation schedule and tumor type and are a critical determinant of the immunoadjuvant potential of RT and its ability to synergize with T cell-targeted immunotherapy.
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Affiliation(s)
- Joseph Sia
- Translational Hematology Program, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Radiation Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jim Hagekyriakou
- Physical Sciences Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ioana Chindris
- Translational Hematology Program, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Hassan Albarakati
- Physical Sciences Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Trevor Leong
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Radiation Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ramona Schlenker
- Roche Pharmaceutical Research and Early Development, Roche Innovation Centre Munich, Penzberg, Germany
| | - Simon P Keam
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Tumour Suppression Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia; Cancer Immunology Research Program, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Scott G Williams
- Radiation Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Paul J Neeson
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia; Cancer Immunology Research Program, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ricky W Johnstone
- Translational Hematology Program, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Nicole M Haynes
- Translational Hematology Program, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia.
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16
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Kong JC, Soucisse M, Michael M, Tie J, Ngan SY, Leong T, McCormick J, Warrier SK, Heriot AG. Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review and Metaanalysis of Oncological and Operative Outcomes. Ann Surg Oncol 2021; 28:7476-7486. [PMID: 33891203 DOI: 10.1245/s10434-021-09837-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 02/24/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Total neoadjuvant therapy in rectal cancer refers to the administration of chemoradiotherapy plus chemotherapy before surgery. Recent studies have shown improved pathological complete response and disease-free survival with this approach. However, survival benefits remain unproven. Our objective is to present a metaanalysis of oncological outcomes of total neoadjuvant therapy in locally advanced rectal cancer. PATIENTS AND METHODS A comprehensive search was performed on PubMed, Medline, and Google Scholars. Studies comparing total neoadjuvant therapy with standard neoadjuvant chemoradiotherapy were included. Data extracted from the individual studies were pooled and a metaanalysis performed. The outcomes of interest are the rate of complete pathological response, nodal response, resection margin, anal preservation, anastomotic leak, local recurrence, distant recurrence, disease-free survival, and overall survival. RESULTS There were 15 comparative studies with 2437 patients in the neoadjuvant chemoradiotherapy group and 2284 in the total neoadjuvant therapy group. The pooled complete pathological response was 22.3% in the total neoadjuvant therapy group, compared with 14.2% in the standard neoadjuvant chemoradiotherapy group (p < 0.001). Even though there was no difference in local recurrence rate, there was a significantly lower rate of distant recurrence (OR 0.81, p = 0.02), and better 3-year disease-free survival (70.6% vs. 65.3%, respectively, p < 0.001) and overall survival (84.9% vs. 82.3%, respectively, p = 0.006), favoring the total neoadjuvant therapy group. Due to significant heterogeneity in the study protocols, there remains uncertainty on the ideal chemotherapy/radiotherapy sequence. CONCLUSIONS This study provides supporting evidence on the favorable immediate and intermediate oncological outcomes with the use of total neoadjuvant therapy for locally advanced rectal cancer.
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Affiliation(s)
- Joseph C Kong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. .,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.
| | - Mikael Soucisse
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael Michael
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jeanne Tie
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.,Division of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Samuel Y Ngan
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Trevor Leong
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Jacob McCormick
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Satish K Warrier
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Alexander G Heriot
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
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17
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Abstract
The only curative treatment for localised gastric cancer is surgical resection. However, survival outcomes post-surgery alone remain poor, particularly in those with node-positive disease with 5-year survival of approximately 30%. Therefore, additional perioperative treatment strategies such as radiotherapy and/or chemotherapy have been explored to improve survival outcomes. Early studies established the role of postoperative radiotherapy in improving locoregional control. However, there are now several adjuvant treatment options available, with many centres favouring perioperative chemotherapy. The delivery of radiotherapy in the postoperative setting can be challenging, thereby resulting in suboptimal patient compliance. Hence, the role of preoperative radiotherapy is currently being evaluated. This review focuses on and summarises the landmark clinical trials that have established the current role of radiation therapy in patients with resectable gastric and gastroesophageal adenocarcinoma, and highlights the potential for preoperative radiotherapy.
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Affiliation(s)
- Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Australia. .,School of Molecular Sciences, La Trobe University, Melbourne, Australia.
| | - Trevor Leong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum, Department of Oncology, The University of Melbourne, Melbourne, Australia
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18
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Best S, Hess J, Souza-Fonseca Guimaraes F, Cursons J, Kersbergen A, You Y, Ng J, Davis M, Leong T, Irving L, Ritchie M, Steinfort D, Huntington N, Sutherland K. FP10.02 Investigating the Immunophenotype of Small Cell Lung Cancer to Improve Immunotherapeutic Targeting. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.124] [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: 11/17/2022]
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19
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Lordick F, Nilsson M, Leong T. Adjuvant radiotherapy for gastric cancer-end of the road? Ann Oncol 2020; 32:287-289. [PMID: 33321194 DOI: 10.1016/j.annonc.2020.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- F Lordick
- Department of Oncology, Gastroenterology, Hepatology, Pulmonology, and Infectious Diseases, University Cancer Center Leipzig (UCCL), University of Leipzig Medical Center, Leipzig, Germany.
| | - M Nilsson
- Division of Surgery, Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm; Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - T Leong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
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20
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Maharaj AD, Evans SM, Zalcberg JR, Ioannou LJ, Graco M, Croagh D, Pilgrim CHC, Dodson T, Goldstein D, Philip J, Kench JG, Merrett ND, Neale RE, White K, Evans P, Leong T, Green SE. Barriers and enablers to the implementation of multidisciplinary team meetings: a qualitative study using the theoretical domains framework. BMJ Qual Saf 2020; 30:792-803. [PMID: 33247002 DOI: 10.1136/bmjqs-2020-011793] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/18/2020] [Accepted: 10/29/2020] [Indexed: 02/06/2023]
Abstract
BackgroundEvidence-based clinical practice guidelines recommend discussion by a multidisciplinary team (MDT) to review and plan the management of patients for a variety of cancers. However, not all patients diagnosed with cancer are presented at an MDT.Objectives(1) To identify the factors (barriers and enablers) influencing presentation of all patients to, and the perceived value of, MDT meetings in the management of patients with pancreatic cancer and; (2) to identify potential interventions that could overcome modifiable barriers and enhance enablers using the theoretical domains framework (TDF).MethodsSemistructured interviews were conducted with radiologists, surgeons, medical and radiation oncologists, gastroenterologists, palliative care specialists and nurse specialists based in New South Wales and Victoria, Australia. Interviews were conducted either in person or via videoconferencing. All interviews were recorded, transcribed verbatim, deidentified and data were thematically coded according to the 12 domains explored within the TDF. Common belief statements were generated to compare the variation between participant responses.ResultsIn total, 29 specialists were interviewed over a 4-month period. Twenty-two themes and 40 belief statements relevant to all the TDF domains were generated. Key enablers influencing MDT practices included a strong organisational focus (social/professional role and identity), beliefs about the benefits of an MDT discussion (beliefs about consequences), the use of technology, for example, videoconferencing (environmental context and resources), the motivation to provide good quality care (motivation and goals) and collegiality (social influences). Barriers included: absence of palliative care representation (skills), the number of MDT meetings (environmental context and resources), the cumulative cost of staff time (beliefs about consequences), the lack of capacity to discuss all patients within the allotted time (beliefs about capabilities) and reduced confidence to participate in discussions (social influences).ConclusionsThe internal and external organisational structures surrounding MDT meetings ideally need to be strengthened with the development of agreed evidence-based protocols and referral pathways, a focus on resource allocation and capabilities, and a culture that fosters widespread collaboration for all stages of pancreatic cancer.
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21
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Ng SP, Chu J, Chander S, Bressel M, McKendrick J, Wong R, Steel M, Murray WK, Leong T, Heriot A, Michael M, Ngan SY. Results of phase II trial of intensified neoadjuvant treatment with interdigitating radiotherapy and chemotherapy with oxaliplatin, 5-fluorouracil and folinic acid in patients with locally advanced rectal cancer (PROARCT trial). Radiother Oncol 2020; 155:27-32. [PMID: 33065186 DOI: 10.1016/j.radonc.2020.10.012] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The chemotherapy exposure during chemoradiotherapy for rectal cancer is adequate for radiosensitization but suboptimal for treatment of distant micrometastasis. This study aimed to determine tolerability, dose intensity, response, and toxicity of a novel intensified neoadjuvant treatment approach. MATERIALS AND METHODS Eligible patients were MRI-staged T3-4NxM0 rectal adenocarcinoma. Treatment consisted of FOLFOX chemotherapy given in weeks 1, 6, and 11 with pelvic radiotherapy (25.2 Gy in 3 weeks in 1.8 Gy/fraction with oxaliplatin and 5-FU continuous infusion) given in weeks 3-5, and weeks 8-10. Surgery was performed 4-6 weeks later. The primary endpoint was tolerability defined as the percentage of patients who were able to complete the planned treatment course. Survival rates were estimated using the Kaplan-Meier method. RESULTS Median age of the 40 patients was 61.5 years. Rectal MRI-stage was T3 in 88%. Overall, 95% completed the regimen. All patients received 50.4 Gy. Relative dose intensity (≥75%) was 92% and 98% for oxaliplatin and 5-FU, respectively. High grade toxicities included neutropenia (25% grade 3; 7.5% grade 4) and diarrhoea (10%). Pathologic CR rate was 20%. Median follow-up was 54 months. The 5-year overall survival, freedom from relapse, locoregional control, and freedom from distant metastasis of the cohort was 82%, 72%, 97% and 72%. CONCLUSIONS Delivery of intensified neoadjuvant treatment with interdigitating chemotherapy and radiotherapy is feasible with no increase in acute perioperative complications. A larger prospective study is required to further evaluate the potential survival benefit of this design.
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Affiliation(s)
- Sweet Ping Ng
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Australia.
| | - Julie Chu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sarat Chander
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Joseph McKendrick
- Department of Medical Oncology, Eastern Health, Box Hill Hospital, Australia
| | - Rachel Wong
- Department of Medical Oncology, Eastern Health, Box Hill Hospital, Australia; Monash University, Eastern Health Clinical School, Box Hill, Australia
| | - Malcolm Steel
- Department of Colorectal Surgery, Box Hill Hospital, Melbourne, Australia
| | - William K Murray
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Trevor Leong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Alexander Heriot
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Michael Michael
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Australia
| | - Samuel Y Ngan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
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Savitz S, Leong T, Sung S, Lee K, Rana J, Tabada G, Go A. Novel Data Domains and Machine Learning Modestly Improved Performance of Risk Calculators for Heart Failure Readmission. Health Serv Res 2020. [DOI: 10.1111/1475-6773.13449] [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] [Indexed: 11/27/2022] Open
Affiliation(s)
- S. Savitz
- Kaiser Permanente Division of Research Oakland CA USA
| | - T. Leong
- Kaiser Permanente Division of Research Oakland CA USA
| | - S.H. Sung
- Kaiser Permanente Division of Research Oakland CA USA
| | - K. Lee
- The Permanente Medical Group Oakland CA USA
| | - J. Rana
- The Permanente Medical Group Oakland CA USA
| | - G. Tabada
- Kaiser Permanente Division of Research Oakland CA USA
| | - A. Go
- Kaiser Permanente Division of Research Oakland CA USA
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Kihira S, Koo C, Mahmoudi K, Leong T, Mei X, Rigney B, Aggarwal A, Doshi AH. Combination of Imaging Features and Clinical Biomarkers Predicts Positive Pathology and Microbiology Findings Suggestive of Spondylodiscitis in Patients Undergoing Image-Guided Percutaneous Biopsy. AJNR Am J Neuroradiol 2020; 41:1316-1322. [PMID: 32554421 DOI: 10.3174/ajnr.a6623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/23/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Pathology and microbiology results for suspected spondylodiscitis on MR imaging are often negative in up to 70% of cases. We aimed to predict whether MR imaging features will add diagnostic value when combined with clinical biomarkers to predict positive findings of spondylodiscitis on pathology and/or microbiology from percutaneous biopsy. MATERIALS AND METHODS In this retrospective single-center institutional review board-approved study, patients with radiologically suspected spondylodiscitis and having undergone percutaneous biopsies were assessed. Demographic characteristics, laboratory values, and tissue and blood cultures were collected. Pathology and microbiology results were used as end points. Three independent observers provided MR imaging-based scoring for typical MR imaging features for spondylodiscitis. Multivariate logistic regression and receiver operating characteristic analysis were performed to determine an optimal combination of imaging and clinical biomarkers in predicting positive findings on pathology and/or microbiology from percutaneous biopsy suggestive of spondylodiscitis. RESULTS Our patient cohort consisted of 72 patients, of whom 33.3% (24/72) had spondylodiscitis. The mean age was 63 ± 16 years with a male/female ratio of 41:31. Logistic regression revealed a combination with an area under the curve of 0.72 for pathology and 0.68 for pathology and/or microbiology. Epidural enhancement on MR imaging improved predictive performance to 0.87 for pathology and 0.78 for pathology and/or microbiology. CONCLUSIONS Our findings demonstrate that epidural enhancement on MR imaging added diagnostic value when combined with clinical biomarkers to help predict which patients undergoing percutaneous biopsy will have positive findings for spondylodiscitis on pathology and/or microbiology.
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Affiliation(s)
- S Kihira
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - C Koo
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - K Mahmoudi
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - T Leong
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - X Mei
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - B Rigney
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - A Aggarwal
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - A H Doshi
- From the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York.
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24
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Maharaj AD, Samoborec S, Evans SM, Zalcberg J, Neale RE, Goldstein D, Merrett N, White K, Croagh D, Pilgrim CHC, Evans P, Knowles B, Leong T, Philip J, Smith M, Ioannou L. Patient-reported outcome measures (PROMs) in pancreatic cancer: a systematic review. HPB (Oxford) 2020; 22:187-203. [PMID: 31635959 DOI: 10.1016/j.hpb.2019.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 09/02/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The aim of this systematic review is to examine patient-reported outcome measures (PROMs), their attributes and application in patients with pancreatic cancer (PC). METHOD A systematic literature search was undertaken of articles published to June 2018 to identify PROMs applied in primary studies in PC. Characteristics of the included studies and PROMs were described with identified scales grouped into five domains. The psychometric properties of the identified PROMs were further assessed for reliability and validity among patients with PC. RESULTS From 1688 studies screened, 170 were included. Almost half (48%) were conducted in patients with unresectable PC; the majority of these (68%) were evaluated in randomized controlled trials. Median questionnaire completion rates fell below 10% of the original cohort within 12 months in patients with unresectable PC compared to 75% in patients with resectable PC. Seventy PROMs were identified, 32 measuring unidimensional parameters (e.g. pain) and 35 measuring multidimensional (e.g. quality of life) constructs. Only five (7%) PROMs were disease-specific and 13 (19%) were validated in patients with PC. Fifty scales were grouped into 19 physical, 9 psychological, 6 psychiatric, 9 social and 7 other domains. CONCLUSION Three multidimensional PROMs, the: (i) FACT-HEP in unresectable PC; (ii) QLQ-PAN26 (in conjunction with its core QLQ-C30 PROM) in resectable PC; and (iii) MDASI-GI are recommended as instruments to capture quality of life in patients with PC. Summarised scales and psychometric evaluation provide a framework to choose PROMs for scales not captured by the recommended PROMs.
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Affiliation(s)
| | | | - Sue M Evans
- Monash University, Melbourne, VIC, Australia
| | | | - Rachel E Neale
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | - Neil Merrett
- Western Sydney University, Penrith, NSW, Australia
| | - Kate White
- University of Sydney, Camperdown, NSW, Australia
| | - Daniel Croagh
- Monash University, Melbourne, VIC, Australia; Monash Health, Clayton, VIC, Australia; Epworth HealthCare, Richmond, VIC, Australia
| | - Charles H C Pilgrim
- Monash University, Melbourne, VIC, Australia; Peninsula Private Hospital, Melbourne, VIC, Australia; Alfred Health, Melbourne, VIC, Australia; Cabrini Health, Malvern, VIC, Australia; Peninsula Health, Frankston, VIC, Australia
| | - Peter Evans
- Monash University, Melbourne, VIC, Australia; Cabrini Health, Malvern, VIC, Australia
| | - Brett Knowles
- Royal Melbourne Hospital, Parkville, VIC, Australia; St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Trevor Leong
- Monash University, Melbourne, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia
| | - Jennifer Philip
- Royal Melbourne Hospital, Parkville, VIC, Australia; St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; University of Melbourne, Parkville, VIC, Australia; Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
| | - Marty Smith
- Alfred Health, Melbourne, VIC, Australia; Cabrini Health, Malvern, VIC, Australia
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Clark J, Lokan J, Fellowes A, Xu H, Smith K, Gan H, Cher L, Desai J, Leong T, Fox S. 51. Adult brainstem anaplastic astrocytoma with an unusual molecular profile. Pathology 2020. [DOI: 10.1016/j.pathol.2020.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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26
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Koh T, Ong W, Leong T, Lapuz C, Lim A. P1.17-17 Outcomes Following Stereotactic Body Radiotherapy (SBRT) for Biopsy-Confirmed vs. Radiologically-Diagnosed Primary Lung Cancer. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1291] [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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27
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Maharaj AD, Holland JF, Scarborough RO, Evans SM, Ioannou LJ, Brown W, Croagh DG, Pilgrim CHC, Kench JG, Lipton LR, Leong T, McNeil JJ, Nikfarjam M, Aly A, Burton PR, Cashin PA, Chu J, Duong CP, Evans P, Goldstein D, Haydon A, Hii MW, Knowles BPF, Merrett ND, Michael M, Neale RE, Philip J, Porter IWT, Smith M, Spillane J, Tagkalidis PP, Zalcberg JR. The Upper Gastrointestinal Cancer Registry (UGICR): a clinical quality registry to monitor and improve care in upper gastrointestinal cancers. BMJ Open 2019; 9:e031434. [PMID: 31575580 PMCID: PMC6773358 DOI: 10.1136/bmjopen-2019-031434] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [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] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The Upper Gastrointestinal Cancer Registry (UGICR) was developed to monitor and improve the quality of care provided to patients with upper gastrointestinal cancers in Australia. PARTICIPANTS It supports four cancer modules: pancreatic, oesophagogastric, biliary and primary liver cancer. The pancreatic cancer (PC) module was the first module to be implemented, with others being established in a staged approach. Individuals are recruited to the registry if they are aged 18 years or older, have received care for their cancer at a participating public/private hospital or private clinic in Australia and do not opt out of participation. FINDINGS TO DATE The UGICR is governed by a multidisciplinary steering committee that provides clinical governance and oversees clinical working parties. The role of the working parties is to develop quality indicators based on best practice for each registry module, develop the minimum datasets and provide guidance in analysing and reporting of results. Data are captured from existing data sources (population-based cancer incidence registries, pathology databases and hospital-coded data) and manually from clinical records. Data collectors directly enter information into a secure web-based Research Electronic Data Capture (REDCap) data collection platform. The PC module began with a pilot phase, and subsequently, we used a formal modified Delphi consensus process to establish a core set of quality indicators for PC. The second module developed was the oesophagogastric cancer (OGC) module. Results of the 1 year pilot phases for PC and OGC modules are included in this cohort profile. FUTURE PLANS The UGICR will provide regular reports of risk-adjusted, benchmarked performance on a range of quality indicators that will highlight variations in care and clinical outcomes at a health service level. The registry has also been developed with the view to collect patient-reported outcomes (PROs), which will further add to our understanding of the care of patients with these cancers.
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Affiliation(s)
- Ashika D Maharaj
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jennifer F Holland
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ri O Scarborough
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sue M Evans
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Liane J Ioannou
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Wendy Brown
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | | | | | - James G Kench
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | - Trevor Leong
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - John J McNeil
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mehrdad Nikfarjam
- Department of Surgery, Austin Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ahmad Aly
- Austin Health, Melbourne, Victoria, Australia
| | - Paul R Burton
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | | | - Julie Chu
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Cuong P Duong
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Evans
- Peninsula Health, Melbourne, Victoria, Australia
| | - David Goldstein
- Nelune Comprehensive Cancer Centre, Prince of Wales, Randwick, New South Wales, Australia
| | | | - Michael W Hii
- St Vincent's Hospital, Melbourne, Victoria, Australia
| | | | - Neil D Merrett
- School of Medicine, Western Sydney University, Penrith South, New South Wales, Australia
| | - Michael Michael
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rachel E Neale
- Population Health Division, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | | | | | - Marty Smith
- Alfred Health, Melbourne, Victoria, Australia
| | - John Spillane
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | - John R Zalcberg
- Public Health and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
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Yin X, Mason J, Lobachevsky PN, Munforte L, Selbie L, Ball DL, Martin RF, Leong T, Siva S, Martin OA. Radiation Therapy Modulates DNA Repair Efficiency in Peripheral Blood Mononuclear Cells of Patients With Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2019; 103:521-531. [DOI: 10.1016/j.ijrobp.2018.10.001] [Citation(s) in RCA: 6] [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] [Received: 04/22/2018] [Revised: 09/18/2018] [Accepted: 10/01/2018] [Indexed: 10/28/2022]
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Ngan D, Chu J, Chander S, Michael M, Heriot AG, Ngan SY, Rischin D, Leong T. A clinical trial with protracted infusion 5-fluorouracil and mitomycin C for localized squamous cell carcinoma of the anus. Asia Pac J Clin Oncol 2018; 15:75-81. [PMID: 30536770 DOI: 10.1111/ajco.13106] [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] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/27/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Mitomycin C (MMC) plus standard 5-fluorouracil (FU) infusion in weeks 1 and 5 often contributes to radiotherapy interruptions and possibly less-than-ideal outcomes in anal cancer. This study was to evaluate alternative strategies for chemotherapy delivery that might be less toxic or more efficacious, and outcomes of patient-initiated treatment interruption for severe acute toxicity. MATERIALS AND METHODS This was a prospective, nonrandomized study for patients with T1-4N0-3M0 anal squamous carcinoma. Radiotherapy of 54 Gy in 30 fractions over 6 weeks was given with infusion FU 300 mg/m2 /day for 96 hours/week for 6 weeks plus bolus MMC at 10 mg/m2 on D1. RESULTS Fifty patients were recruited (72% female). Median age was 60.5 years (35-84). Forty-seven patients (94%) received 54 Gy. Median duration of chemoradiation was 39 days (37-105). Grade 3 and 4 acute toxicity were observed in 66%. Thirty-one percent with severe acute toxicity developed severe late toxicity. Of those who experienced severe late skin toxicity, 29% did not have severe acute toxicity. Disease-free survival at 5 years was 74% (95% confidence interval [CI], 60-84), and at 9 years 61% (95% CI, 46-74). Overall survival at 5 years was 84% (95% CI, 71-92), and at 9 years 67% (95% CI, 50-81). Colostomy-free survival at 5 years was 70% (95% CI, 56-81), and at 9 years 57% (95% CI, 40-72). CONCLUSION It is feasible to deliver chemoradiation with bolus MMC and protracted infusion FU for anal cancer. Efficacy and toxicity of this regimen seem similar to conventional chemoradiation with FU/MMC. Acute skin toxicity is not a reliable predictor of severe late skin toxicity.
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Affiliation(s)
- David Ngan
- Royal Adelaide Hospital, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Julie Chu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Sarat Chander
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Michael Michael
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Alexander G Heriot
- Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Samuel Y Ngan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Trevor Leong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Chen X, Gaglione R, Leong T, Bednor L, de los Santos T, Luk E, Airola M, Hollingsworth NM. Mek1 coordinates meiotic progression with DNA break repair by directly phosphorylating and inhibiting the yeast pachytene exit regulator Ndt80. PLoS Genet 2018; 14:e1007832. [PMID: 30496175 PMCID: PMC6289461 DOI: 10.1371/journal.pgen.1007832] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/11/2018] [Accepted: 11/13/2018] [Indexed: 02/02/2023] Open
Abstract
Meiotic recombination plays a critical role in sexual reproduction by creating crossovers between homologous chromosomes. These crossovers, along with sister chromatid cohesion, connect homologs to enable proper segregation at Meiosis I. Recombination is initiated by programmed double strand breaks (DSBs) at particular regions of the genome. The meiotic recombination checkpoint uses meiosis-specific modifications to the DSB-induced DNA damage response to provide time to convert these breaks into interhomolog crossovers by delaying entry into Meiosis I until the DSBs have been repaired. The meiosis-specific kinase, Mek1, is a key regulator of meiotic recombination pathway choice, as well as being required for the meiotic recombination checkpoint. The major target of this checkpoint is the meiosis-specific transcription factor, Ndt80, which is essential to express genes necessary for completion of recombination and meiotic progression. The molecular mechanism by which cells monitor meiotic DSB repair to allow entry into Meiosis I with unbroken chromosomes was unknown. Using genetic and biochemical approaches, this work demonstrates that in the presence of DSBs, activated Mek1 binds to Ndt80 and phosphorylates the transcription factor, thus inhibiting DNA binding and preventing Ndt80's function as a transcriptional activator. Repair of DSBs by recombination reduces Mek1 activity, resulting in removal of the inhibitory Mek1 phosphates. Phosphorylation of Ndt80 by the meiosis-specific kinase, Ime2, then results in fully activated Ndt80. Ndt80 upregulates transcription of its own gene, as well as target genes, resulting in prophase exit and progression through meiosis.
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Affiliation(s)
- Xiangyu Chen
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, United States of America
| | - Robert Gaglione
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, United States of America
| | - Trevor Leong
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, United States of America
| | - Lauren Bednor
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, United States of America
| | - Teresa de los Santos
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, United States of America
| | - Ed Luk
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, United States of America
| | - Michael Airola
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, United States of America
| | - Nancy M. Hollingsworth
- Department of Biochemistry and Cell Biology, Stony Brook University, Stony Brook, New York, United States of America
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Guidos PJ, Arlen AM, Leong T, Bonnett MA, Cooper CS. Impact of continuous low-dose antibiotic prophylaxis on growth in children with vesicoureteral reflux. J Pediatr Urol 2018; 14:325.e1-325.e7. [PMID: 30181099 DOI: 10.1016/j.jpurol.2018.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/12/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Continuous antibiotic prophylaxis (CAP) is a mainstay of treatment for children with vesicoureteral reflux (VUR). There has been an increasing focus on the effect of antibiotics on gut microbiota and subsequent repercussions on growth. Continuous antibiotic prophylaxis is generally considered safe; however, its impact on growth in children with VUR remains unknown. OBJECTIVE This objective of this study was to determine whether CAP altered height, weight, or body mass index (BMI) in children with VUR. STUDY DESIGN Children diagnosed with primary VUR were identified. Demographics including weight and height percentiles, BMI and BMI percentiles, age, gender, antibiotic class, prior antibiotic use, urinary tract infection history, and breakthrough infections were tested in univariate and multivariate analyses. Primary outcome was change in BMI as well as weight, height, and BMI percentiles. RESULTS One hundred eighty patients (146 girls, 34 boys) were prescribed CAP at mean age of 29.2 ± 26.2 months. Mean follow-up on CAP was 4.1 ± 3.3 years, with median follow-up of 3.08 years. Mean increase in weight percentile was 1.49 (2.02 males, 1.37 females; P = 0.46). Mean decrease in height percentile was -4.44 (-2.18 males, -4.95 females; P = 0.51). Age at diagnosis (P = 0.004) and history of prior treatment courses of antibiotics (P = 0.007) were associated with a significant BMI increase (Fig. 1). Body mass index percentile increased from 58.4 to 66.5; however, this increase was only significant in children aged above 1 year (P < 0.0001). Of note, children above 1 year of age were significantly more likely to have a history of prior treatment courses of antibiotics (58% vs 32%; P < 0.0001), and when controlling for prior antibiotic use, the increase in BMI percentile in those over 1 year of age did not reach significance. DISCUSSION The use of antibiotics has been associated with alterations in pediatric growth parameters in both animal models and clinical studies. However, little information exists on the impact of prophylactic-dosed antibiotics on growth. While this study is limited by the retrospective analysis and small sample size, it was found that the use of CAP did impact growth parameters, with a stronger effect seen in children who had received prior treatment courses of antibiotics before the infection leading to the initiation of CAP. CONCLUSION Continuous antibiotic prophylaxis was correlated with significant increase in BMI in children with prior antibiotic usage and a significant increase in BMI percentile in children aged above 1 year. Continuous antibiotic prophylaxis was also associated with decreased height percentiles, particularly in patients aged less than 1 year, though it did not reach statistical significance. Further analysis is needed to investigate whether these effects on weight, height, and BMI are persistent and clinically significant.
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Affiliation(s)
- P J Guidos
- Department of Urology and Pediatrics, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 3RCP, Iowa City, IA, 52242-1089, USA
| | - A M Arlen
- Department of Urology, Yale University, 789 Howard Avenue, New Haven, CT, 06520-8234, USA
| | - T Leong
- Biostatistics and Bioinformation, Rollins School of Public Health, Emory University School of Medicine, 1518 Clifton Rd. NE, Atlanta, GA, 30322, USA
| | - M A Bonnett
- Department of Urology and Pediatrics, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 3RCP, Iowa City, IA, 52242-1089, USA
| | - C S Cooper
- Department of Urology and Pediatrics, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 3RCP, Iowa City, IA, 52242-1089, USA.
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Herschtal A, Martin RF, Leong T, Lobachevsky P, Martin OA. A Bayesian Approach for Prediction of Patient Radiosensitivity. Int J Radiat Oncol Biol Phys 2018; 102:627-634. [PMID: 30244880 DOI: 10.1016/j.ijrobp.2018.06.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Revised: 05/14/2018] [Accepted: 06/24/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE A priori identification of the small proportion of radiation therapy patients who prove to be severely radiosensitive is a long-held goal in radiation oncology. A number of published studies indicate that analysis of the DNA damage response after ex vivo irradiation of peripheral blood lymphocytes, using the γ-H2AX assay to detect DNA damage, provides a basis for a functional assay for identification of the small proportion of severely radiosensitive cancer patients undergoing radiotherapy. METHODS AND MATERIALS We introduce a new, more rigorous, integrated approach to analysis of radiation-induced γ-H2AX response, using Bayesian statistics. RESULTS This approach shows excellent discrimination between radiosensitive and non-radiosensitive patient groups described in a previously reported data set. CONCLUSIONS Bayesian statistical analysis provides a more appropriate and reliable methodology for future prospective studies.
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Affiliation(s)
- Alan Herschtal
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Roger F Martin
- Research Division, Peter MacCallum Cancer Center, Melbourne, Australia; School of Chemistry, The University of Melbourne, Melbourne, Australia
| | - Trevor Leong
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Pavel Lobachevsky
- Research Division, Peter MacCallum Cancer Center, Melbourne, Australia
| | - Olga A Martin
- Research Division, Peter MacCallum Cancer Center, Melbourne, Australia; Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia.
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Balasubramanian A, Ireland-Jenkin K, McDonald A, Khor R, Yeo B, Leong T. Abstract P2-03-08: A retrospective study to identify the frequency of discordant HER2 results using both immunohistochemistry (IHC) and in-situ hybridization (ISH) assays. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-03-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
HER2 targeted therapies have substantially improved survival outcomes for patients with breast cancer and HER2 amplification of their tumour. The recently updated American Society of Clinical Oncology/College of American Pathologists (ASCO CAP) guidelines recommend that HER2 testing to be performed on all invasive breast cancers and that positive HER2 status is defined by either evidence of HER2 protein over-expression measured by immunohistochemistry status (IHC 3+) or by in-situ hybridisation (ISH) amplification. Equivocal results require further testing with the alternative assay.
In Australia, Medicare-funded access to HER2 targeted therapies requires demonstration of HER2 positivity by ISH, regardless of IHC status. Thus, currently most breast units perform IHC and ISH on all breast cancers. Given this discrepancy in practice and significant additional cost of performing ISH, this study evaluated the frequency of discordance and the cost burden in using both assays in a historical series of patients with breast cancer.
Methods
A retrospective audit of HER2 histopathology reports was performed for all breast cancers diagnosed between 2007 and 2016 at a single tertiary hospital in Melbourne, Australia (The Austin Hospital). HER2 IHC results were classified as negative (0 or 1+), equivocal (2+) or positive (3+). An analysis was performed to assess the proportion of concordant (defined as samples with IHC 0/1+ and negative ISH, samples with IHC3+ and positive ISH, and samples with IHC2+ regardless of ISH) and discordant results (defined as IHC 3+ and ISH non-amplified or IHC 0/1+ and ISH amplified). Tumour blocks and slides from discordant cases were reviewed by a breast cancer histopathologist. The cost of additional testing in concordant cases was performed based on the Australian Medicare Benefits Schedule (MBS).
Results
Eight hundred and forty-six histopathology reports were reviewed from 786 patients, all of whom had both IHC and ISH assays. There were 832 (98.8%) concordant cases. There were 10 discordant cases (1.2%) in total, including three cases (0.4%) with a negative IHC (1+) result but positive ISH, and 7 cases (0.8%) with a positive IHC but negative ISH result. A detailed analysis of 10 discordant cases will be presented. HER2 status and subsequent treatment remain unchanged with the addition of ISH testing in 665 (79.0%) cases, which amounted to an additional $209,741 (AUD) being spent on unnecessary ISH testing. Given an estimated incidence of 17,730 new cases of breast cancer per year in Australia, the population cost of performing additional HER2 ISH testing ($315.40 per case) in concordant cases would equate to $4.4 million (AUD) per year.
Conclusion
These results describe an extremely low rate of HER2 IHC/ISH discordance suggesting that routine use of both assays is unnecessary in cases with an unequivocal IHC result. The fiscal burden and potential delays to deciding treatment provide a strong rationale for access to HER2 targeted therapies to be based IHC or ISH, as advised by the ASCO CAP guidelines. Our results will be used to support a national review of IHC and ISH discordance using Australian national registry data.
Citation Format: Balasubramanian A, Ireland-Jenkin K, McDonald A, Khor R, Yeo B, Leong T. A retrospective study to identify the frequency of discordant HER2 results using both immunohistochemistry (IHC) and in-situ hybridization (ISH) assays [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-03-08.
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Affiliation(s)
- A Balasubramanian
- Austin Health, Melbourne, Victoria, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences
| | - K Ireland-Jenkin
- Austin Health, Melbourne, Victoria, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences
| | - A McDonald
- Austin Health, Melbourne, Victoria, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences
| | - R Khor
- Austin Health, Melbourne, Victoria, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences
| | - B Yeo
- Austin Health, Melbourne, Victoria, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences
| | - T Leong
- Austin Health, Melbourne, Victoria, Australia; Olivia Newton-John Cancer Research Institute, Melbourne, Victoria, Australia; University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences
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Pattison S, Leong T, Busuttil R, Boussioutas A. MAGEA family gene expression influences survival in intestinal gastric cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx660.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Leong T, Loveland P, Irving L, Steinfort D. MA 20.09 Accuracy & Utility of Systematic Mediastinal LN Staging via EBUS-TBNA in cN0/N1 NSCLC: Systematic Review & Meta-Analysis. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Leong T. Consolidation Chemoradiation Improves Local Control in Unresectable Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2017; 99:299. [DOI: 10.1016/j.ijrobp.2017.05.033] [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: 11/29/2022]
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Pattison S, Mitchell C, Lade S, Leong T, Busuttil RA, Boussioutas A. Early relapses after adjuvant chemotherapy suggests primary chemoresistance in diffuse gastric cancer. PLoS One 2017; 12:e0183891. [PMID: 28922362 PMCID: PMC5602536 DOI: 10.1371/journal.pone.0183891] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 08/14/2017] [Indexed: 01/19/2023] Open
Abstract
Background Survival from gastric cancer remains poor, particularly in Western populations. Previous pre-clinical and subgroup analyses of clinical trials have suggested differing benefits from fluoropyrimidine-based chemotherapeutics for diffuse and intestinal gastric cancer. This analysis examines patterns of relapse with and without adjuvant chemotherapy after curative resection for gastric cancer in these subtypes to explore the Lauren classification as a predictive marker of benefit for fluoropyrimidine-based adjuvant chemotherapy. Patients and methods Gastric cancer patients enrolled in an ongoing tissue banking study were analysed, 164 patients who would currently be considered for adjuvant therapy after curative resection were included in the analysis. Patients who did and did not receive adjuvant chemotherapy were compared. The primary end point was relapse free survival. Results Approximately 50% of patients received adjuvant chemotherapy, the majority receiving a fluoropyrimidine-based regimen. The comparison of Kaplan-Meier curves for patients who did and did not receive adjuvant chemotherapy are different between patients with intestinal and diffuse gastric cancer, and suggest that there may be a benefit in intestinal gastric cancer. The hazard ratio for adjuvant chemotherapy for intestinal gastric cancer was 0.56, (95% CI 0.27–1.17), suggesting a trend towards benefit that was lacking in diffuse gastric cancer patients (1.26, 95% CI 0.70–2.38). The patterns of relapse after adjuvant chemotherapy also differed between diffuse and intestinal gastric cancer. More than 50% of diffuse gastric cancer patients who received adjuvant chemotherapy relapsed within 12 months of surgery despite similar surgical parameters. Conclusions Lauren classification is prognostic in gastric cancer. This analysis adds further evidence that it may also be predictive of benefit for fluoropyrimidine-based chemotherapeutics, with lower chemosensitivity seen in diffuse gastric cancer. Treating diffuse and intestinal gastric cancer as separate entities, with identification of efficacious treatments for diffuse gastric cancer will help in improving outcomes from gastric cancer.
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Affiliation(s)
- Sharon Pattison
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Catherine Mitchell
- Department of Pathology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Stephen Lade
- Department of Pathology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - Trevor Leong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Department of Pathology, University of Melbourne, Parkville, Victoria, Australia
| | - Rita A. Busuttil
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Upper Gastrointestinal Translational Research Laboratory, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Alex Boussioutas
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
- Upper Gastrointestinal Translational Research Laboratory, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
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Bird T, Michael M, Bressel M, Chu J, Chander S, Cooray P, McKendrick J, Jefford M, Heriot A, Steel M, Leong T, Ngan S. FOLFOX and intensified split-course chemoradiation as initial treatment for rectal cancer with synchronous metastases. Acta Oncol 2017; 56:646-652. [PMID: 28301974 DOI: 10.1080/0284186x.2017.1296584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Optimal initial management of rectal carcinoma with synchronous metastases (RCSM) is controversial - both for patients being treated with curative and palliative intent. This study aims to evaluate the use of an upfront treatment strategy combining FOLFOX chemotherapy with split-course pelvic chemoradiation (FOLFOX + CRT) for patients with RCSM. MATERIAL AND METHODS An analysis of all patients who commenced treatment with FOLFOX + CRT at our institutions between January 2009 and June 2014 was performed. The regimen consisted of a total of 12 weeks of treatment with split-course pelvic chemoradiation (50.4Gy with concurrent oxaliplatin and 5-FU) alternating with FOLFOX chemotherapy. Restaging imaging was performed following treatment, with subsequent management as per local standard of care. RESULTS 78 patients (15 with resectable liver-only metastases) were identified. 77 (99%) completed at least 45Gy of radiation and 87% completed ≥75% of planned dose intensity of both oxaliplatin and 5FU. Two (2.6%) patients died within 30 days of treatment. Rates of radiological complete or partial response for local and metastatic disease were 90% and 66%, respectively. 24% patients had radiological disease progression of metastatic disease. Median overall survival for patients with unresectable metastatic disease at baseline was 23 months (95%CI: 19-28). 12 patients underwent radical surgery to both the rectum and liver and had an estimated 3-year overall survival rate of 62% (95%CI: 37-100). For those patients who did not proceed to rectal surgery, only 7% required palliative re-irradiation or surgery at a later date and all >20months from initial treatment. CONCLUSIONS In patients with unresectable metastatic disease, FOLFOX + CRT provides durable pelvic control for the majority without the need for additional local treatment. For patients with an advanced primary tumor and synchronous resectable liver-only metastases, FOLFOX + CRT can be considered a feasible and tolerable upfront treatment option.
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Affiliation(s)
- T. Bird
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - M. Michael
- Department of Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - M. Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - J. Chu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - S. Chander
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - P. Cooray
- Department of Medical Oncology, Eastern Health, Box Hill, Melbourne, Australia
| | - J. McKendrick
- Department of Medical Oncology, Eastern Health, Box Hill, Melbourne, Australia
| | - M. Jefford
- Department of Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - A. Heriot
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - M. Steel
- Department of Surgical Oncology, Eastern Health, Box Hill, Melbourne, Australia
| | - T. Leong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - S. Ngan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
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Leong T, Smithers BM, Haustermans K, Michael M, Gebski V, Miller D, Zalcberg J, Boussioutas A, Findlay M, O'Connell RL, Verghis J, Willis D, Kron T, Crain M, Murray WK, Lordick F, Swallow C, Darling G, Simes J, Wong R. TOPGEAR: A Randomized, Phase III Trial of Perioperative ECF Chemotherapy with or Without Preoperative Chemoradiation for Resectable Gastric Cancer: Interim Results from an International, Intergroup Trial of the AGITG, TROG, EORTC and CCTG. Ann Surg Oncol 2017; 24:2252-2258. [PMID: 28337660 DOI: 10.1245/s10434-017-5830-6] [Citation(s) in RCA: 149] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Postoperative chemoradiation and perioperative chemotherapy using epirubicin/cisplatin/5-fluorouracil (ECF) represent two standards of care for resectable gastric cancer. In the TOPGEAR (Trial Of Preoperative therapy for Gastric and Esophagogastric junction AdenocaRcinoma) trial, we hypothesized that adding preoperative chemoradiation to perioperative ECF will improve survival; however, the safety and feasibility of preoperative chemoradiation have yet to be determined. METHODS TOPGEAR is an international phase III trial in which patients with adenocarcinoma of the stomach were randomized to perioperative ECF alone or with preoperative chemoradiation. The ECF-alone group received three preoperative cycles of ECF, while the chemoradiation group received two cycles of preoperative ECF followed by chemoradiation. Both groups received three postoperative cycles of ECF. A planned interim analysis of the first 120 patients was conducted, and was reviewed by the Independent Data Safety Monitoring Committee to assess treatment compliance, toxicity/safety, and response rates. RESULTS The proportion of patients who received all cycles of preoperative chemotherapy was 93% (ECF group) and 98% (chemoradiation group), while 65 and 53%, respectively, received all cycles of postoperative chemotherapy. Overall, 92% of patients allocated to preoperative chemoradiation received this treatment. The proportion of patients proceeding to surgery was 90% (ECF group) and 85% (chemoradiation group). Grade 3 or higher surgical complications occurred in 22% of patients in both groups. Furthermore, grade 3 or higher gastrointestinal toxicity occurred in 32% (ECF group) and 30% (chemoradiation group) of patients, while hematologic toxicity occurred in 50 and 52% of patients. CONCLUSIONS These results demonstrate that preoperative chemoradiation can be safely delivered to the vast majority of patients without a significant increase in treatment toxicity or surgical morbidity.
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Affiliation(s)
- Trevor Leong
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
| | - B Mark Smithers
- Upper Gastrointestinal and Soft Tissue Unit, School of Medicine, Princess Alexandra Hospital, University of Queensland, Woolloongabba, QLD, Australia
| | - Karin Haustermans
- Radiation Oncology, University Hospitals Leuven, Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Danielle Miller
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Michael Findlay
- Faculty of Medical and Health Sciences, University of Auckland, Grafton, Auckland, New Zealand
| | - Rachel L O'Connell
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Jaclyn Verghis
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - David Willis
- North West Cancer Centre, NEMSC, Tamworth, NSW, Australia
| | - Tomas Kron
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Melissa Crain
- TROG Cancer Research, c/o Calvary Mater Newcastle, HRMC, Waratah, NSW, Australia
| | | | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Leipzig, Germany
| | | | | | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
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Forrester HB, de Kretser DM, Leong T, Hagekyriakou J, Sprung CN. Follistatin attenuates radiation-induced fibrosis in a murine model. PLoS One 2017; 12:e0173788. [PMID: 28301516 PMCID: PMC5354399 DOI: 10.1371/journal.pone.0173788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 02/27/2017] [Indexed: 02/06/2023] Open
Abstract
Purpose Fibrosis can be a disabling, severe side effect of radiotherapy that can occur in patients, and for which there is currently no effective treatment. The activins, proteins which are members of the TGFβ superfamily, have a major role in stimulating the inflammatory response and subsequent fibrosis. Follistatin is an endogenous protein that binds the activins virtually irreversibly and inhibits their actions. These studies test if follistatin can attenuate the fibrotic response using a murine model of radiation-induced fibrosis. Experimental design C57BL/6 mice were subcutaneously injected with follistatin 24 hours prior to irradiation. Mice were irradiated in a 10 x 10 mm square area of the right hind leg with 35 Gy and were given follistatin 24 hours before radiation and three times a week for six months following. Leg extension was measured, and tissue was collected for histological and molecular analysis to evaluate the progression of the radiation-induced fibrosis. Results Leg extension was improved in follistatin treated mice compared to vehicle treated mice at six months after irradiation. Also, epidermal thickness and cell nucleus area of keratinocytes were decreased by the follistatin treatment compared to the cells in irradiated skin of control mice. Finally, the gene expression of transforming growth factor β1 (Tgfb1), and smooth muscle actin (Acta2) were decreased in the irradiated skin and Acta2 and inhibin βA subunit (Inhba) were decreased in the irradiated muscle of the follistatin treated mice. Conclusions Follistatin attenuated the radiation-induced fibrotic response in irradiated mice. These studies provide the data to support further investigation of the use of follistatin to reduce radiation-induced fibrosis in patients undergoing radiotherapy for cancer.
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Affiliation(s)
- Helen B. Forrester
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
| | - David M. de Kretser
- Centre for Reproductive Health, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Trevor Leong
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Jim Hagekyriakou
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Carl N. Sprung
- Centre for Innate Immunity and Infectious Diseases, Hudson Institute of Medical Research, Clayton, Victoria, Australia
- Department of Molecular and Translational Science, Monash University, Clayton, Victoria, Australia
- * E-mail:
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Ng SP, Tan J, Osbourne G, Williams L, Bressel MAB, Hicks RJ, Lau EWF, Chu J, Ngan SYK, Leong T. Follow up results of a prospective study to evaluate the impact of FDG-PET on CT-based radiotherapy treatment planning for oesophageal cancer. Clin Transl Radiat Oncol 2017; 2:76-82. [PMID: 29658005 PMCID: PMC5893524 DOI: 10.1016/j.ctro.2017.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 11/20/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 11/03/2022] Open
Abstract
Background This prospective study aims to determine the impact of PET/CT on radiotherapy planning and outcomes in patients with oesophageal cancer. Methods All patients underwent PET/CT scanning in the radiotherapy treatment position, and received treatment planned using the PET/CT dataset. GTV was defined separately on PET/CT (GTV-PET) and CT (GTV-CT) datasets. A corresponding PTV was generated for each patient. Volumetric and spatial analysis quantified the proportion of FDG-avid disease not included in CT-based volumes. Clinical data was collected to determine locoregional control and overall survival rates. Results 13 (24.1%) of 57 accrued patients had metastatic disease detected on PET. Median follow up was 4 years. FDG-avid disease would have been excluded from GTV-CT in 29 of 38 patients (76%). In 5 patients, FDG-avid disease would have been completely excluded from the PTV-CT. GTV-CT underestimated the cranial and caudal extent of FDG-avid tumour in 14 (36%) and 10 (26%) patients. 4-Year overall survival and locoregional failure free survival were 37% and 65%. Conclusions PET/CT altered the delineation of tumour volumes when compared to CT alone, and should be considered standard for treatment planning. Although clinical outcomes were not improved with PET/CT planning, it did allow the use of smaller radiotherapy volumes.
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Affiliation(s)
- Sweet Ping Ng
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Jennifer Tan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Glen Osbourne
- Department of Radiation Therapy, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Luke Williams
- Department of Radiation Therapy, Radiation Oncology Victoria, GenesisCare, Melbourne, Victoria, Australia
| | - Mathias A B Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Rodney J Hicks
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Eddie W F Lau
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Julie Chu
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Samuel Y K Ngan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
| | - Trevor Leong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,The University of Melbourne, Parkville, Victoria, Australia
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McKinley M, Leong T. Extrapleural solitary fibrous tumour with malignant histological features: a case report and review of current and emerging prognostic factors. Pathology 2017. [DOI: 10.1016/j.pathol.2016.09.030] [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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Ngan S, Bressel M, Chu J, McKendrick J, Chander S, Cooray P, Jefford M, Wong R, Steel M, Leong T, Heriot A, Michael M. A 12-week regimen with interdigitating FOLFOX/bevacizumab and pelvic chemoradiation for synchronous primary and metastatic rectal cancer. The CHROME B trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.51] [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: 11/13/2022] Open
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Ng SP, Tan J, Osbourne G, Williams L, Bressel M, Hicks RJ, Lau E, Chu J, Ngan S, Leong T. Impact of combined PET/CT on radiotherapy treatment planning and outcomes in esophageal cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e15519] [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: 11/20/2022] Open
Affiliation(s)
| | - Jennifer Tan
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | | | - Eddie Lau
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Julie Chu
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sam Ngan
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Trevor Leong
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Michael M, Chu J, Bressel M, McKendrick J, Cooray P, Chander S, Jefford M, Vanevski M, Wong R, Steel M, Leong T, Heriot AG, Ngan S. A phase II study of oxaliplatin/5FU/bevacizumab and concurrent pelvic radiation in patients with simultaneous primary and metastatic rectal cancer: The Chrome-B trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.3613] [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: 11/20/2022] Open
Affiliation(s)
| | - Julie Chu
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - Prasad Cooray
- Box Hill Hospital, Eastern Health, Box Hill, Australia
| | - Sarat Chander
- Peter MacCallum Cancer Centre, East Melbourne, Australia
| | | | | | - Rachel Wong
- Eastern Health Department of Medical Oncology, Monash University, Melbourne, Australia
| | - Malcolm Steel
- Box Hill Hospital, Eastern Health, Box Hill, Australia
| | | | | | - Sam Ngan
- University of Melbourne, Melbourne, Australia
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Wong SW, Gantner D, McGloughlin S, Leong T, Worth LJ, Klintworth G, Scheinkestel C, Pilcher D, Cheng AC, Udy AA. The influence of intensive care unit-acquired central line-associated bloodstream infection on in-hospital mortality: A single-center risk-adjusted analysis. Am J Infect Control 2016; 44:587-92. [PMID: 26874406 DOI: 10.1016/j.ajic.2015.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/07/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the risk-adjusted association between intensive care unit (ICU)-acquired central line-associated bloodstream infection (CLABSI) and in-hospital mortality. DESIGN Retrospective observational study. SETTING Forty-five-bed adult ICU. PATIENTS All non-extracorporeal membrane oxygenation ICU admissions between July 1, 2008, and April 30, 2014, requiring a central venous catheter (CVC), with a length of stay > 48 hours, were included. METHODS Data were extracted from our infection prevention and ICU databases. A multivariable logistic regression model was constructed to identify independent risk factors for ICU-acquired CLABSI. The propensity toward developing CLABSI was then included in a logistic regression of in-hospital mortality. RESULTS Six thousand three hundred fifty-three admissions were included. Forty-six cases of ICU-acquired CLABSI were identified. The overall CLABSI rate was 1.12 per 1,000 ICU CVC-days. Significant independent risk factors for ICU-acquired CLABSI included: double lumen catheter insertion (odds ratio [OR], 2.59; 95% confidence interval [CI], 1.16-5.77), CVC exposure > 7 days (OR, 2.07; 95% CI, 1.06-4.04), and CVC insertion before 2011 (OR, 2.20; 95% CI, 1.22-3.97). ICU-acquired CLABSI was crudely associated with greater in-hospital mortality, although this was attenuated once the propensity to develop CLABSI was adjusted for (OR, 1.20; 95% CI, 0.54-2.68). CONCLUSIONS A greater propensity toward ICU-acquired CLABSI was independently associated with higher in-hospital mortality, although line infection itself was not. The requirement for prolonged specialized central venous access appears to be a key risk factor for ICU-acquired CLABSI, and likely informs mortality as a marker of persistent organ dysfunction.
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Affiliation(s)
- S W Wong
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia
| | - D Gantner
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Perioperative and Critical Care Services, Intensive Care Unit, Footscray Hospital, Footscray, Victoria, Australia
| | - S McGloughlin
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia
| | - T Leong
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - L J Worth
- Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia; Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - G Klintworth
- Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - C Scheinkestel
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - D Pilcher
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia
| | - A C Cheng
- Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia; Infectious Diseases Unit, The Alfred, Prahran, Melbourne, Victoria, Australia; Infection Prevention and Healthcare Epidemiology, Alfred Health, Prahran, Melbourne, Victoria, Australia
| | - A A Udy
- Department of Intensive Care and Hyperbaric Medicine, The Alfred, Prahran, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, The Alfred Centre, Monash University, Prahran, Melbourne, Victoria, Australia.
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Ng SP, Tan J, Osbourne G, Williams L, Bressel M, Hicks RJ, Lau E, Chu J, Ngan S, Leong T. Impact of 18F-fluorodeoxyglucose position emission tomography/computed tomography on radiotherapy treatment planning and outcomes in esophageal cancer. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
67 Background: Currently there is no universally accepted method to accurately delineate the gross tumor volume (GTV) of primary esophageal cancer in patients undergoing radiotherapy. This prospective study aims to determine the impact of PET/CT on radiotherapy planning and outcomes in patients with localized esophageal cancer. Methods: 54 patients were recruited between June 2003 - May 2008. All underwent PET/CT scanning in the radiotherapy treatment position and received treatment planned using the PET/CT dataset. Of these, 13 (24.1%) had metastatic disease detected on PET and 3 patients had no radical radiotherapy, while another 3 patients had missing planning PET/CT data (excluded from planning component analysis). GTV was defined separately on PET/CT (GTV-PET) and CT (GTV-CT) data sets. A corresponding planning target volume (PTV) was generated for each patient. Volumetric and spatial analysis quantified the proportion of FDG-avid disease not included in CT-based volumes. Clinical data was collected for 38 patients treated radically to determine locoregional control and overall survival rates. Results: Mean age was 67 years (range:32 - 88). Median follow up was 4 years (range:2.7 – 6.8). FDG-avid disease would have been excluded from GTV-CT in 29 patients (79%) with a mean volume of 17% (range:1-100%). In 5 patients, FDG-avid disease would have been completely excluded from the PTV-CT (median volume missed = 6%, range:2-92%). For 8 patients, less than 95% of PTV-PET would have received at least 95% of prescription dose based on the CT-based plan. GTV-CT underestimated the cranial and caudal extent of FDG-avid tumor in 14 (36%) and 10 (26%) patients respectively. There were no significant differences in radiation doses to the lungs and liver. 5-year overall survival and locoregional failure free survival were 24%, and 42% respectively. Conclusions: PET/CT prevented futile radiotherapy for 1 in 4 patients and avoided geographic misses without significant impact on normal tissues in apparently localized esophageal cancer. However, survival remains suboptimal and indicates the need for further improvement in planning and therapeutic paradigms.
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Affiliation(s)
| | - Jennifer Tan
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | | | - Eddie Lau
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Julie Chu
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sam Ngan
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Trevor Leong
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Leong T, Smithers B, Michael M, Gebski V, Simes J, Boussioutas A, Miller D, Zalcberg J, O'Connell R, Swallow C, Darling G, Wong R, Schuhmacher C, Lordick F, Haustermans K. 2200 TOPGEAR: A randomized phase M/MI trial of perioperative ECF chemotherapy versus preoperative chemoradiation plus perioperative ECF chemotherapy for resectable gastric cancer. Interim results from an international, intergroup trial of the AGITG/TROG/NCIC CTG/EORTC. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(15)30043-5] [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: 11/27/2022]
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Leong T, Smithers BM, Michael M, Gebski V, Boussioutas A, Miller D, Simes J, Zalcberg J, Haustermans K, Lordick F, Schuhmacher C, Swallow C, Darling G, Wong R. TOPGEAR: a randomised phase III trial of perioperative ECF chemotherapy versus preoperative chemoradiation plus perioperative ECF chemotherapy for resectable gastric cancer (an international, intergroup trial of the AGITG/TROG/EORTC/NCIC CTG). BMC Cancer 2015; 15:532. [PMID: 26194186 PMCID: PMC4507314 DOI: 10.1186/s12885-015-1529-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [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] [Received: 05/21/2015] [Accepted: 06/30/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The optimal management of patients with resectable gastric cancer continues to evolve in Western countries. Following publication of the US Intergroup 0116 and UK Medical Research Council MAGIC trials, there are now two standards of care for adjuvant therapy in resectable gastric cancer, at least in the Western world: postoperative chemoradiotherapy and perioperative epirubicin/cisplatin/fluorouracil (ECF) chemotherapy. We hypothesize that adding chemoradiation to standard perioperative ECF chemotherapy will achieve further survival gains. We also believe there are advantages to administering chemoradiation in the preoperative rather than postoperative setting. In this article, we describe the TOPGEAR trial, which is a randomised phase III trial comparing control arm therapy of perioperative ECF chemotherapy with experimental arm therapy of preoperative chemoradiation plus perioperative ECF chemotherapy. METHODS/DESIGN Eligible patients with resectable adenocarcinoma of the stomach or gastroesophageal junction will be randomized to receive either perioperative chemotherapy alone (3 preoperative and 3 postoperative cycles of ECF) or perioperative chemotherapy plus preoperative chemoradiation. In the chemoradiation arm, patients receive 2 cycles of ECF plus chemoradiation prior to surgery, and then following surgery 3 further cycles of ECF are given. The trial is being conducted in two Parts; Part 1 (phase II component) has recruited 120 patients with the aim of assessing feasibility, safety and preliminary efficacy of preoperative chemoradiation. Part 2 (phase III component) will recruit a further 632 patients to provide a total sample size of 752 patients. The primary endpoint of the phase III trial is overall survival. The trial includes quality of life and biological substudies, as well as a health economic evaluation. In addition, the trial incorporates a rigorous quality assurance program that includes real time central review of radiotherapy plans and central review of surgical technique. DISCUSSION TOPGEAR is an international, intergroup collaboration led by the Australasian Gastro-Intestinal Trials Group (AGITG), in collaboration with the Trans-Tasman Radiation Oncology Group (TROG), European Organisation for Research and Treatment of Cancer (EORTC) and the NCIC Clinical Trials Group. It addresses a globally significant question that will help inform future international standards for clinical practice in resectable gastric cancer. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry: ACTRN12609000035224 . Registered 30 May 2009.
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Affiliation(s)
- Trevor Leong
- Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Victoria, 8006, Australia.
| | - B Mark Smithers
- Upper Gastro-intestinal and Soft Tissue Unit, School of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD, 4102, Australia.
| | - Michael Michael
- Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Victoria, 8006, Australia.
| | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Locked bag 77, Camperdown, NSW, 1450, Australia.
| | - Alex Boussioutas
- Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Victoria, 8006, Australia.
| | - Danielle Miller
- NHMRC Clinical Trials Centre, University of Sydney, Locked bag 77, Camperdown, NSW, 1450, Australia.
| | - John Simes
- NHMRC Clinical Trials Centre, University of Sydney, Locked bag 77, Camperdown, NSW, 1450, Australia.
| | - John Zalcberg
- School of Public Health and Preventive Medicine, Monash University, Level 5 The Alfred Centre, 99 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Karin Haustermans
- Radiation Oncology, University Hospitals Leuven, Department of Oncology, KU, Leuven, Belgium.
| | - Florian Lordick
- University Cancer Center Leipzig (UCCL), University Medicine Leipzig, Leipzig, Germany.
| | - Christoph Schuhmacher
- European Clinical Research Infrastructure Network, ECRIN-ERIC, Paris Biopark, 5 rue Watt, 75013, Paris, France.
| | - Carol Swallow
- Mount Sinai Hospital, Rm 1225, 600 University Avenue, Toronto, ON, M5G 1X5, Canada.
| | - Gail Darling
- Toronto General Hospital, 9N-955, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada.
| | - Rebecca Wong
- Princess Margaret Hospital, Rm 5-807, 610 University Avenue, Toronto, M5G 2M9, Canada.
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Blom RLGM, Bogush T, Brücher BLDM, Chang AC, Davydov M, Dudko E, Leong T, Polotsky B, Swanson PE, van Rossum PSN, Ruurda JP, Sagaert X, Tjulandin S, Schraepen MC, Sosef MN, van Hillegersberg R. Therapeutic approaches to gastroesophageal junction adenocarcinomas. Ann N Y Acad Sci 2015; 1325:197-210. [PMID: 25266026 DOI: 10.1111/nyas.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/23/2022]
Abstract
The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the distinction between adenocarcinomas above, below, or within the gastroesophageal junction; combined modality therapy; tumor markers for use in personalized medicine; PET-CT and endoscopic biopsies in the evaluation of response to neoadjuvant chemoradiation therapy; a standardized grading system for tumor regression in squamous cell cancer and adenocarcinoma; the experimental basis for new approaches to medical treatment; the criteria measuring response in esophageal cancer; and the impact of novel imaging on staging and response assessment.
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Affiliation(s)
- Rachel L G M Blom
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
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