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Kravietz A, Crosby T, Yang J, Balou S, Dion GR, Logan A, Amin MR. A Large Cohort Analysis of Epiglottic Phenotypes and Pharyngeal Residue. Ann Otol Rhinol Laryngol 2024; 133:375-383. [PMID: 38197379 DOI: 10.1177/00034894231218892] [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] [Indexed: 01/11/2024]
Abstract
OBJECTIVE To describe the phenotypic characteristics of the epiglottis at rest and their impact on vallecular residue. METHODS Videofluoroscopic studies (VFSS) were pooled from 2 Laryngology practices, and Image J was used to measure epiglottic anatomic features at rest. Studies were rated by the MBSImp and presence of vallecular residue following swallow of thin and puree boluses. A conditional inference tree analysis was performed to isolate which epiglottic parameters were risk factors for presence of vallecular reside followed by logistic regression. RESULTS The majority of patients had a normal shaped epiglottis, followed by omega shape. The mean angle of the epiglottis from the hyoid was approximately 90°. Only abnormal epiglottic movement was associated with increased risk of residue for thin boluses (OR 35.09, CI 10.93-158.66, P < .001). However, in those with normal epiglottic movement, age >70 years old was associated with increased risk of residue (OR 3.98, CI 1.73-9.23, P = .001). For puree boluses, a normal or omega shaped epiglottis was associated with residue (OR 5.19, CI 2.41-11.51, P < .001), and this relationship was further modulated by increased distance of the epiglottic tip from the posterior pharyngeal wall. No other anatomic features of the resting epiglottis were associated with residue. Comorbidities potentially affecting swallow were infrequent in the cohort and were not associated with residue. CONCLUSION Abnormal epiglottic movement is associated with aspiration, and in this study we find that abnormal epiglottic movement increases the risk of vallecular residue and that older age is a risk factor for residue. The resting properties of the epiglottis do not appear to be associated with abnormal epiglottic movement or residue.
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Affiliation(s)
- Adam Kravietz
- Department of Otolaryngology/Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Tyler Crosby
- Department of Otolaryngology/Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
| | - Jackie Yang
- New York University Grossman School of Medicine, New York, NY, USA
| | - Stamatela Balou
- New York University Grossman School of Medicine, New York, NY, USA
| | - Gregory R Dion
- Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Ashley Logan
- Department of Otolaryngology-Head and Neck Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA
| | - Milan R Amin
- Department of Otolaryngology/Head and Neck Surgery, New York University Grossman School of Medicine, New York, NY, USA
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2
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Crosby T, Ezeh UC, Achlatis S, Kwak PE, Amin MR, Johnson AM. Vocal Health Assessment of Professional Performers Returning to the Stage After the COVID-19 Pandemic Shutdown. J Voice 2024:S0892-1997(24)00002-X. [PMID: 38296764 DOI: 10.1016/j.jvoice.2024.01.002] [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: 11/03/2023] [Revised: 01/10/2024] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
OBJECTIVES/HYPOTHESIS This study assessed the vocal health of performers returning to full-time performance after the COVID-19 pandemic shutdown and investigated how differences in voice usage, exposure to voice care professionals, and vocal pathology before and during the pandemic contributed to variability in self-perceived and instrumental vocal outcome measures. STUDY DESIGN This was a prospective, case-control observational study conducted at a single outpatient site. METHODS Twenty-two patients, 11 cases and 11 controls, were enrolled for the study. All participants were full-time singing professionals prior to the COVID-19 pandemic. Cases were recruited from patients presenting to a tertiary care voice center for vocal or pharyngeal complaints. Controls were healthy volunteers recruited from the general population of professional singers in the surrounding metropolitan area. All participants provided responses to the Voice Handicap Index-10, Evaluation of Ability to Sing Easily, and Laryngopharyngeal Measure of Perceived Sensation validated questionnaires as well as a study survey with questions regarding vocal use and history prior to and during the pandemic. All participants underwent instrumental acoustic and videostroboscopic voice evaluations. RESULTS Cases had poorer outcome measures overall and were more likely to report their voices were worse at study enrollment when compared to their prepandemic perception (P = 0.027). Cases tended to be older and less likely to have pursued alternative employment during the pandemic that involved increased speaking voice use (27% vs 55%), but these differences were not statistically significant. CONCLUSIONS There was a variable response among performers to the prolonged hiatus from performing during the COVID-19 pandemic. Those with poorer outcomes tended to be older and may have used their voice less during the pandemic. These findings are consistent with detraining periods in the exercise physiology literature and support the construct of treating vocal performers as vocal athletes.
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Affiliation(s)
- Tyler Crosby
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Uche C Ezeh
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Stratos Achlatis
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Paul E Kwak
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York
| | - Aaron M Johnson
- Department of Otolaryngology-Head and Neck Surgery, New York University Grossman School of Medicine, New York, New York.
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Peters CJ, Ang Y, Ciccarelli FD, Coles H, Coleman HG, Contino G, Crosby T, Devonshire G, Eldridge M, Freeman A, Grehan N, McCord M, Nutzinger B, Zamani S, Parsons SL, Petty R, Sharrocks AD, Skipworth RJE, Smyth EC, Soomro I, Underwood TJ, Fitzgerald RC. A decade of the Oesophageal Cancer Clinical and Molecular Stratification Consortium. Nat Med 2024; 30:14-16. [PMID: 38114667 DOI: 10.1038/s41591-023-02676-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- C J Peters
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Y Ang
- Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
| | - F D Ciccarelli
- Cancer Systems Biology, The Francis Crick Institute, London, UK
| | - H Coles
- Early Cancer Institute, University of Cambridge, Cambridge, UK
| | - H G Coleman
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - G Contino
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - T Crosby
- Velindre University NHS Trust, Cardiff, UK
| | - G Devonshire
- Cancer Research UK Cambridge Institute, Cambridge, UK
| | - M Eldridge
- Cancer Research UK Cambridge Institute, Cambridge, UK
| | - A Freeman
- Early Cancer Institute, University of Cambridge, Cambridge, UK
| | - N Grehan
- Early Cancer Institute, University of Cambridge, Cambridge, UK
| | - M McCord
- Heartburn Cancer UK, Basingstoke, UK
| | - B Nutzinger
- Early Cancer Institute, University of Cambridge, Cambridge, UK
| | - S Zamani
- Early Cancer Institute, University of Cambridge, Cambridge, UK
| | - S L Parsons
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R Petty
- School of Medicine, University of Dundee, Dundee, UK
| | - A D Sharrocks
- Division of Molecular and Cellular Function, University of Manchester, Manchester, UK
| | | | - E C Smyth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - I Soomro
- Nottingham University Hospital, Nottingham, UK
| | - T J Underwood
- Institute for Life Sciences, University of Southampton, Southampton, UK
| | - R C Fitzgerald
- Early Cancer Institute, University of Cambridge, Cambridge, UK.
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4
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Kostas JC, Lee AS, Arunkumar A, Han C, Lee M, Goel AN, Alrassi J, Crosby T, Clark CM, Amin M, Abu-Ghanem S, Kirke D, Rameau A. Validation of a 3D-Printed Percutaneous Injection Laryngoplasty Simulator: A Randomized Controlled Trial. Laryngoscope 2024; 134:318-323. [PMID: 37466294 PMCID: PMC10796838 DOI: 10.1002/lary.30878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Simulation may be a valuable tool in training laryngology office procedures on unsedated patients. However, no studies have examined whether existing awake procedure simulators improve trainee performance in laryngology. Our objective was to evaluate the transfer validity of a previously published 3D-printed laryngeal simulator in improving percutaneous injection laryngoplasty (PIL) competency compared with conventional educational materials with a single-blinded randomized controlled trial. METHODS Otolaryngology residents with fewer than 10 PIL procedures in their case logs were recruited. A pretraining survey was administered to participants to evaluate baseline procedure-specific knowledge and confidence. The participants underwent block randomization by postgraduate year to receive conventional educational materials either with or without additional training with a 3D-printed laryngeal simulator. Participants performed PIL on an anatomically distinct laryngeal model via trans-thyrohyoid and trans-cricothyroid approaches. Endoscopic and external performance recordings were de-identified and evaluated by two blinded laryngologists using an objective structured assessment of technical skill scale and PIL-specific checklist. RESULTS Twenty residents completed testing. Baseline characteristics demonstrate no significant differences in confidence level or PIL experience between groups. Senior residents receiving simulator training had significantly better respect for tissue during the trans-thyrohyoid approach compared with control (p < 0.0005). There were no significant differences in performance for junior residents. CONCLUSIONS In this first transfer validity study of a simulator for office awake procedure in laryngology, we found that a previously described low-cost, high-fidelity 3D-printed PIL simulator improved performance of PIL amongst senior otolaryngology residents, suggesting this accessible model may be a valuable educational adjunct for advanced trainees to practice PIL. LEVEL OF EVIDENCE NA Laryngoscope, 134:318-323, 2024.
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Affiliation(s)
- Julianna C Kostas
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, New York, New York, U.S.A
| | - Andrew S Lee
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, New York, New York, U.S.A
| | - Amit Arunkumar
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, New York, New York, U.S.A
| | - Catherine Han
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, New York, New York, U.S.A
| | - Mark Lee
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, New York, New York, U.S.A
| | - Alexander N Goel
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - James Alrassi
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Tyler Crosby
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Christine M Clark
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, New York, New York, U.S.A
| | - Milan Amin
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, U.S.A
| | - Sara Abu-Ghanem
- Department of Otolaryngology, SUNY Downstate Medical Center, Brooklyn, New York, U.S.A
| | - Diana Kirke
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Anaïs Rameau
- Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, Sean Parker Institute for the Voice, New York, New York, U.S.A
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5
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Ezeh UC, Achlatis E, Crosby T, Kwak PE, Phillips MS, Amin MR. The Effectiveness of Ultraviolet Smart D60 in Reducing Contamination of Flexible Fiberoptic Laryngoscopes. Laryngoscope 2023; 133:3512-3519. [PMID: 37485725 DOI: 10.1002/lary.30869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
OBJECTIVE To compare the effectiveness of disinfection protocols utilizing a ultraviolet (UV) Smart D60 light system with Impelux™ technology with a standard Cidex ortho-phthalaldehyde (OPA) disinfection protocol for cleaning flexible fiberoptic laryngoscopes (FFLs). METHODS Two hundred FFLs were tested for bacterial contamination after routine use, and another 200 FFLs were tested after disinfection with one of four methods: enzymatic detergent plus Cidex OPA (standard), enzymatic detergent plus UV Smart D60, microfiber cloth plus UV Smart D60, and nonsterile wipe plus UV Smart D60. Pre- and post-disinfection microbial burden levels and positive culture rates were compared using Kruskal-Wallis ANOVA and Fisher's two-sided exact, respectively. RESULTS After routine use, approximately 56% (112/200) of FFLs were contaminated, with an average contamination level of 9,973.7 ± 70,136.3 CFU/mL. The standard reprocessing method showed no positive cultures. The enzymatic plus UV, microfiber plus UV, and nonsterile wipe plus UV methods yielded contamination rates of 4% (2/50), 6% (3/50), and 12% (6/50), respectively, with no significant differences among the treatment groups (p > 0.05). The pre-disinfection microbial burden levels decreased significantly after each disinfection technique (p < 0.001). The average microbial burden recovered after enzymatic plus UV, microfiber plus UV, and nonsterile wipe plus UV were 0.40 CFU/mL ± 2, 0.60 CFU/mL ± 2.4, and 12.2 CFU/mL ± 69.5, respectively, with no significant difference among the treatment groups (p > 0.05). Micrococcus species (53.8%) were most frequently isolated, and no high-concern organisms were recovered. CONCLUSION Disinfection protocols utilizing UV Smart D60 were as effective as the standard chemical disinfection protocol using Cidex OPA. LEVEL OF EVIDENCE NA Laryngoscope, 133:3512-3519, 2023.
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Affiliation(s)
- Uche C Ezeh
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Efstratios Achlatis
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Tyler Crosby
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Paul E Kwak
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
| | - Michael S Phillips
- Division of Infectious Disease, Department of Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York, USA
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6
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Case AN, Hutchings H, Crosby T, Nicholas O, Thomas B, Morgan C, Gwynne S. Gastric Radiotherapy in the UK - Current Practice and Opinion on Future Directions. Int J Radiat Oncol Biol Phys 2023; 117:e286. [PMID: 37785062 DOI: 10.1016/j.ijrobp.2023.06.1273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Gastric radiotherapy (RT) is more commonly practiced in the US compared to the UK, where postoperative chemoradiotherapy (CRT) is reserved for selected high-risk patients, and preoperative CRT is not standard of care pending the results of phase 3 trials, TOPGEAR and CRITICSII. CRT for inoperable, non-metastatic gastric cancer is also not recommended in the UK, despite being listed in NCCN guidelines. Recent systematic review of definitive gastric CRT (dCRT) conducted by the authors found median overall survival of 11-26.4 months, clinical complete response rates of 8-45% and acceptable rates of ≥G3 toxicity, supporting further research. Given these promising findings and perceived low uptake of gastric RT in the UK, we set out to establish current UK practice, opinion and RT technique to inform the development of a UK gastric RT protocol and future clinical trials. MATERIALS/METHODS A 19 question survey was developed. Following local ethical approval and pilot by 4 clinical oncologists, the final survey was distributed electronically on 13/12/22 to UK Consultant Clinical Oncologists specializing in esophago-gastric (OG) cancer. Responses were anonymous. Survey was closed 6/2/23 and data analyzed using JISC/spreadsheet software. RESULTS A total of 43 clinicians completed the survey. For gastric cancer, 28.6%, 7.1% and 9.5% would agree/strongly agree with use of postoperative (postopRT), preoperative (preopRT) or definitive RT (dRT) respectively, compared to 26.2%, 45.2% and 46.6% for type III gastro-esophageal junction tumors. 93% had prescribed palliative gastric RT in the last 3 years compared to 40.5% postopRT, 16.7% dRT and 9.5% preopRT. Main reasons for infrequent use were; rarely indicated within standard UK practice 88.4%, lack of UK gastric RT protocol 53.5%, toxicity concerns 44.2%. 45Gy/25# was most commonly used for preopRT (66%) and postopRT (86%), and 50Gy/25# for dRT (58%). 96% use IMRT/VMAT, 85% CT simulation with IV/oral contrast, 69% gastric filling protocol and 54% 4DCT. When ranked out of 10 (1 = low 10 = high), clinician confidence in accurately delineating gastric volumes mean rank was 4.33 for postopRT, with 9% rating ≥8/10, and 4.52 for dCRT/preopRT with 17% rating ≥8/10. However, 48.8% were experienced in outlining upper abdominal nodes and 62.8% duodenum. 93% would find a detailed outlining protocol useful, 81.4% wanted some form of peer review, 76.7% a nodal atlas, and 74.4% a workshop with an expert. 77.6% would be supportive of a future clinical trial of dCRT, with 23.4% needing more supporting evidence. No-one would not support a future trial in this setting. CONCLUSION Gastric RT is not often practiced in the UK, due to lacking evidence and toxicity concerns. Given the growing evidence and supportive OG community, it is time to consider a trial of dCRT in the UK, which must include detailed RT protocols, atlases and educational materials to improve clinician confidence and ensure good RT quality assurance.
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Affiliation(s)
- A N Case
- South West Wales Cancer Centre, Swansea, United Kingdom; Swansea University, Swansea, United Kingdom
| | | | - T Crosby
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - O Nicholas
- South West Wales Cancer Centre, Swansea, United Kingdom
| | - B Thomas
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - C Morgan
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - S Gwynne
- South West Wales Cancer Centre, Swansea, United Kingdom; Swansea University, Swansea, United Kingdom
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7
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Helbrow J, Graby J, Lewis G, Cox S, Nicholas O, Radhakrishna G, Crosby T, Gwynne S. Dose Escalation in Esophageal Cancer: Comparing Pre-Accrual and On-Trial Target Volume Delineation in the UK SCOPE2 Trial. Int J Radiat Oncol Biol Phys 2023; 117:e301-e302. [PMID: 37785101 DOI: 10.1016/j.ijrobp.2023.06.2318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) The ongoing UK SCOPE2 trial evaluates radiotherapy (RT) dose escalation and PET-guided systemic therapy in esophageal cancer, and has an accompanying RT trials quality assurance (RTTQA) program, evolved through the preceding SCOPE trials. We compare pre-accrual with on-trial individual case review (ICR) target volume delineation (TVD). MATERIALS/METHODS Prior to recruitment, centers were required to undertake TVD exercises using 3D/4D DICOM datasets with relevant clinical details and a RT planning guidance document (RPGD) provided. Contours were then compared against the RTTQA team-defined gold standard. Exceptions were those who had satisfied QA requirements for a previous esophageal RT trial (NeoSCOPE). For ICRs, prospective reviews (prior RT start, PRs) were undertaken for each center's first submission, plus high-dose cases submitted pending formal safety review. Additional PRs were undertaken at the RTTQA team's discretion. Timely retrospective reviews (within 2 weeks of RT start, TRR) were also undertaken for a random 10% sample. TVDs were assessed for compliance using predefined criteria and the RPGD. Resubmission was requested at reviewer's discretion, usually due to unacceptable variation (UV) from protocol. Clarification was sought before contour approval/resubmission request if appropriate. Review outcomes were then evaluated. PTV6000 was new to SCOPE2, along with a greater emphasis on use of 4DCT than in prior SCOPE trials. RESULTS A total of 85 pre-accrual cases from 33 UK centers were reviewed, of which 20 (24%) were resubmissions, and 50 (59%) were accepted. 99 TVD UVs were observed in 49 cases, most commonly in CTVB (42/99, 42%), which included editing for normal structures and elective lymph node regions, followed by ITV (4D cases only, 14/52, 27%) and PTV6000 (13/99, 13%). 121 ICRs from 31 UK centers were available for review. 87 (72%) were PRs and 34 (28%) TRRs. 43 (36%) completed the relevant SCOPE2 exercise. 19 (16%) were resubmissions, and 82 (68%) were accepted. 72 UVs were observed in 45 ICRs; again, most commonly in CTVB (34/72, 48%), PTV6000 (high dose arm only, 11/46, 24%) and ITV (4D only, 5/26, 19%). Of the 45 cases where a UV was recorded, 16 (36%) had completed the relevant SCOPE2 pre-accrual. Comparing area of UV on SCOPE2 pre-accrual cases and ICRs, 3 (19%) contours contained the same (2 = CTVB, 1 = PTV6000), 5 (31%) contained different and 8 (50%) had no UVs at pre-accrual. The rate of UV was significantly lower for ICR than for pre-accrual submissions (0.60 and 1.16 respectively, p = 0.001). CONCLUSION Significantly fewer UVs in ICR compared with pre-accrual supports a robust, educational RTTQA program through national collaboration and evolving trial series. CTVB, along with newer volumes of ITV and PTV6000, were recurring UV domains and should inform RPGD development and RTTQA for ongoing recruitment and future trials.
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Affiliation(s)
- J Helbrow
- South West Wales Cancer Centre, Swansea, United Kingdom
| | - J Graby
- University of Bath, Bath, United Kingdom
| | - G Lewis
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - S Cox
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - O Nicholas
- South West Wales Cancer Centre, Swansea, United Kingdom; Swansea University, Swansea, United Kingdom
| | | | - T Crosby
- Velindre Cancer Centre, Cardiff, United Kingdom
| | - S Gwynne
- South West Wales Cancer Centre, Swansea, United Kingdom; Swansea University, Swansea, United Kingdom
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Yang J, Crosby T, Chen S, Ezeh UC, Patil S, Kwak PE, Chin WA, Amin MR. Paralysis Versus Non-Paralysis Anesthesia for Operative Laryngoscopy: A Randomized Controlled Trial. Laryngoscope 2023; 133:2654-2664. [PMID: 36715102 DOI: 10.1002/lary.30571] [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: 03/23/2022] [Revised: 12/14/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To compare outcomes between two standard-of-care anesthesia regimens for operative laryngoscopy: general anesthesia with a neuromuscular blocking agent (NMBA) versus remifentanil and propofol (non-NMBA). METHODS This was a prospective, single-blinded, randomized controlled trial at a tertiary care center. Patients were randomized to either anesthesia using rocuronium (NMBA) or with remifentanil/propofol infusion alone (non-NMBA). Intraoperative impressions, anesthesia data, and post-operative patient surveys were collected. RESULTS Sixty-one patients who underwent suspension laryngoscopy from 2020 to 2022 were included (25 female, 36 male, ranging 20-81 years). Thirty patients were enrolled in the NMBA arm and 31 patients in the non-NMBA arm. Heart rate and mean arterial pressure were higher in the NMBA (p < 0.01). Patients in the non-NMBA group were more likely to require vasopressors (p = 0.04, RR = 3.08 [0.86-11.05]). Surgeons were more frequently satisfied with conditions in the NMBA group (86.7%) compared to the non-NMBA group (58.1%, p < 0.01). Procedures were more likely to be paused due to movement in the non-NMBA group (45.1%) compared to the NMBA group (16.6%, p < 0.03, RR = 2.26 [1.02-4.99]). Patients in the non-NMBA group were more likely to endorse myalgia the week after surgery (44%) compared to the NMBA group (8.3%, p < 0.01) and reported higher average pain levels on a 0-10 pain scale (3.7) compared to the paralysis group (2.0). CONCLUSIONS Anesthesia with rocuronium was associated with better intraoperative conditions and postoperative pain compared to anesthesia with remifentanil/propofol. Remifentanil/propofol were associated with lower blood pressure and suppression of laryngoscopy-associated tachycardia. LEVEL OF EVIDENCE 2 Laryngoscope, 133:2654-2664, 2023.
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Affiliation(s)
- Jackie Yang
- NYU Grossman School of Medicine, New York, New York, USA
| | - Tyler Crosby
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone, New York, New York, USA
| | - Sophia Chen
- NYU Grossman School of Medicine, New York, New York, USA
| | - Uche C Ezeh
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone, New York, New York, USA
| | - Sachi Patil
- NYU Grossman School of Medicine, New York, New York, USA
| | - Paul E Kwak
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone, New York, New York, USA
| | - Wanda A Chin
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - Milan R Amin
- Department of Otolaryngology-Head and Neck Surgery, NYU Langone, New York, New York, USA
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Ellis SDP, Kenney-Herbert E, Crosby T, Mukherjee S. Cervical Oesophageal Cancer: A Call for Treatment Consensus. Clin Oncol (R Coll Radiol) 2023; 35:478-481. [PMID: 37087356 DOI: 10.1016/j.clon.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/06/2023] [Indexed: 04/24/2023]
Affiliation(s)
- S D P Ellis
- Churchill Hospital, Oxford University NHS Trust, Oxford, UK
| | | | - T Crosby
- Velindre Cancer Centre, Cardiff, UK
| | - S Mukherjee
- Churchill Hospital, Oxford University NHS Trust, Oxford, UK
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Booth ME, Jones CM, Helbrow J, Mansoor W, Peters CJ, Petty RD, Underwood TJ, Smyth EC, Crosby T. The UK National Oesophagogastric Multidisciplinary Team Meeting: An Initiative From the UK & Ireland Oesophagogastric Group. Clin Oncol (R Coll Radiol) 2023; 35:417-420. [PMID: 37069000 DOI: 10.1016/j.clon.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Affiliation(s)
- M E Booth
- Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - C M Jones
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - J Helbrow
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea, UK
| | - W Mansoor
- The Christie Hospital, The Christie Hospitals NHS Foundation Trust, Manchester, UK
| | - C J Peters
- Faculty of Medicine, Imperial College London, London, UK
| | - R D Petty
- The University of Dundee, Dundee, UK
| | - T J Underwood
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - E C Smyth
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre NHS Foundation Trust, Cardiff, UK.
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11
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Crosby T, Adkins L, McWhorter A, Kunduk M, Dunham M. Computational fluid dynamics model of laryngotracheal stenosis and correlation to pulmonary function measures. Respir Physiol Neurobiol 2023; 312:104037. [PMID: 36842729 DOI: 10.1016/j.resp.2023.104037] [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: 09/03/2022] [Revised: 02/16/2023] [Accepted: 02/21/2023] [Indexed: 02/28/2023]
Abstract
3D models of airway lumens were created from CT scans of 19 patients with laryngotracheal stenosis. Computational fluid dynamics (CFD) simulations were completed for each, and results were compared to measured peak inspiratory flow rate, grade of lumen constriction, and measures of airway geometry. Results demonstrate flow resistance and shear stress correlate with degree of lumen constriction and absolute cross-sectional area as well as flow rate. Flow recirculation depends on airway constriction but does not vary with flow rate. Resistance and wall shear stress did not correlate well with functional measures. Flow recirculation did differ between subjects with higher functional measures and subjects with lower functional measures. This analysis provides mathematical models to predict airway resistance, wall shear stress, and flow reversal according lumen constriction and inspiratory flow rate. It suggests aerodynamic factors such as flow recirculation play a role in differences in functional performance between patients with similar airway measures.
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Affiliation(s)
- Tyler Crosby
- Louisiana State University Health Science Center, New Orleans - Department of Otolaryngology, Head and Neck Surgery, 533 Bolivar Street, Suite 566, New Orleans, LA 70112, USA; Department of Otolaryngology-Head and Neck Surgery, NYU Langone Health, New York, New York.
| | - Lacey Adkins
- Louisiana State University Health Science Center, New Orleans - Department of Otolaryngology, Head and Neck Surgery, 533 Bolivar Street, Suite 566, New Orleans, LA 70112, USA; Our Lady of the Lake Regional Medical Center, Voice Center, 4950 Essen Ln Ste 401, Baton Rouge, LA 70809, USA
| | - Andrew McWhorter
- Louisiana State University Health Science Center, New Orleans - Department of Otolaryngology, Head and Neck Surgery, 533 Bolivar Street, Suite 566, New Orleans, LA 70112, USA; Our Lady of the Lake Regional Medical Center, Voice Center, 4950 Essen Ln Ste 401, Baton Rouge, LA 70809, USA
| | - Melda Kunduk
- Our Lady of the Lake Regional Medical Center, Voice Center, 4950 Essen Ln Ste 401, Baton Rouge, LA 70809, USA; Louisiana State University Department of Communication Sciences and Disorders, Louisiana State University, 68 Hatcher Hall, Field House Drive, Baton Rouge, LA 70803, USA
| | - Michael Dunham
- Louisiana State University Health Science Center, New Orleans - Department of Otolaryngology, Head and Neck Surgery, 533 Bolivar Street, Suite 566, New Orleans, LA 70112, USA; Our Lady of the Lake Children's Hospital, 8200 Constanin Blvd, Floor 3, Baton Rouge, LA 70809, USA
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12
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Bridges S, Thomas B, Radhakrishna G, Hawkins M, Holborow A, Hurt C, Mukherjee S, Nixon L, Crosby T, Gwynne S. SCOPE 2 - Still Answering the Unanswered Questions in Oesophageal Radiotherapy? SCOPE 2: a Randomised Phase II/III Trial to Study Radiotherapy Dose Escalation in Patients with Oesophageal Cancer Treated with Definitive Chemoradiation with an Embedded Phase II Trial for Patients with a Poor Early Response using Positron Emission Tomography/Computed Tomography. Clin Oncol (R Coll Radiol) 2022; 34:e269-e280. [PMID: 35466013 DOI: 10.1016/j.clon.2022.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/01/2022] [Accepted: 03/23/2022] [Indexed: 12/18/2022]
Abstract
The SCOPE 2 trial of definitive chemoradiotherapy in oesophageal cancer investigates the benefits of radiotherapy dose escalation and systemic therapy optimisation. The trial opened in 2016. The landscape of oesophageal cancer treatment over the lifetime of this trial has changed significantly and the protocol has evolved to reflect this. However, with the recent results of the Dutch phase III ART DECO study showing no improvement in local control or overall survival with radiotherapy dose escalation in a similar patient group, we sought to determine if the SCOPE 2 trial is still answering the key unanswered questions for oesophageal radiotherapy. Here we discuss the rationale behind the SCOPE 2 trial, outline the trial schema and review current data on dose escalation and outline recommendations for future areas of research.
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Affiliation(s)
- S Bridges
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - B Thomas
- Velindre University NHS Trust, Cardiff, UK.
| | | | - M Hawkins
- University College London, Medical Physics and Biomedical Engineering, London, UK
| | - A Holborow
- South West Wales Cancer Centre, Swansea, UK
| | - C Hurt
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - S Mukherjee
- Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - L Nixon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - T Crosby
- Velindre University NHS Trust, Cardiff, UK
| | - S Gwynne
- South West Wales Cancer Centre, Swansea, UK; Swansea University Medical School, Swansea, UK
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13
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O'Keeffe R, Shirazi SY, Mehrdad S, Crosby T, Johnson AM, Atashzar SF. Perilaryngeal-Cranial Functional Muscle Network Differentiates Vocal Tasks: A Multi-Channel sEMG Approach. IEEE Trans Biomed Eng 2022; 69:3678-3688. [PMID: 35594214 DOI: 10.1109/tbme.2022.3175948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Objective evaluation of physiological responses using non-invasive methods for the assessment of vocal performance and voice disorders has attracted great interest. This paper, for the first time, aims to implement and evaluate perilaryngeal-cranial functional muscle networks. The study investigates the variations in topographical characteristics of the network and the corresponding ability to differentiate vocal tasks. METHOD Twelve surface electromyography (sEMG) signals were collected bilaterally from six perilaryngeal and cranial muscles. Data were collected from eight subjects (four females) without a known history of voice disorders. The proposed muscle network is composed of pairwise coherence between sEMG recordings. The network metrics include (a) network degree and (b) weighted clustering coefficient (WCC). RESULTS The varied phonation tasks showed the median degree and WCC of the muscle network ascend monotonically, with a high effect size ( |rrb| ∼ 0.5). Pitch glide, singing, and speech tasks were significantly distinguishable using degree and WCC ( |rrb| ∼ 0.8). Also, pitch glide had the highest degree and WCC among all tasks (degree , WCC ). In comparison, classic spectrotemporal measures showed far less effectiveness (max |rrb|=0.12) in differentiating the vocal tasks. CONCLUSION Perilaryngeal-cranial functional muscle network was proposed in this paper. The study showed that the functional muscle network could robustly differentiate the vocal tasks while the classic assessment of muscle activation fails to differentiate. SIGNIFICANCE For the first time, we demonstrate the power of a perilaryngeal-cranial muscle network as a neurophysiological window to vocal performance. In addition, the study also discovers tasks with the highest network involvement, which may be utilized in the future to monitor voice disorders and rehabilitation.
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14
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Foley KG, Franklin J, Jones CM, Coles B, Roberts SA, Underwood TJ, Crosby T. The impact of endoscopic ultrasound on the management and outcome of patients with oesophageal cancer: an update of a systematic review. Clin Radiol 2022; 77:e346-e355. [PMID: 35289292 DOI: 10.1016/j.crad.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 02/01/2022] [Indexed: 11/30/2022]
Abstract
AIM To provide an updated systematic review concerning the impact of endoscopic ultrasound (EUS) in the modern era of oesophageal cancer staging. MATERIALS AND METHODS To update the previous systematic review, databases including MEDLINE and EMBASE were searched and studies published from 2005 onwards were selected. Studies reporting primary data in patients with oesophageal or gastro-oesophageal junction cancer who underwent radiological staging and treatment, regardless of intent, were included. The primary outcome was the reported change in management after EUS. Secondary outcomes were recurrence rate and overall survival. Two reviewers extracted data from included articles. This study was registered with PROSPERO (CRD42021231852). RESULTS Eighteen studies with 11,836 patients were included comprising 2,805 patients (23.7%) who underwent EUS compared to 9,031 (76.3%) without EUS examination. Reported change of management varied widely from 0% to 56%. When used, EUS fine-needle aspiration precluded curative treatment in 37.5%-71.4%. Overall survival improvements ranged between 121 and 639 days following EUS intervention compared to patients without EUS. Smaller effect sizes were observed in a randomised controlled trial, compared to larger differences reported in observational studies. CONCLUSION Current evidence for the effectiveness of EUS in oesophageal cancer pathways is conflicting and of limited quality. In particular, the extent to which EUS adds value to contemporary cross-sectional imaging techniques is unclear and requires formal re-evaluation.
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Affiliation(s)
- K G Foley
- Department of Clinical Radiology, Royal Glamorgan Hospital, Llantrisant, UK; Department of Clinical Radiology, Velindre Cancer Centre, Cardiff, UK.
| | - J Franklin
- Institute of Medical Imaging and Visualisation, Bournemouth University, UK
| | - C M Jones
- Department of Clinical Oncology, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - B Coles
- Velindre University NHS Trust Library & Knowledge Service, Cardiff University, UK
| | - S A Roberts
- Department of Clinical Radiology, University Hospital of Wales, Cardiff, UK
| | - T J Underwood
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, UK
| | - T Crosby
- Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK
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15
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Rahman SA, Maynard N, Trudgill N, Crosby T, Park M, Wahedally H, Underwood TJ, Cromwell DA. Prediction of long-term survival after gastrectomy using random survival forests. Br J Surg 2021; 108:1341-1350. [PMID: 34297818 PMCID: PMC10364915 DOI: 10.1093/bjs/znab237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND No well validated and contemporaneous tools for personalized prognostication of gastric adenocarcinoma exist. This study aimed to derive and validate a prognostic model for overall survival after surgery for gastric adenocarcinoma using a large national dataset. METHODS National audit data from England and Wales were used to identify patients who underwent a potentially curative gastrectomy for adenocarcinoma of the stomach. A total of 2931 patients were included and 29 clinical and pathological variables were considered for their impact on survival. A non-linear random survival forest methodology was then trained and validated internally using bootstrapping with calibration and discrimination (time-dependent area under the receiver operator curve (tAUC)) assessed. RESULTS The median survival of the cohort was 69 months, with a 5-year survival of 53.2 per cent. Ten variables were found to influence survival significantly and were included in the final model, with the most important being lymph node positivity, pT stage and achieving an R0 resection. Patient characteristics including ASA grade and age were also influential. On validation the model achieved excellent performance with a 5-year tAUC of 0.80 (95 per cent c.i. 0.78 to 0.82) and good agreement between observed and predicted survival probabilities. A wide spread of predictions for 3-year (14.8-98.3 (i.q.r. 43.2-84.4) per cent) and 5-year (9.4-96.1 (i.q.r. 31.7-73.8) per cent) survival were seen. CONCLUSIONS A prognostic model for survival after a potentially curative resection for gastric adenocarcinoma was derived and exhibited excellent discrimination and calibration of predictions.
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Affiliation(s)
- S A Rahman
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - N Maynard
- Oxford University Hospitals NHS Trust, Oxford, UK
| | - N Trudgill
- Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - T Crosby
- Velindre Cancer Centre, Cardiff, UK
| | - M Park
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - H Wahedally
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
| | - T J Underwood
- School of Cancer Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK
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16
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Mukherjee S, O'Connor H, Harman R, O'Donovan M, Debiram-Beecham I, Alias B, Bailey A, Bateman A, de Caestecker J, Crosby T, Falk S, Gollins S, Hawkins M, Levy S, Radhakrishna G, Roy R, Sripadam R, Fitzgerald R. P-109 CYTOFLOC: Evaluation of a non-endoscopic immunocytological device (Cytosponge™) for post-chemo-radiotherapy surveillance in patients with oesophageal cancer – a feasibility study. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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17
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Rahman SA, Walker RC, Crosby T, Maynard N, Cromwell DA, Underwood TJ. O14: RANDOM FOREST MODELS FOR PREDICTING SURVIVAL AFTER OESOPHAGECTOMY. Br J Surg 2021. [DOI: 10.1093/bjs/znab117.014] [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: 11/12/2022]
Abstract
Abstract
Introduction
For patients with oesophageal cancer, producing accurate prediction models for survival after oesophagectomy has proved challenging. We investigated whether Random Survival Forests (RSF), a novel machine learning method, could produce an accurate prognostic model for overall survival after oesophagectomy.
Method
The study used data from the National Oesophago-Gastric Cancer Audit and included patients diagnosed with oesophageal adenocarcinoma or squamous cell carcinoma between 2012 and 2018 in England and Wales and who underwent a curative oesophagectomy with adequate lymphadenectomy (15 LN) and survived to discharge (n=6198). Missing data was handled using multiple imputation and the data was split into training and validation cohorts. 13 variables were selected for inclusion using Random Forest variable importance and used to train the final model. The same variables were used to develop a traditional Cox regression model.
Result
Median survival was 53 months in both cohorts. The final RSF model had good discrimination in the validation cohort with a C-index of 0.757(0.755-0.759), exceeding the Cox model; 0.748(0.746-0.750). At 3 years post-surgery, overall survival was 56.2%. The RSF yielded a mean predicted survival of 55.8%(IQR 29.5%-81.7%) compared to 55.4%(40.0%-77.7%) for the Cox model. The most important variables were lymph node involvement and pT/ypT stage, however other variables including neoadjuvant treatment completion and surgical complications were also found to be important.
Conculsion
A Random Forest survival model provided better performance in predicting survival after curative oesophagectomy. This will allow more personalised predictions to be delivered clinicians and patients.
Take-home message
Random Forest survival models can accurately predict post-operative prognosis after oesophagectomy.
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Affiliation(s)
- SA Rahman
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton
| | - RC Walker
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton
| | | | - N Maynard
- Oxford University Hospitals NHS Foundation Trust
| | - DA Cromwell
- Clinical Effectiveness Unit, Royal College of Surgeons of England
| | - TJ Underwood
- Cancer Sciences Unit, Faculty of Medicine, University of Southampton
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18
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Jones CM, Hawkins M, Mukherjee S, Radhakrishna G, Crosby T. Corrigendum to "Considerations for the Treatment of Oesophageal Cancer with Radiotherapy During the COVID-19 Pandemic" [Clin Oncol 32 (2020) 354-357]. Clin Oncol (R Coll Radiol) 2021; 33:e362. [PMID: 33795184 PMCID: PMC8436418 DOI: 10.1016/j.clon.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- C M Jones
- School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Hawkins
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - G Radhakrishna
- Christie Hospital, The Christie NHS Foundation Trust, Manchester, UK
| | - T Crosby
- Velindre Cancer Centre, Cardiff, UK.
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19
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Crosby T, McWhorter A, McDaniel L, Kunduk M, Adkins L. Predicting Need for Surgery in Recurrent Laryngotracheal Stenosis Using Changes in Spirometry. Laryngoscope 2020; 131:2199-2203. [PMID: 33152152 DOI: 10.1002/lary.29239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS We sought to identify changes that occur in spirometric values between surgical interventions in patients with recurrent laryngotracheal stenosis and assess the utility of tracking those changes in predicting the need to return to surgery. METHODS This is a retrospective, case-control study of laryngotracheal stenosis. Charts from a 10 year period were reviewed, and 80 patients were identified with recurrent laryngotracheal stenosis and serial spirometry. Recorded forced expiratory volume in 1 second (FEV1 ), forced inspiratory volume in 1 second (FIV1 ), peak expiratory flow (PEF), and peak inspiratory flow (PIF), and body mass index (BMI) were tabulated. Calculations were then performed to determine deviations in spirometric measurements from maximums. Comparing the patients who required intervention to those who did not, we used a regression analysis to generate a decision tree based on factors with the strongest predictive power. We then calculated receiver operating characteristic (ROC) curves for all calculated variables. RESULTS Deviations in PEF, PIF, and FIV1 from each patient's maximums had strong predictive power in determining return to surgery. PIF was the only fixed measurement found to have a statistically significant role in predicting return to surgery. BMI did not play a role. CONCLUSION For each patient, the deviation from their overall spirometric maximums had the statistically strongest predictive power in determining need to return to surgery. This suggests the importance of the trends in spirometric measures for each individual, and implies these trends have greater import than fixed measures alone. LEVEL OF EVIDENCE 4 Laryngoscope, 131:2199-2203, 2021.
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Affiliation(s)
- Tyler Crosby
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana, U.S.A
| | - Andrew McWhorter
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana, U.S.A.,Voice Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, U.S.A
| | - Lee McDaniel
- School of Public Health, Louisiana State University Health Science Center, New Orleans, Louisiana, U.S.A
| | - Melda Kunduk
- Voice Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, U.S.A.,Department of Communication Sciences and Disorders, Louisiana State University, Baton Rouge, Louisiana, U.S.A
| | - Lacey Adkins
- Department of Otolaryngology, Head and Neck Surgery, Louisiana State University Health Science Center, New Orleans, Louisiana, U.S.A.,Voice Center, Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana, U.S.A
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20
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Nicholas O, Radhakrishna G, Banner R, Mukherjee S, Hawkins M, Crosby T, Gwynne S. PO-1037: A new nodal delineation protocol for upper third oesophageal cancers in the SCOPE 2 trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01054-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Shi Z, Zhang C, Kalendralis P, Whybra P, Parkinson C, Berbee M, Spezi E, Roberts A, Christian A, Crosby T, Dekker A, Wee L, Foley K. PO-1532: Prediction of Lymph Node Metastases via PET Radiomics of Primary Tumour in Esophageal Adenocarcinoma. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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22
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Shaw P, Wills L, Jones S, Lamont H, Morgan C, Crosby T, Radhakrishna G. Flip-flop Oesophageal Movement During Radical Radiotherapy for Oesophageal Malignancy. Clin Oncol (R Coll Radiol) 2020; 32:e214-e215. [PMID: 32682687 DOI: 10.1016/j.clon.2020.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/03/2020] [Indexed: 10/23/2022]
Affiliation(s)
- P Shaw
- Velindre Cancer Centre, Cardiff, UK
| | - L Wills
- Velindre Cancer Centre, Cardiff, UK
| | - S Jones
- Velindre Cancer Centre, Cardiff, UK
| | - H Lamont
- The Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - C Morgan
- Velindre Cancer Centre, Cardiff, UK
| | - T Crosby
- Velindre Cancer Centre, Cardiff, UK
| | - G Radhakrishna
- The Christie Hospital, Withington, Greater Manchester, UK
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23
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Jones CM, Hawkins M, Mukherjee S, Radhakrishna G, Crosby T. Considerations for the Treatment of Oesophageal Cancer With Radiotherapy During the COVID-19 Pandemic. Clin Oncol (R Coll Radiol) 2020; 32:354-357. [PMID: 32299723 PMCID: PMC7144663 DOI: 10.1016/j.clon.2020.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 02/07/2023]
Affiliation(s)
- C M Jones
- School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Radiotherapy Research Group, Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Hawkins
- Department of Medical Physics & Biomedical Engineering, University College London, London, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - G Radhakrishna
- Christie Hospital, The Christie NHS Foundation Trust, Manchester, UK
| | - T Crosby
- Velindre Cancer Centre, Cardiff, UK.
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24
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Owens R, Radhakrishna G, Crosby T, Mukherjee S. The Changing Face of Chemoradiotherapy Practice for Oesophageal Cancer: Responses to a UK-wide Questionnaire. Clin Oncol (R Coll Radiol) 2019; 31:e119. [DOI: 10.1016/j.clon.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 11/25/2022]
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25
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Levy S, Moschandreas J, Debiram-Beecham I, O’Donovan M, Brooks C, Bailey A, Hawkins M, Kadri S, de Caestecker J, Crosby T, Fitzgerald R, Mukherjee S. Cytosponge™ for post‐chemoradiation surveillance of oesophageal cancer: a feasibility study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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26
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Jones CM, Spencer K, Hitchen C, Pelly T, Wood B, Hatfield P, Crellin A, Sebag-Montefiore D, Goody R, Crosby T, Radhakrishna G. Hypofractionated Radiotherapy in Oesophageal Cancer for Patients Unfit for Systemic Therapy: A Retrospective Single-Centre Analysis. Clin Oncol (R Coll Radiol) 2019; 31:356-364. [PMID: 30737068 DOI: 10.1016/j.clon.2019.01.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 11/24/2018] [Accepted: 12/06/2018] [Indexed: 02/06/2023]
Abstract
AIMS Chemoradiotherapy (CRT) is established as a superior treatment option to definitive radiotherapy in the non-surgical management of oesophageal cancer. For patients precluded from CRT through choice or comorbidity there is little evidence to guide delivery of single-modality radiotherapy. In this study we outline outcomes for patients unfit for CRT who received a hypofractionated radiotherapy (HRT) regimen. MATERIALS AND METHODS A retrospective UK single-centre analysis of 61 consecutive patients with lower- or middle-third adenocarcinoma (OAC; 61%) or squamous cell carcinoma of the oesophagus managed using HRT with radical intent between April 2009 and 2014. Treatment consisted of 50 Gy in 16 fractions (n = 49, 80.3%) or 50-52.5 Gy in 20 fractions (n = 12, 19.7%). Outcomes were referenced against a contemporaneous comparator cohort of 80 (54% OAC) consecutive patients managed with conventionally fractionated CRT within the same centre. RESULTS Three-year and median overall survival were, respectively, 56.9% and 29 months with HRT compared with 55.5% and 26 months for CRT; adjusted hazard ratio 0.79 (95% confidence interval 0.48-1.28). Grade 3 and 4 toxicity rates were low at 16.4% (n = 10) for those receiving HRT and 40.2% (n = 32) for the CRT group. In patients with OAC, CRT delivered superior overall survival (hazard ratio 0.46; 95% confidence interval 0.25-0.85) and progression-free survival (hazard ratio 0.45; 95% confidence interval 0.23-0.88) when compared with HRT. CONCLUSIONS The HRT regimen described here was safe and tolerable in patients unable to receive CRT, and delivered promising survival outcomes. The use of HRT for the treatment of oesophageal cancer, both alone and as a sequential or concurrent treatment with chemotherapy, requires further study. New precision radiotherapy technologies may provide additional scope for improving outcomes in oesophageal cancer using HRT-based approaches and should be evaluated.
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Affiliation(s)
- C M Jones
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; School of Molecular & Cellular Biology, Faculty of Biological Sciences, University of Leeds, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - K Spencer
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK; Leeds Institute of Health Sciences, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - C Hitchen
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - T Pelly
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - B Wood
- School of Medicine, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - P Hatfield
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Crellin
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Sebag-Montefiore
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK; Leeds Institute of Medical Research at St James's, Faculty of Medicine & Health, University of Leeds, Leeds, UK
| | - R Goody
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
| | - G Radhakrishna
- Radiotherapy Research Group, Leeds Cancer Centre, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
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Cox S, Gwynne S, Staffurth J, Crosby T. OC-0416 Assessing the quality of oesophageal cancer target volume delineation in the SCOPE1 trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30836-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gwynne S, Higgins E, Poon King A, Radhakrishna G, Wills L, Mukherjee S, Hawkins M, Jones G, Staffurth J, Crosby T. Driving developments in UK oesophageal radiotherapy through the SCOPE trials. Radiat Oncol 2019; 14:26. [PMID: 30717810 PMCID: PMC6360789 DOI: 10.1186/s13014-019-1225-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 01/20/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SCOPE trials (SCOPE 1, NeoSCOPE and SCOPE 2) have been the backbone of oesophageal RT trials in the UK. Many changes in oesophageal RT techniques have taken place in this time. The SCOPE trials have, in addition to adopting these new techniques, been influential in aiding centres with their implementation. We discuss the progress made through the SCOPE trials and include details of a questionnaire sent to participating centres. to establish the role that trial participation played in RT changes in their centre. METHODS Questionnaires were sent to 47 centres, 27 were returned. RESULTS 100% of centres stated their departmental protocol for TVD was based on the relevant SCOPE trial protocol. 4DCT use has increased from 42 to 71%. Type B planning algorithms, mandated in the NeoSCOPE trial, were used in 79.9% pre NeoSCOPE and now in 83.3%. 12.5% of centres were using a stomach filling protocol pre NeoSCOPE, now risen to 50%. CBCT was mandated for IGRT in the NeoSCOPE trial. 66.7% used this routinely pre NeoSCOPE/SCOPE 2 which has risen to 87.5% in the survey. CONCLUSION The results of the questionnaires show how participation in national oesophageal RT trials has led to the adoption of newer RT techniques in UK centres, leading to better patient care.
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Affiliation(s)
- S. Gwynne
- South West Wales Cancer Centre, Swansea, UK
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - E. Higgins
- South West Wales Cancer Centre, Swansea, UK
| | | | | | - L. Wills
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - S. Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - Maria Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - G. Jones
- NIHR Cardiff RTTQA Group, Cardiff, UK
| | - J. Staffurth
- NIHR Cardiff RTTQA Group, Cardiff, UK
- Cardiff University, Cardiff, UK
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Smyth E, Kouvelakis K, Cunningham D, Hahne J, Peckitt C, Vlachogiannis G, Watkins D, Rao S, Starling N, Wilson S, Waddell T, Okines A, Crosby T, Mansoor W, Wadsley J, Middleton G, Wotherspoon A, Chau I, Valeri N. EGFR amplification (amp) and survival in the REAL-3 trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cox S, Jones G, Radhakrishna G, Mukherjee S, Hawkins M, Crosby T, Gwynne S. PO-1080: 4DCT oesophageal tumour delineation in SCOPE2 – how is radiotherapy quality assurance beneficial? Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Gwynne S, Higgins E, Poon King A, Radhakrishna G, Jones G, Wills L, Crosby T. PO-0760: SCOPE trial involvement as driver of oesophageal radiotherapy developments in UK centres. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31070-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Shi Z, Wee L, Foley K, Spezi E, Whybra P, Crosby T, Pablo de Mey J, Van Soest J, Dekker A. PV-0318: External Validation of Radiation-Induced Dyspnea Models on Esophageal Cancer Radiotherapy Patients. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30628-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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33
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Evans E, Jones G, Rackley T, Maggs R, Radhakrishna G, Mukherjee S, Hawkins M, Crosby T, Gwynne S. PO-0769: NeoSCOPE RTTQA: pre-accrual and on-trial review of all patients in a UK oesophageal RT trial. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31079-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Reynolds JV, Preston SR, O’Neill B, Baeksgaard L, Griffin SM, Mariette C, Cuffe S, Cunningham M, Crosby T, Parker I, Hofland K, Hanna G, Svendsen LB, Donohoe CL, Muldoon C, O’Toole D, Johnson C, Ravi N, Jones G, Corkhill AK, Illsley M, Mellor J, Lee K, Dib M, Marchesin V, Cunnane M, Scott K, Lawner P, Warren S, O’Reilly S, O’Dowd G, Leonard G, Hennessy B, Dermott RM. ICORG 10-14: NEOadjuvant trial in Adenocarcinoma of the oEsophagus and oesophagoGastric junction International Study (Neo-AEGIS). BMC Cancer 2017; 17:401. [PMID: 28578652 PMCID: PMC5457631 DOI: 10.1186/s12885-017-3386-2] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/25/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Neoadjuvant therapy is increasingly the standard of care in the management of locally advanced adenocarcinoma of the oesophagus and junction (AEG). In randomised controlled trials (RCTs), the MAGIC regimen of pre- and postoperative chemotherapy, and the CROSS regimen of preoperative chemotherapy combined with radiation, were superior to surgery only in RCTs that included AEG but were not powered on this cohort. No completed RCT has directly compared neoadjuvant or perioperative chemotherapy and neoadjuvant chemoradiation. The Neo-AEGIS trial, uniquely powered on AEG, and including comprehensive modern staging, compares both these regimens. METHODS This open label, multicentre, phase III RCT randomises patients (cT2-3, N0-3, M0) in a 1:1 fashion to receive CROSS protocol (Carboplatin and Paclitaxel with concurrent radiotherapy, 41.4Gy/23Fr, over 5 weeks). The power calculation is a 10% difference in favour of CROSS, powered at 80%, two-sided alpha level of 0.05, requiring 540 patients to be evaluable, 594 to be recruited if a 10% dropout is included (297 in each group). The primary endpoint is overall survival, with a minimum 3-year follow up. Secondary endpoints include: disease free survival, recurrence rates, clinical and pathological response rates, toxicities of induction regimens, post-operative pathology and tumour regression grade, operative in-hospital complications, and health-related quality of life. The trial also affords opportunities for establishing a bio-resource of pre-treatment and resected tumour, and translational research. DISCUSSION This RCT directly compares two established treatment regimens, and addresses whether radiation therapy positively impacts on overall survival compared with a standard perioperative chemotherapy regimen Sponsor: Irish Clinical Research Group (ICORG). TRIAL REGISTRATION NCT01726452 . Protocol 10-14. Date of registration 06/11/2012.
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Affiliation(s)
- JV Reynolds
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - SR Preston
- Royal Surrey County Hospital, Guildford, UK
| | | | | | | | - C Mariette
- University Hospital C. Huriez Place de Verdun, Lille, France
| | - S Cuffe
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - M Cunningham
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - T Crosby
- Velindre Cancer Centre, Cardiff, Wales UK
| | - I Parker
- St Mary’s Hospital and Imperial College London, London, UK
| | | | - G Hanna
- St Mary’s Hospital and Imperial College London, London, UK
| | | | - CL Donohoe
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - C Muldoon
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - D O’Toole
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - C Johnson
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - N Ravi
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - G Jones
- Velindre Cancer Centre, Cardiff, Wales UK
| | - AK Corkhill
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - M Illsley
- Royal Surrey County Hospital, Guildford, UK
| | - J Mellor
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - K Lee
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - M Dib
- University Hospital C. Huriez Place de Verdun, Lille, France
| | - V Marchesin
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - M Cunnane
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - K Scott
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - P Lawner
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - S Warren
- St. James’s Hospital and Trinity College Dublin, Dublin, Ireland
| | - S O’Reilly
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - G O’Dowd
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - G Leonard
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - B Hennessy
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
| | - R Mc Dermott
- Irish Clinical Oncology Research Group (ICORG), Dublin, Ireland
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Hurt CN, Falk S, Crosby T, McDonald A, Ray R, Joseph G, Staffurth J, Abrams RA, Griffiths G, Maughan T, Mukherjee S. Long-term results and recurrence patterns from SCALOP: a phase II randomised trial of gemcitabine- or capecitabine-based chemoradiation for locally advanced pancreatic cancer. Br J Cancer 2017; 116:1264-1270. [PMID: 28376080 PMCID: PMC5482737 DOI: 10.1038/bjc.2017.95] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 03/07/2017] [Accepted: 03/17/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND SCALOP, a randomised, phase II trial, tested the activity and safety of gemcitabine (GEM)-based and capecitabine (CAP)-based chemoradiation (CRT) for locally advanced pancreatic cancer (LAPC). Here we present the long-term outcomes. METHODS Eligibility: histologically proven LAPC ⩽7 cm. Following 12 weeks of induction GEMCAP chemotherapy (three cycles: GEM 1000 mg m-2 days 1, 8, 15; CAP 830 mg m-2 days 1-21 q28 days) patients with stable/responding disease, tumour ⩽6 cm, and WHO Performance Status 0-1 were randomised to receive one cycle GEMCAP followed by CAP (830 mg m-2 b.d. on weekdays only) or GEM (300 mg m-2 weekly) with radiation (50.4 Gy per 28 fractions). RESULTS One-hundred fourteen patients (28 UK centres) were registered between 24 December 2009 and 25 October 2011, and 74 were randomised (CAP-RT=36; GEM-RT=38). At the time of this analysis, 105 of the 114 patients had died and the surviving 9 patients had been followed up for a median of 10.9 months (IQR: 2.9-18.7). Updated median OS was 17.6 months (95% CI: 14.6-22.7) in the CAP-CRT arm and 14.6 months (95% CI: 11.1-16.0) in the GEM-CRT arm (intention-to-treat adjusted hazard ratio (HR): 0.68 (95% CI: 0.38-1.21, P=0.185)); median progression-free survival (PFS) was 12.0 months (95% CI: 10.0-15.2) in the CAP-CRT arm and 10.4 months (95% CI: 8.8-12.7) in the GEM-CRT arm (intention-to-treat adjusted HR: 0.60 (95% CI: 0.32-1.14, P=0.120)). In baseline multivariable model, age ⩾65 years, better performance status, CA19.9<613 IU l-1, and shorter tumour diameter predicted improved OS. CAP-CRT, age ⩾65 years, better performance status, CA19.9 <46 IU ml-1 predicted improved OS and PFS in the pre-radiotherapy model. Nine-month PFS was highly predictive of OS. CONCLUSIONS CAP-CRT remains the superior regimen. SCALOP showed that patients with CA19.9 <46 IU ml-1 after induction chemotherapy are more likely to benefit from CRT.
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Affiliation(s)
- C N Hurt
- Centre for Trials Research, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - S Falk
- Bristol Haematology and Oncology Centre, Bristol BS2 8ED, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Velindre Road, Cardiff CF14 2TL, UK
| | - A McDonald
- Beatson West of Scotland Cancer Centre, 1053 Great Western Road, Glasgow G12 0YN, UK
| | - R Ray
- Centre for Trials Research, Cardiff University, 6th Floor, Neuadd Meirionnydd, Heath Park, Cardiff CF14 4YS, UK
| | - G Joseph
- Velindre Cancer Centre, Velindre Hospital, Velindre Road, Cardiff CF14 2TL, UK
| | - J Staffurth
- Velindre Cancer Centre, Velindre Hospital, Velindre Road, Cardiff CF14 2TL, UK
| | - R A Abrams
- Department of Radiation Oncology, Rush University Medical Center, 500 S. Paulina, 013 Atrium Building, Chicago, IL 60612, USA
| | - G Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK
| | - T Maughan
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, Oxford University, Oxford OX3 7DQ, UK
| | - S Mukherjee
- CRUK MRC Oxford Institute for Radiation Oncology Gray Laboratories, Oxford University, Oxford OX3 7DQ, UK
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Foley K, Hills R, Berthon B, Marshall C, Lewis W, Crosby T, Spezi E, Roberts A. PV-0323: Development of a prognostic model incorporating PET texture analysis in oesophageal cancer patients. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30765-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Crosby T, Hurt CN, Falk S, Gollins S, Staffurth J, Ray R, Bridgewater JA, Geh JI, Cunningham D, Blazeby J, Roy R, Maughan T, Griffiths G, Mukherjee S. Long-term results and recurrence patterns from SCOPE-1: a phase II/III randomised trial of definitive chemoradiotherapy +/- cetuximab in oesophageal cancer. Br J Cancer 2017; 116:709-716. [PMID: 28196063 PMCID: PMC5355926 DOI: 10.1038/bjc.2017.21] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/03/2017] [Accepted: 01/16/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The SCOPE-1 study tested the role of adding cetuximab to conventional definitive chemoradiotherapy (dCRT), and demonstrated greater toxicity and worse survival outcomes. We present the long-term outcomes and patterns of recurrence. METHODS SCOPE-1 was a phase II/III trial in which patients were randomised to cisplatin 60 mg m-2 (day 1) and capecitabine 625 mg m-2 bd (days 1-21) for four cycles +/- cetuximab 400 mg m-2 day 1 then by 250 mg m-2 weekly. Radiotherapy consisted of 50 Gy/25# given concurrently with cycles 3 and 4. Recruitment was between February 2008 and February 2012, when the IDMC recommended closure on the basis of futility. RESULTS About 258 patients (dCRT=129; dCRT+cetuximab (dCRT+C)=129) were recruited from 36 centres. About 72.9% (n=188) had squamous cell histology. The median follow-up (IQR) was 46.2 (35.9-48.3) months for surviving patients. The median overall survival (OS; months; 95% CI) was 34.5 (24.7-42.3) in dCRT and 24.7 (18.6-31.3) in dCRT+C (hazard ratio (HR)=1.25, 95% CIs: 0.93-1.69, P=0.137). Median progression-free survival (PFS; months; 95% CI) was 24.1 (15.3-29.9) and 15.9 (10.7-20.8) months, respectively (HR=1.28, 95% CIs: 0.94-1.75; P=0.114). On multivariable analysis only earlier stage, full-dose RT, and higher cisplatin dose intensity were associated with improved OS. CONCLUSIONS The mature analysis demonstrates that the dCRT regimen used in the study provided useful survival outcomes despite its use in patients who were largely unfit for surgery or who had inoperable disease. Given the competing risk of systemic and local failure, future studies should continue to focus on enhancing local control as well as optimising systemic therapy.
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Affiliation(s)
- T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff CF14 2TL, UK
| | - C N Hurt
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - S Falk
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8ED, UK
| | - S Gollins
- North Wales Cancer Treatment Centre, Conwy and Denbighshire NHS Trust, Rhyl LL18 5UJ, UK
| | - J Staffurth
- Velindre Cancer Centre, Velindre Hospital, Cardiff CF14 2TL, UK
| | - R Ray
- Wales Cancer Trials Unit, Cardiff University, Cardiff CF14 4YS, UK
| | - J A Bridgewater
- UCL Cancer Institute, University College London, London WC1E 6BT, UK
| | - J I Geh
- Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust Birmingham B15 2GW, UK
| | - D Cunningham
- The Royal Marsden Hospital NHS Foundation Trust, London SM2 5PT, UK
| | - J Blazeby
- Centre for Surgical Research, University of Bristol, Bristol BS8 2PS, UK
| | - R Roy
- Diana Princess of Wales Hospital, Northern Lincolnshire and Goole NHS Foundation Trust, Grimsby DN33 2BA, UK
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
| | - G Griffiths
- Southampton Clinical Trials Unit, University of Southampton, Southampton SO16 6YD, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford OX3 7DQ, UK
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Meyer T, Qian W, Valle J, Talbot D, Cunningham D, Reed N, Wall L, Waters J, Ross P, Anthoney A, Sumpter K, Sarwar N, Crosby T, Begum N, Young G, Hardy R, Corrie P. Capecitabine and streptozocin ± cisplatin for gastroenteropancreatic neuroendocrine tumours: predictors of long-term survival in the NET01 trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw369.31] [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: 11/13/2022] Open
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Smyth E, Rowley S, Allum W, Stenning S, Wotherspoon A, Robb C, Grabsch H, Alderson D, Crosby T, Mason R, Griffin M, Mansoor W, Darby S, Seymour M, Thompson J, Sothi S, Sumpter K, Blazeby J, Langley R, Cunningham D. A randomised phase II study of perioperative epirubicin, cisplatin and capecitabine (ECX) ± lapatinib for operable, HER-2 positive gastric, oesophagogastric junctional (OGJ) or lower oesophageal adenocarcinoma: Results from the UK MRC ST03 lapatinib feasibility study (ISRCTN 46020948). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.17] [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: 11/13/2022] Open
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Ward G, Ramasamy S, Sykes JR, Prestwich R, Chowdhury F, Scarsbrook A, Murray P, Harris K, Crellin A, Hatfield P, Sebag-Montefiore D, Spezi E, Crosby T, Radhakrishna G. Superiority of Deformable Image Co-registration in the Integration of Diagnostic Positron Emission Tomography-Computed Tomography to the Radiotherapy Treatment Planning Pathway for Oesophageal Carcinoma. Clin Oncol (R Coll Radiol) 2016; 28:655-62. [PMID: 27266819 DOI: 10.1016/j.clon.2016.05.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 11/26/2022]
Abstract
AIMS To investigate the use of image co-registration in incorporating diagnostic positron emission tomography-computed tomography (PET-CT) directly into the radiotherapy treatment planning pathway, and to describe the pattern of local recurrence relative to the PET-avid volume. MATERIALS AND METHODS Fourteen patients were retrospectively identified, six of whom had local recurrence. The accuracy of deformable image registration (DIR) and rigid registration of the diagnostic PET-CT and recurrence CT, to the planning CT, were quantitatively assessed by comparing co-registration of oesophagus, trachea and aorta contours. DIR was used to examine the correlation between PET-avid volumes, dosimetry and site of recurrence. RESULTS Positional metrics including the dice similarity coefficient (DSC) and conformity index (CI), showed DIR to be superior to rigid registration in the co-registration of diagnostic and recurrence imaging to the planning CT. For diagnostic PET-CT, DIR was superior to rigid registration in the transfer of oesophagus (DSC=0.75 versus 0.65, P<0.009 and CI=0.59 versus 0.48, P<0.003), trachea (DSC=0.88 versus 0.65, P<0.004 and CI=0.78 versus 0.51, P<0.0001) and aorta structures (DSC=0.93 versus 0.86, P<0.006 and CI=0.86 versus 0.76, P<0.006). For recurrence imaging, DIR was superior to rigid registration in the transfer of trachea (DSC=0.91 versus 0.66, P<0.03 and CI=0.83 versus 0.51, P<0.02) and oesophagus structures (DSC=0.74 versus 0.51, P<0.004 and CI=0.61 versus 0.37, P<0.006) with a non-significant trend for the aorta (DSC=0.91 versus 0.75, P<0.08 and CI=0.83 versus 0.63, P<0.06) structure. A mean inclusivity index of 0.93 (range 0.79-1) showed that the relapse volume was within the planning target volume (PTVPET-CT); all relapses occurred within the high dose region. CONCLUSION DIR is superior to rigid registration in the co-registration of PET-CT and recurrence CT to the planning CT, and can be considered in the direct integration of PET-CT to the treatment planning process. Local recurrences occur within the PTVPET-CT, suggesting that this is a suitable target for dose-escalation strategies.
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Affiliation(s)
- G Ward
- Medical Physics and Engineering, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - S Ramasamy
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J R Sykes
- Radiation Oncology and Medical Physics, Blacktown Hospital, Blacktown, Australia
| | - R Prestwich
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - F Chowdhury
- Clinical Radiology and Nuclear Medicine, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Scarsbrook
- Clinical Radiology and Nuclear Medicine, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Murray
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Harris
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Crellin
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - P Hatfield
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D Sebag-Montefiore
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Spezi
- Biomedical Engineering Research Group, School of Engineering, Cardiff University, Cardiff, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
| | - G Radhakrishna
- Radiation Oncology, Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Crosby T, Phillips J, Carbo A, Babcock K, Nathan CA. Use of modified barium swallow study to measure posterior airway space in obstructive sleep apnea. Acta Otolaryngol 2016; 136:592-7. [PMID: 26852777 DOI: 10.3109/00016489.2015.1136431] [Citation(s) in RCA: 4] [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] [Indexed: 11/13/2022]
Abstract
Conclusion Measurement of the posterior airway space (PAS) using modified barium swallow (MBS) appears to correlate well with CT imaging. This data suggests MBS may be a low-cost alternative imaging modality to assess obstructive sleep apnea patients. Objectives Obstructive sleep apnea research has focused on imaging modalities that supplement polysomnography in evaluation of potential sites of airway obstruction. While several techniques have been used to assess the PAS, many incur significant costs and risks to the patient. This study proposes use of MBS as a simple modality to measure PAS. Advantages include its simplicity, lower radiation, and dynamic tongue base visualization, which may help predict surgical outcomes. It is hypothesized that cephalometric measurements obtained using MBS will correlate well with CT. Methods Thirty-six adult patients who underwent both CT imaging and MBS for head and neck cancer were included. Cephalometric measurements of the PAS were obtained using each imaging modality. Statistical analysis focused on correlating measurements taken using CT and MBS. Results The average PAS measurements were 12.53 ± 1.81 mm and 12.80 ± 1.75 mm by MBS and CT imaging, respectively. In comparing the two modalities, Pearson correlation between CT and MBS measurements revealed significant positive correlations between r = 0.769 and 0.937.
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Affiliation(s)
- Tyler Crosby
- Department of Otolaryngology-Head & Neck Surgery, LSUHSC Shreveport, LA, USA
| | - Jeff Phillips
- Department of Otolaryngology-Head & Neck Surgery, LSUHSC Shreveport, LA, USA
| | | | | | - Cherie-Ann Nathan
- Department of Otolaryngology-Head & Neck Surgery, LSUHSC Shreveport, LA, USA
- Feist-Weiller Cancer Center, LSUHSC Shreveport, LA, USA
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Hurt C, Bridgewater J, Falk S, Cummins S, Wasan H, Crosby T, Radhakrishna G, Jephcott C, Roy R, McDonald A, Ray R, Joseph G, Staffurth J, Abrams R, Griffiths G, Maughan T, Mukherjee S. O-003 Long-term outcome from the SCALOP trial: a multi-centre randomized phase II trial of gemcitabine or capecitabine-based chemoradiation (CRT) for locally advanced pancreatic cancer (LAPC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw198.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Carrington R, Spezi E, Gwynne S, Staffurth J, Crosby T. PO-0711: Relating CT image heterogeneity to patient outcome in the SCOPE 1 oesophageal cancer trial. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31961-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Carrington R, Spezi E, Thomas B, Gwynne S, Crosby T, Staffurth J. EP-1794: Quantification of stomach movement using CBCT images. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33045-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Warren S, Hurt C, Crosby T, Partridge M, Hawkins M. PV-0171: Can protons reduce bone marrow toxicity in definitive chemoradiotherapy for oesophageal tumours? Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31420-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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McNair AGK, MacKichan F, Donovan JL, Brookes ST, Avery KNL, Griffin SM, Crosby T, Blazeby JM. What surgeons tell patients and what patients want to know before major cancer surgery: a qualitative study. BMC Cancer 2016; 16:258. [PMID: 27036216 PMCID: PMC4815149 DOI: 10.1186/s12885-016-2292-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 03/23/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The information surgeons impart to patients and information patients want about surgery for cancer is important but rarely examined. This study explored information provided by surgeons and patient preferences for information in consultations in which surgery for oesophageal cancer surgery was discussed. METHODS Pre-operation consultations in which oesophagectomy was discussed were studied in three United Kingdom hospitals and patients were subsequently interviewed. Consultations and interviews were audio-recorded, transcribed in full and anonymized. Interviews elicited views about the information provided by surgeons and patients' preferences for information. Thematic analysis of consultation-interview pairs was used to investigate similarities and differences in the information provided by surgeons and desired by patients. RESULTS Fifty two audio-recordings from 31 patients and 7 surgeons were obtained (25 consultations and 27 patient interviews). Six consultations were not recorded because of equipment failure and four patients declined an interview. Surgeons all provided consistent, extensive information on technical operative details and in-hospital surgical risks. Consultations rarely included discussion of the longer-term outcomes of surgery. Whilst patients accepted that information about surgery and risks was necessary, they really wanted details about long-term issues including recovery, impact on quality of life and survival. CONCLUSIONS This study demonstrated a need for surgeons to provide information of importance to patients concerning the longer term outcomes of surgery. It is proposed that "core information sets" are developed, based on surgeons' and patients' views, to use as a minimum in consultations to initiate discussion and meet information needs prior to cancer surgery.
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Affiliation(s)
- Angus G. K. McNair
- />School of Social & Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
- />Severn School of Surgery, Deanery House, Unit D, Vantage Office Park, Old Gloucester Road, Hambrook, Bristol, BS16 1GW UK
| | - F MacKichan
- />School of Social & Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - J. L. Donovan
- />School of Social & Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - S. T. Brookes
- />School of Social & Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - K. N. L. Avery
- />School of Social & Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
| | - S. M. Griffin
- />Northern Oesophago-Gastric Unit, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne, NE1 4LP UK
| | - T. Crosby
- />Department of Oncology, Velindre Hospital, Whitchurch, Cardiff, CF14 2TL UK
| | - J. M. Blazeby
- />School of Social & Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS UK
- />University Hospitals Bristol NHS Foundation Trust, Bristol, BS2 8HW UK
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Chadwick G, Riley S, Hardwick RH, Crosby T, Hoare J, Hanna G, Greenaway K, Varagunam M, Cromwell DA, Groene O. Population-based cohort study of the management and survival of patients with early-stage oesophageal adenocarcinoma in England. Br J Surg 2016; 103:544-52. [PMID: 26865114 DOI: 10.1002/bjs.10116] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 10/12/2015] [Accepted: 12/21/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Until recently, oesophagectomy was the treatment of choice for early oesophageal cancer. Endoscopic treatment has been introduced relatively recently. This observational national database study aimed to describe how endoscopic therapy has been introduced in England and to examine the safety of this approach. METHODS A population-based cohort study was undertaken of patients diagnosed with oesophageal adenocarcinoma between October 2007 and June 2009 using three linked national databases. Patients with early-stage disease (T1 tumours with no evidence of spread) were identified, along with the primary treatment modality where treatment intent was curative. Short-term outcomes after treatment and 5-year survival were evaluated. RESULTS Of 5192 patients diagnosed with oesophageal adenocarcinoma, 306 (5·9 per cent) were considered to have early-stage disease before any treatment, of whom 239 (79·9 per cent of 299 patients with data on treatment intent) were managed with curative intent. Of 175 patients who had an oesophagectomy, 114 (65·1 (95 per cent c.i. 57·6 to 72·7) per cent) survived for 5 years. Among these, 47 (30·3 per cent of 155 patients with tissue results available) had their disease upstaged after pathological staging; this occurred more often in patients who did not have staging endoscopic ultrasonography before surgery. Of 41 patients who had an endoscopic resection, 27 (66 (95 per cent c.i. 49 to 80) per cent) survived for 5 years. Repeat endoscopic therapy was required by 23 (56 per cent) of these 41 patients. CONCLUSION Between 2007 and 2009, oesophagectomy remained the initial treatment of choice (73·2 per cent) among patients with early-stage oesophageal cancer treated with curative intent; one in five patients were managed endoscopically, and this treatment was more common in elderly patients. Although the groups had different patient characteristics, 5-year survival rates were similar.
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Affiliation(s)
- G Chadwick
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Gastroenterology, St Mary's Hospital, London, UK
| | - S Riley
- Department of Gastroenterology, Northern General Hospital, Sheffield, UK
| | - R H Hardwick
- Department of Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - T Crosby
- Velindre Cancer Centre, Cardiff, UK
| | - J Hoare
- Department of Gastroenterology, St Mary's Hospital, London, UK
| | - G Hanna
- Department of Surgery and Cancer, Imperial College, London, UK
| | - K Greenaway
- Health and Social Care Information Centre, Leeds, UK
| | - M Varagunam
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK
| | - D A Cromwell
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - O Groene
- Clinical Effectiveness Unit, The Royal College of Surgeons of England, London, UK.,Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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Rees J, Hurt CN, Gollins S, Mukherjee S, Maughan T, Falk SJ, Staffurth J, Ray R, Bashir N, Geh JI, Cunningham D, Roy R, Bridgewater J, Griffiths G, Nixon LS, Blazeby JM, Crosby T. Patient-reported outcomes during and after definitive chemoradiotherapy for oesophageal cancer. Br J Cancer 2015; 113:603-10. [PMID: 26203761 PMCID: PMC4647690 DOI: 10.1038/bjc.2015.258] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 05/07/2015] [Accepted: 06/15/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Limited data describe patient-reported outcomes (PROs) of localised oesophageal cancer treated with definitive chemoradiotherapy(CRT). The phase 2/3 SCOPE-1 trial assessed the effectiveness of CRT±cetuximab. The trial for the first time provided an opportunity to describe PROs from a multi-centre group of patients treated with CRT that are presented here. METHODS Patients undergoing CRT±cetuximab within the SCOPE-1 trial (258 patients from 36 UK centres) completed generic-, disease- and treatment-specific health-related quality of life (HRQL) questionnaires (EORTC QLQ-C30, QLQ-OES18, Dermatology Life-Quality Index (DLQI)) at baseline and at 7, 13, 24, 52 and 104 weeks. Mean EORTC functional scale scores (>15 point change significant), DLQI scores (>4 point change significant) and proportions of patients (>15% significant) with 'minimal' or 'severe' symptoms are presented. RESULTS Questionnaire response rates were good. At baseline, EORTC functional scores were high (>75%) and few symptoms were reported except for severe problems with fatigue, insomnia and eating-related symptoms (e.g., appetite loss, dysphagia, dry mouth) in both groups(>15%). Functional aspects of health deteriorated and symptoms increased with treatment and by week 13 global quality of life, physical, role and social function significantly deteriorated and more problems with fatigue, dyspnoea, appetite loss and trouble with taste were reported. Recovery occurred by 6 months (except severe fatigue and insomnia in >15% of patients) and maintained at follow-up with no differences between groups. CONCLUSIONS CRT for localised oesophageal cancer has a significant detrimental impact on many aspects of HRQL; however, recovery is achieved by 6 months and maintained with the exception of persisting problems with severe fatigue and insomnia. The data suggest that the HRQL recovery after definitive CRT is quicker, and there is little lasting deficit compared with treatment including surgery. These data need to be compared with HRQL data from studies evaluating treatments including surgery for oesophageal cancer.
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Affiliation(s)
- J Rees
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - C N Hurt
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - S Gollins
- North Wales Cancer Treatment Centre, Glan Clwyd Hospital, Rhyl, North Wales, UK
| | - S Mukherjee
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, UK
| | - T Maughan
- CRUK/MRC Oxford Institute for Radiation Oncology, Oxford University, Oxford, UK
| | - S J Falk
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - J Staffurth
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - R Ray
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - N Bashir
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - J I Geh
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Medical Centre, Birmingham, UK
| | - D Cunningham
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - R Roy
- Queen's Centre for Oncology and Haematology, Hull and East Yorkshire NHS Trust, Hull, UK
| | | | - G Griffiths
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - L S Nixon
- Wales Cancer Trials Unit, School of Medicine, Cardiff University, Cardiff, UK
| | - J M Blazeby
- Centre for Surgical Research, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Surgery, Head and Neck, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - T Crosby
- Velindre Cancer Centre, Velindre Hospital, Cardiff, UK
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Carrington R, Staffurth J, Warren S, Partridge M, Spezi E, Gwynne S, Hawkins M, Crosby T. SU-E-T-69: A Radiobiological Investigation of Dose Escalation in Lower Oesophageal Tumours with a Focus On Gastric Toxicity. Med Phys 2015. [DOI: 10.1118/1.4924430] [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: 11/07/2022] Open
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