1
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Tait D, Scriba MF, Robinson C, Jonas EG, Chinnery GE. Technical success of endoscopic stenting for malignant gastric outlet obstruction. S AFR J SURG 2023; 61:33-39. [PMID: 38450694] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
BACKGROUND Palliation of irresectable malignant gastric outlet obstruction (GOO) using self-expanding metal stents (SEMS) is gaining popularity with high technical success rates. The aim of this study was to review and compare GOO stenting for malignancy with other series. METHODS A retrospective review of all patients undergoing pyloroduodenal stenting for malignant GOO at Groote Schuur Hospital, 1 March 2018-31 August 2021, evaluating demographics, technical success, pathology, and stentrelated complications was done. RESULTS One hundred and fourteen patients, of which 38.6% were female, were included, with gastric malignancies (74.6%) being the most frequent underlying pathology. Median age was 64 years (IQR 53-70 years), with 48.2% having at least one comorbidity. The majority (96 patients; 85.7%) required only one stent. In total, 132 stent insertion attempts were undertaken. Three technical failures were experienced (one incorrect stent placement and two failed insertions), equating to a 97.4% technical success rate. Four immediate complications occurred (3.1%): two related to sedation, one incorrect stent placement and an oesophagogastric junction perforation with procedural death. Fifteen delayed complications occurred: 13 tumour in-growth blockages, one stent fracture and one case of poor radial stent expansion. Stent blockages occurred at a median of 107 days (IQR 80-275 days). Salvage stenting was 100% successful in 14 cases requiring re-stenting. CONCLUSION Technical insertion success rates of primary and salvage duodenal stenting for malignant GOO are on par with international high-volume units. The leading pathology locally is gastric adenocarcinoma, with palliative stenting remaining a feasible and accessible option.
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Affiliation(s)
- D Tait
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - M F Scriba
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - C Robinson
- Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - E G Jonas
- Surgical Gastroenterology, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
| | - G E Chinnery
- Upper Gastrointestinal Surgery Unit, Department of Surgery, Groote Schuur Hospital, University of Cape Town, South Africa
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2
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Ratnakumaran R, van As N, Khoo V, McDonald F, Tait D, Ahmed M, Taylor H, Griffin C, Dunne EM, Tree AC. Patterns of Failure After Stereotactic Body Radiotherapy to Sacral Metastases. Clin Oncol (R Coll Radiol) 2023; 35:339-346. [PMID: 36805131 DOI: 10.1016/j.clon.2023.01.020] [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: 12/16/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023]
Abstract
AIMS Stereotactic body radiotherapy (SBRT) is increasingly used to treat sacral metastases. We analysed our centre's local relapse rates and patterns of failure after sacral SBRT and assessed whether using the consensus contouring recommendation (CCR) may have prevented local relapse. MATERIALS AND METHODS We conducted a single-centre retrospective review of patients treated with sacral SBRT between February 2012 and December 2021. The cumulative incidence of local relapse, patterns of failure and overall survival were determined. Two investigators reviewed planning computed tomography scans and imaging at relapse to determine if local relapse was potentially preventable with a larger CCR-derived radiotherapy field. RESULTS In total, 34 patients received sacral SBRT, with doses ranging from 24 to 40 Gy over three to five fractions. The most frequently used schedule was 30 Gy in three fractions. Common primaries treated included prostate (n = 16), breast (n = 6), lung (n = 3) and renal (n = 3) cancers. The median follow-up was 20 months (interquartile range 13-55 months). The cumulative incidence of local relapse (4/34) was 2.9% (95% confidence interval 0.2-13.2), 6.3% (95% confidence interval 1.1-18.5) and 16.8% (95% confidence interval 4.7-35.4) at 6 months, 1 year and 2 years, respectively. The patterns of failure were local-only (1/34), local and distant (3/34) and distant relapse (10/34). The overall survival was 96.7% (95% confidence interval 90.5-100) and 90.6% (95% confidence interval 78.6-100) at 1 and 2 years, respectively. For prostate/breast primaries, the cumulative incidence of local relapse was 4.5% (95% confidence interval 0.3-19.4), 4.5% (95% confidence interval 0.3-19.4) and 12.5% (95% confidence interval 1.7-34.8) at 6 months, 1 and 2 years, respectively. Twenty-nine cases (85.3%) deviated from the CCR. Sacral relapse was potentially preventable if the CCR was used in one patient (2.9% of the whole cohort and 25% of the relapsed cohort). DISCUSSION We have shown excellent local control rates with sacral SBRT, which was largely planned with a margin expansion approach.
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Affiliation(s)
- R Ratnakumaran
- The Royal Marsden NHS Foundation Trust, Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London, UK.
| | - N van As
- The Royal Marsden NHS Foundation Trust, Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London, UK
| | - V Khoo
- The Royal Marsden NHS Foundation Trust, Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London, UK
| | - F McDonald
- The Royal Marsden NHS Foundation Trust, Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London, UK
| | - D Tait
- The Royal Marsden NHS Foundation Trust, Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London, UK
| | - M Ahmed
- The Royal Marsden NHS Foundation Trust, Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London, UK
| | - H Taylor
- The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - C Griffin
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, UK
| | - E M Dunne
- Department of Radiation Oncology, BC Cancer - Vancouver Centre, Vancouver, British Columbia, Canada
| | - A C Tree
- The Royal Marsden NHS Foundation Trust, Sutton, UK; Radiotherapy and Imaging Division, Institute of Cancer Research, London, UK
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3
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Brogden DRL, Kontovounisios C, Chong I, Tait D, Warren OJ, Bower M, Tekkis P, Mills SC. Local excision and treatment of early node-negative anal squamous cell carcinomas in a highly HIV prevalent population. Tech Coloproctol 2021; 25:1027-1036. [PMID: 34117969 PMCID: PMC8370967 DOI: 10.1007/s10151-021-02473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/30/2021] [Indexed: 11/25/2022]
Abstract
Background Anal squamous cell carcinoma (ASCC) is an uncommon cancer associated with human immunodeficiency virus (HIV) infection. There has been increasing interest in providing organ-sparing treatment in small node-negative ASCC’s, however, there is a paucity of evidence about the use of local excision alone in people living with HIV (PLWH). The aim of this study was to evaluate the efficacy of local excision alone in this patient population. Methods We present a case series of stage 1 and stage 2 ASCC in PLWH and HIV negative patients. Data were extracted from a 20-year retrospective cohort study analysing the treatment and outcomes of patients with primary ASCC in a cohort with a high prevalence of HIV. Results Ninety-four patients were included in the analysis. Fifty-seven (61%) were PLWH. Thirty-five (37%) patients received local excision alone as treatment for ASCC, they were more likely to be younger (p = 0.037, ANOVA) and have either foci of malignancy or well-differentiated tumours on histology (p = 0.002, Fisher’s exact test). There was no statistically significant difference in 5-year disease-free survival and recurrence between treatment groups, however, patients who had local excision alone and PLWH were both more likely to recur later compared to patients who received other treatments for ASCC. (72.3 months vs 27.3 months, p = 0.06, ANOVA, and 72.3 months vs 31.8 months, p = 0.035, ANOVA, respectively). Conclusions We recommend that local excision be considered the sole treatment for stage 1 node-negative tumours that have clear margins and advantageous histology regardless of HIV status. However, PLWH who have local excision alone must have access to an expert long-term surveillance programme after treatment to identify late recurrences.
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Affiliation(s)
- D R L Brogden
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.,Imperial College London, London, UK
| | - C Kontovounisios
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK. .,Imperial College London, London, UK.
| | - I Chong
- Royal Marsden NHS Foundation Trust, London, UK.,Institute of Cancer Research, London, UK
| | - D Tait
- Royal Marsden NHS Foundation Trust, London, UK.,Institute of Cancer Research, London, UK
| | - O J Warren
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.,Imperial College London, London, UK
| | - M Bower
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.,Imperial College London, London, UK
| | - P Tekkis
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.,Imperial College London, London, UK.,Royal Marsden NHS Foundation Trust, London, UK
| | - S C Mills
- Chelsea and Westminster Hospitals NHS Foundation Trust, London, UK.,Imperial College London, London, UK
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4
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Tait D, Haase G, Wiechen A. A fast method for monitoring I-129 in milk in the surveillance of radioactive waste repositories in the event of accıdental releases / Eine schnelle Methode zur Bestimmung des I-129 in Milch im Rahmen der Überwachung von Endlagern für radioaktive Abfälle im Falle von Störfällen. KERNTECHNIK 2021. [DOI: 10.1515/kern-2000-650413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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5
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Sclafani F, Kalaitzaki E, Cunningham D, Tait D, Brown G, Chau I. Neoadjuvant rectal score: run with the hare and hunt with the hounds. Ann Oncol 2019; 29:2261-2262. [PMID: 30204839 DOI: 10.1093/annonc/mdy403] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- F Sclafani
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - E Kalaitzaki
- Clinical Research & Development, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - D Cunningham
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey.
| | - D Tait
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - G Brown
- Department of Radiology, The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | - I Chau
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
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6
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Khakoo S, Carter P, Valeri N, Shaikh R, Jones T, Begum R, Rana I, Picchia S, Bali M, Brown G, Wotherspoon A, Terlizzo M, von Loga K, Ahmed I, Watkins D, Chau I, Starling N, Tait D, Hubank M, Cunningham D. Circulating tumour DNA (ctDNA) as a tool to assess response and guide therapy adaptation in rectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy303.037] [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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7
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Dattani M, Marijnen C, Moran B, Tait D, Cunningham C, Rodriguez-Bigas M, Brown G. Session 4: Shaping radiotherapy for rectal cancer: should this be personalized? Colorectal Dis 2018; 20 Suppl 1:92-96. [PMID: 29878670 DOI: 10.1111/codi.14087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Preoperative radiotherapy continues to be widely used in patients with operable rectal cancer. However, the indications and goals for such treatment are evolving. Professor Marijnen reviews the historic and current evidence base for the use of preoperative neoadjuvant radiotherapy and the future challenges in tailoring the therapy according to the patients' needs and tumour stage.
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Affiliation(s)
- M Dattani
- Pelican Cancer Foundation, Basingstoke, UK
| | - C Marijnen
- Leiden University Medical Center, Leiden, The Netherlands
| | - B Moran
- North Hampshire Hospital, Basingstoke, UK
| | - D Tait
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - M Rodriguez-Bigas
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G Brown
- The Royal Marsden NHS Foundation Trust, London, UK.,Imperial College London, London, UK
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8
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Bhoday J, Glimelius B, Tait D, Glynne-Jones R, Adams R, Brown G. Session 4: What should we do for poor responders after chemoradiotherapy: bad biology or should the fight go on? Colorectal Dis 2018; 20 Suppl 1:97-99. [PMID: 29878687 DOI: 10.1111/codi.14088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Just over 50% of patients with advanced rectal cancer have a poor response to chemoradiotherapy with resultant poor outcomes. Professor Glimelius reviews the evidence base for defining such patients and the potential role, if any, of further treatment.
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Affiliation(s)
- J Bhoday
- The Royal Marsden NHS Foundation Trust, Croydon University Hospital, Croydon, UK
| | | | - D Tait
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - R Adams
- Cardiff University and Velindre Cancer Centre, Cardiff, UK
| | - G Brown
- The Royal Marsden NHS Foundation Trust, London, UK
- Imperial College London, London, UK
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9
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Nimalasena S, Gothard L, Kothari G, Allen S, Sinnett V, Musallam A, Kirby A, Ross G, Lucy C, Castell F, Cleator S, Locke I, Sawyer E, Tait D, Westbury C, Wolstenholme V, Box C, Robinson S, Yarnold J, Somaiah N. EP-1315: KORTUC phase I/II trial testing a novel radiation sensitiser in breast cancer: preliminary results. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31625-6] [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: 11/27/2022]
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10
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Athauda A, Watkins D, Mohammed K, Ramessur A, Chau I, Starling N, Rao S, Tait D, Aitken K, van As N, Cunningham D. Cisplatin substitution with carboplatin during radical chemoradiation (CRT) for localised gastroesophageal carcinoma (GEC): Outcomes from a tertiary referral centre. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx660.006] [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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11
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Augustin Y, Chaw C, van As N, Tait D, Wells E, Khoo V, Aitken K. Stereotactic Body Radiation Therapy for Pelvic Re-Irradiation: Review of Dose, Toxicity, and Clinical Outcomes. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.2134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Sclafani F, Brown G, Cunningham D, Wotherspoon A, Sena Teixeira Mendes L, Evans J, Peckitt C, Begum R, Tait D, Capdevila J, Glimelius B, Roselló S, Thomas J, Oates J, Chau I. Comparison between magnetic resonance imaging (MRI) and pathology in the assessment of tumour regression grade (TRG) in rectal cancer (RC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.030] [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: 11/12/2022] Open
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13
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Brooks C, Bernier L, Hansen V, Tait D. PO-1014: Target volume motion during anal cancer IGRT using cone-beam CT. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31450-0] [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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14
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Kontovounisios C, Tan E, Pawa N, Brown G, Tait D, Cunningham D, Rasheed S, Tekkis P. The selection process can improve the outcome in locally advanced and recurrent colorectal cancer: activity and results of a dedicated multidisciplinary colorectal cancer centre. Colorectal Dis 2017; 19:331-338. [PMID: 27629565 DOI: 10.1111/codi.13517] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 06/23/2016] [Indexed: 12/31/2022]
Abstract
AIM There is wide disparity in the care of patients with multivisceral involvement of rectal cancer. The results are presented of treatment of advanced and recurrent colorectal cancer from a centre where a dedicated multidisciplinary team (MDT) is central to the management. METHOD All consecutive MDT referrals between 2010 and 2014 were examined. Analysis was undertaken of the referral pathway, site, selection process, management decision, R0 resection rate, mortality/morbidity/Clavien-Dindo (CD) classification of morbidity, length of stay (LOS) and improvement of quality of life. RESULTS There were 954 referrals. These included locally advanced primary rectal cancer (LAPRC b-TME) (39.0%), rectal recurrence (RR) (22.0%), locally advanced primary colon cancer (LAPCC T3c/d-T4) (21.1%), colon cancer recurrence (CR) (12.4%), locally advanced primary anal cancer (LAPAC-failure of CRT/T3c/d-T4) (3.0%) and anal cancer recurrence (AR) (2.2%). Among these patients 271 operations were performed, 212 primary and 59 for recurrence. These included 16 sacrectomies, 134 total pelvic exenterations and 121 other multi-visceral exenterative procedures. An R0 resection (no microscopic margin involvement) was achieved in 94.4% and R1 (microscopic margin involvement) in 5.1%. In LAPRC b-TME the R0 rate was 96.1% and for RR it was 79%. The LOS varied from 13.3 to 19.9 days. RR operations had the highest morbidity (CD 1-2, 33.3%) and LAPRC operations had the highest rate of CD 3-4 complications (18.4%). Most (39.6%) of the referred patients were from other UK hospitals. CONCLUSION Advanced colorectal cancer can be successfully treated in a dedicated referral centre, achieving R0 resection in over 90% with low morbidity and mortality. Implementation of a standardized referral pathway is encouraged.
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Affiliation(s)
- C Kontovounisios
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - E Tan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - N Pawa
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK
| | - G Brown
- Department of Radiology, The Royal Marsden Hospital, London, UK
| | - D Tait
- Department of Clinical Oncology, The Royal Marsden Hospital, London, UK
| | - D Cunningham
- Gastrointestinal and Lymphoma Unit, The Royal Marsden Hospital, London, UK
| | - S Rasheed
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
| | - P Tekkis
- Department of Colorectal Surgery, The Royal Marsden Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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15
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Balyasnikova S, Read J, Tait D, Wotherspoon A, Swift I, Cunningham D, Tekkis P, Brown G. The results of local excision with or without postoperative adjuvant chemoradiotherapy for early rectal cancer among patients choosing to avoid radical surgery. Colorectal Dis 2017; 19:139-147. [PMID: 27474876 DOI: 10.1111/codi.13477] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 04/17/2016] [Indexed: 01/28/2023]
Abstract
AIM The study aimed to establish the oncological outcome of patients who opted for close surveillance with or without adjuvant chemoradiotherapy rather than radical surgery after local excision (LE) of early rectal cancer. METHOD The Royal Marsden Hospital Rectal Cancer database was used to identify rectal cancer patients treated by primary LE from 2006 to 2015. All patients were entered in an intensive surveillance programme. RESULTS Twenty-eight of 34 analysed patients had a high or very high risk of residual disease predicted by adverse histopathological features for which the recommendation had been radical surgery. Eighteen (52%) of the 34 had received radiotherapy following LE. Three-year disease-free survival for the 34 patients was 85% (95% CI 78.8%-91.2%) and overall survival was 100%. Twenty-two of 24 patients with a low tumour which would have required total rectal excision have so far avoided radical surgery and remain disease free at a median follow-up of 3.2 years. CONCLUSION The findings suggest that with modern MRI and clinical surveillance radical surgery can be avoided in patients following initial LE of a histopathologically defined high risk early rectal cancer. These findings are comparable with those obtained after major radical resection and warrant further prospective investigation as a treatment arm in larger prospective trials.
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Affiliation(s)
- S Balyasnikova
- Royal Marsden Hospital, NHS Foundation Trust, Sutton and Fulham, UK.,Imperial College London, London, UK
| | - J Read
- Imperial College London, London, UK.,Croydon University Hospital, NHS Foundation Trust, Croydon, UK
| | - D Tait
- Royal Marsden Hospital, NHS Foundation Trust, Sutton and Fulham, UK
| | - A Wotherspoon
- Royal Marsden Hospital, NHS Foundation Trust, Sutton and Fulham, UK
| | - I Swift
- Imperial College London, London, UK.,Croydon University Hospital, NHS Foundation Trust, Croydon, UK
| | - D Cunningham
- Royal Marsden Hospital, NHS Foundation Trust, Sutton and Fulham, UK
| | - P Tekkis
- Royal Marsden Hospital, NHS Foundation Trust, Sutton and Fulham, UK.,Imperial College London, London, UK
| | - G Brown
- Royal Marsden Hospital, NHS Foundation Trust, Sutton and Fulham, UK.,Imperial College London, London, UK
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16
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Bernier L, De Francesco I, Tait D. Results of radical chemoradiotherapy for oesophageal and junctional cancers: The Royal Marsden Hospital experience. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30348-9] [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: 10/20/2022]
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17
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Sclafani F, Chau I, Cunningham D, Vlachogiannis G, Eltahir Z, Lampis A, Braconi C, Kalaitzaki E, De Castro DG, Wotherspoon A, Capdevila J, Glimelius B, Cervantes A, Begum R, Lote H, Mentrasti G, Hahne J, Tait D, Brown G, Valeri N. KRAS mutations in circulating tumour DNA (ctDNA) in MRI-defined, high-risk, locally-advanced rectal cancer (LARC) patients (pts) from the EXPERT-C trial. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Evans J, Bhoday J, Sizer B, Tekkis P, Swift R, Perez R, Tait D, Brown G. Results of a prospective randomised control 6 vs 12 trial: Is greater tumour downstaging observed on post treatment MRI if surgery is delayed to 12-weeks versus 6-weeks after completion of neoadjuvant chemoradiotherapy? Ann Oncol 2016. [DOI: 10.1093/annonc/mdw370.01] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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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19
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De Francesco I, Thomas K, Wedlake L, Tait D. Intensity-modulated Radiotherapy and Anal Cancer: Clinical Outcome and Late Toxicity Assessment. Clin Oncol (R Coll Radiol) 2016; 28:604-10. [DOI: 10.1016/j.clon.2016.04.039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 02/15/2016] [Accepted: 03/08/2016] [Indexed: 10/21/2022]
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20
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Pollock S, Tse R, Martin D, McLean L, Pham M, Tait D, Estoesta R, Whittington G, Turley J, Kearney C, Cho G, Hill R, Pickard S, Aston P, Makhija K, O'Brien R, Keall P. SU-F-J-136: Impact of Audiovisual Biofeedback On Interfraction Motion Over a Course of Liver Cancer Stereotactic Body Radiotherapy. Med Phys 2016. [DOI: 10.1118/1.4956044] [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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21
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Sclafani F, Brown G, Cunningham D, Wotherspoon A, Tait D, Peckitt C, Evans J, Yu S, Sena Teixeira Mendes L, Tabernero J, Glimelius B, Cervantes A, Thomas J, Begum R, Oates J, Chau I. PAN-EX: a pooled analysis of two trials of neoadjuvant chemotherapy followed by chemoradiotherapy in MRI-defined, locally advanced rectal cancer. Ann Oncol 2016; 27:1557-65. [PMID: 27217542 DOI: 10.1093/annonc/mdw215] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/13/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND EXPERT and EXPERT-C were phase II clinical trials of neoadjuvant chemotherapy (NACT) followed by chemoradiotherapy (CRT) in high-risk, locally advanced rectal cancer (LARC). DESIGN We pooled individual patient data from these trials. The primary objective was overall survival (OS) in the intention-to-treat (ITT) population. Prognostic factors were also analysed. RESULTS A total of 269 patients were included. Of these, 91.1% completed NACT, 88.1% completed CRT and 240 (89.2%) underwent curative surgery (R0/R1). After a median follow-up of 71.9 months, 5-year progression-free survival (PFS) and OS were 66.4% and 73.3%, respectively. In the group of R0/R1 resection patients, 5-year relapse-free survival (RFS) and OS were 71.6% and 77.2%, respectively, with local recurrence occurring in 5.5% and distant metastases in 20.6% of cases. Significant prognostic factors after multivariate analyses included age, tumour grade and MRI extramural venous invasion (mrEMVI) at baseline, MRI tumour regression grade (mrTRG) after CRT, ypT stage after surgery and adherence to study treatment. mrTRG after NACT was associated with PFS (P = 0.002) and OS (P = 0.018) and appeared to stratify patients based on the incremental benefit from sequential CRT. Among the outcome measures considered, in the subgroup of R0/R1 resection patients, ypT and ypStage had the highest predictive accuracy for RFS (concordance index: 0.6238 and 0.6252, respectively) and OS (concordance index: 0.6094 and 0.6132, respectively). CONCLUSIONS Administering NACT before CRT could be a potential strategy for high-risk LARC. In this setting, mrTRG after CRT is an independent prognostic factor, while mrTRG after NACT should be tested as a parameter for treatment selection in trials of NACT ± CRT. ypT stage may be a valuable surrogate end point for future phase II trials investigating intensified neoadjuvant treatments in similar patient populations.
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Affiliation(s)
| | | | | | | | | | - C Peckitt
- Department of Clinical Research & Development, The Royal Marsden NHS Foundation Trust, London and Surrey, UK
| | | | | | | | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B Glimelius
- Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology, University of Uppsala, Uppsala, Sweden
| | - A Cervantes
- Department of Haematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
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Pollock S, Tse R, Martin D, McLean L, Pham M, Martin D, Tait D, Estoesta P, Whittington G, Turley J, Kearney C, Cho G, Hill R, Pickard S, Aston P, Makhija K, O'Brien R, Keall P. EP-1742: The first clinical implementation of audiovisual biofeedback in liver cancer SBRT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32993-0] [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: 12/01/2022]
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Sclafani F, Chau I, Cunningham D, Peckitt C, Lampis A, Hahne JC, Braconi C, Tabernero J, Glimelius B, Cervantes A, Begum R, Gonzalez De Castro D, Hulkki Wilson S, Eltahir Z, Wotherspoon A, Tait D, Brown G, Oates J, Valeri N. Prognostic role of the LCS6 KRAS variant in locally advanced rectal cancer: results of the EXPERT-C trial. Ann Oncol 2015; 26:1936-1941. [PMID: 26162609 PMCID: PMC4551162 DOI: 10.1093/annonc/mdv285] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 05/29/2015] [Accepted: 06/26/2015] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Lethal-7 (let-7) is a tumour suppressor miRNA which acts by down-regulating several oncogenes including KRAS. A single-nucleotide polymorphism (rs61764370, T > G base substitution) in the let-7 complementary site 6 (LCS-6) of KRAS mRNA has been shown to predict prognosis in early-stage colorectal cancer (CRC) and benefit from anti-epidermal growth factor receptor monoclonal antibodies in metastatic CRC. PATIENTS AND METHODS We analysed rs61764370 in EXPERT-C, a randomised phase II trial of neoadjuvant CAPOX followed by chemoradiotherapy, surgery and adjuvant CAPOX plus or minus cetuximab in locally advanced rectal cancer. DNA was isolated from formalin-fixed paraffin-embedded tumour tissue and genotyped using a PCR-based commercially available assay. Kaplan-Meier method and Cox regression analysis were used to calculate survival estimates and compare treatment arms. RESULTS A total of 155/164 (94.5%) patients were successfully analysed, of whom 123 (79.4%) and 32 (20.6%) had the LCS-6 TT and LCS-6 TG genotype, respectively. Carriers of the G allele were found to have a statistically significantly higher rate of complete response (CR) after neoadjuvant therapy (28.1% versus 10.6%; P = 0.020) and a trend for better 5-year progression-free survival (PFS) [77.4% versus 64.5%: hazard ratio (HR) 0.56; P = 0.152] and overall survival (OS) rates (80.3% versus 71.9%: HR 0.59; P = 0.234). Both CR and survival outcomes were independent of the use of cetuximab. The negative prognostic effect associated with KRAS mutation appeared to be stronger in patients with the LCS-6 TT genotype (HR PFS 1.70, P = 0.078; HR OS 1.79, P = 0.082) compared with those with the LCS-6 TG genotype (HR PFS 1.33, P = 0.713; HR OS 1.01, P = 0.995). CONCLUSION This analysis suggests that rs61764370 may be a biomarker of response to neoadjuvant treatment and an indicator of favourable outcome in locally advanced rectal cancer possibly by mitigating the poor prognosis of KRAS mutation. In this setting, however, this polymorphism does not appear to predict cetuximab benefit.
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Affiliation(s)
- F Sclafani
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - I Chau
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - D Cunningham
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - C Peckitt
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - A Lampis
- Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton
| | - J C Hahne
- Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton
| | - C Braconi
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey; Division of Cancer Therapeutics, The Institute of Cancer Research, London and Sutton, UK
| | - J Tabernero
- Department of Medical Oncology, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B Glimelius
- Department of Immunology, Genetics and Pathology, University of Uppsala, Uppsala, Sweden
| | - A Cervantes
- Department of Hematology and Medical Oncology, Biomedical Research Institute INCLIVA, University of Valencia, Valencia, Spain
| | - R Begum
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - D Gonzalez De Castro
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - S Hulkki Wilson
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - Z Eltahir
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - A Wotherspoon
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - D Tait
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - G Brown
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - J Oates
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey
| | - N Valeri
- Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey; Division of Molecular Pathology, The Institute of Cancer Research, London and Sutton.
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Aitken K, Tree A, Thomas K, Nutting C, Hawkins M, Tait D, Mandeville H, Ahmed M, Lalondrelle S, Miah A, Taylor A, Ross G, Khoo V, van As N. Initial UK Experience of Stereotactic Body Radiotherapy for Extracranial Oligometastases: Can We Change the Therapeutic Paradigm? Clin Oncol (R Coll Radiol) 2015; 27:411-9. [PMID: 25912366 DOI: 10.1016/j.clon.2015.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 11/09/2014] [Revised: 03/10/2015] [Accepted: 03/19/2015] [Indexed: 12/21/2022]
Abstract
AIMS To retrospectively review the toxicity and early outcome data from patients who have received stereotactic body radiotherapy (SBRT) for extracranial oligometastases at a single UK institution. MATERIALS AND METHODS Eligible patients had ≤3 extracranial metastases and performance status ≤2. Prior systemic therapy and radical treatment of oligometastastic relapse with any standard treatment modality was permitted. Patients with synchronous metastatic disease were excluded unless they had evidence of controlled primary disease after radical therapy. Follow-up consisted of clinical examination, biochemical and radiological assessments in accordance with standard clinical care. Progression events were defined using RECIST. Toxicity was evaluated using CTCAE v4.0. Local control, progression-free survival (PFS), freedom from widespread distant metastasis (defined as disease not amenable to further radical salvage therapy) and overall survival were calculated. RESULTS Between July 2011 and April 2014, 73 patients with 87 metastases received SBRT (range 1-3 per patient). The median follow-up was 14.5 months (range 0-26.4). The median PFS was 14.5 months (1 year PFS 57%, 2 year 28%); 1 year overall survival 96%, 2 year 79.8%; 2 year local control 88%. At 2 years, 46% of patients were free from widespread distant metastases. No ≥ grade 3 acute or late toxicity was observed. CONCLUSION At this time point, observed toxicity is minimal with excellent local control rates. This promising treatment paradigm requires further investigation in the context of a randomised controlled trial to establish if the addition of SBRT to standard care improves survival outcomes.
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Affiliation(s)
- K Aitken
- Department of Radiotherapy, Royal Marsden Hospital, London, UK.
| | - A Tree
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - K Thomas
- Department of Statistics, Royal Marsden Hospital, London, UK
| | - C Nutting
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - M Hawkins
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - D Tait
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - H Mandeville
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - M Ahmed
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - S Lalondrelle
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - A Miah
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - A Taylor
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - G Ross
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - V Khoo
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - N van As
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
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25
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Yu S, Tait D, Brown G. O-017 The prognostic relevance of MRI Tumor Regression Grade versus histopathological complete response in rectal cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv235.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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26
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Ellis R, Hatherill M, Tait D, Snowden M, Churchyard G, Hanekom W, Evans T, Ginsberg A. Innovative clinical trial designs to rationalize TB vaccine development. Tuberculosis (Edinb) 2015; 95:352-7. [DOI: 10.1016/j.tube.2015.02.036] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 12/22/2022]
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27
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Harris R, Beardmore C, Bolderston A, James S, Probst H, Bennett C, Bostock S, Downs C, Faithfull S, Hoy S, Scott A, Tait D, Trueman E, Wells M. EP-1678: Practice Guidelines skin care advice for patients undergoing radical external beam megavoltage radiotherapy. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41670-6] [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: 11/29/2022]
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28
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Bhangu A, Rasheed S, Brown G, Tait D, Cunningham D, Tekkis P. Does rectal cancer height influence the oncological outcome? Colorectal Dis 2014; 16:801-8. [PMID: 24980955 DOI: 10.1111/codi.12703] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 03/16/2014] [Indexed: 02/08/2023]
Abstract
AIM The influence of the height of rectal cancer from the anal verge on the oncological outcome is controversial. This study aimed to determine the influence of the height of the tumour on the survival of patients treated in a specialized rectal cancer unit. METHOD Patients undergoing surgery for primary rectal cancer from 2006 to 2013 were identified from a prospectively maintained rectal cancer database. Those requiring total or multicompartmental pelvic exenteration were excluded. Low cancer was defined as tumour < 5 cm from the anal verge, as assessed by endoscopy and/or digital rectal examination. The primary outcome was 3-year disease-free survival (DFS). RESULTS Of 340 patients, 203 (59.7%) had low cancer. There were 302 (89%) restorative and 38 (11%) nonrestorative procedures. The rate of positive circumferential resection margin was similar for low compared with high cancer (3.4% vs 2.9%, P = 1.0) and for restorative compared with nonrestorative procedures in low cancer only (3.0% and 5.3%, P = 0.619). Low compared with high anterior resection was associated with increased anastomotic leakage (8.5% vs 2.2%, P = 0.023). Three-year DFS was similar for low and high resection (82% vs 86%, P = 0.305) and between restorative vs nonrestorative procedures in low cancer only (88% vs 77%, P = 0.215). In an adjusted model, low height did not lead to worse survival outcome (3-year DFS hazard ratio 0.54, 95% CI 0.24-1.24, P = 0.147). CONCLUSION With careful planning and a multidisciplinary approach, equivalent oncological outcome can be achieved for patients with rectal cancer who undergo curative surgery regardless of differences in tumour characteristics, location and operation performed.
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Affiliation(s)
- A Bhangu
- Department of Colorectal Surgery, Royal Marsden Hospital, London, UK; Division of Surgery, Imperial College London, Chelsea and Westminster Campus, London, UK
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29
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Sclafani F, Gonzalez D, Cunningham D, Hulkki Wilson S, Peckitt C, Giralt J, Glimelius B, Roselló Keränen S, Wotherspoon A, Brown G, Tait D, Oates J, Chau I. RAS mutations and cetuximab in locally advanced rectal cancer: results of the EXPERT-C trial. Eur J Cancer 2014; 50:1430-6. [PMID: 24582914 DOI: 10.1016/j.ejca.2014.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [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: 10/25/2013] [Revised: 01/28/2014] [Accepted: 02/02/2014] [Indexed: 01/17/2023]
Abstract
BACKGROUND RAS mutations predict resistance to anti-epidermal growthfactor receptor (EGFR) monoclonal antibodies in metastatic colorectal cancer. We analysed RAS mutations in 30 non-metastatic rectal cancer patients treated with or without cetuximab within the 31 EXPERT-C trial. METHODS Ninety of 149 patients with tumours available for analysis were KRAS/BRAF wild-type, and randomly assigned to capecitabine plus oxaliplatin (CAPOX) followed by chemoradiotherapy, surgery and adjuvant CAPOX or the same regimen plus cetuximab (CAPOX-C). Of these, four had a mutation of NRAS exon 3, and 84 were retrospectively analysed for additional KRAS (exon 4) and NRAS (exons 2/4) mutations by using bi-directional Sanger sequencing. The effect of cetuximab on study end-points in the RAS wild-type population was analysed. RESULTS Eleven (13%) of 84 patients initially classified as KRAS/BRAF wild-type were found to have a mutation in KRAS exon 4 (11%) or NRAS exons 2/4 (2%). Overall, 78/149 (52%) assessable patients were RAS wild-type (CAPOX, n=40; CAPOX-C, n=38). In this population, after a median follow-up of 63.8months, in line with the initial analysis, the addition of cetuximab was associated with numerically higher, but not statistically significant, rates of complete response (15.8% versus 7.5%, p=0.31), 5-year progression-free survival (75.5% versus 67.5%, hazard ratio (HR) 0.61, p=0.25) and 5-year overall survival (83.8% versus 70%, HR 0.54, p=0.20). CONCLUSIONS RAS mutations beyond KRAS exon 2 and 3 were identified in 17% of locally advanced rectal cancer patients. Given the small sample size, no definitive conclusions on the effect of additional RAS mutations on cetuximab treatment in this setting can be drawn and further investigation of RAS in larger studies is warranted.
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Affiliation(s)
- F Sclafani
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - D Gonzalez
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - D Cunningham
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom.
| | - S Hulkki Wilson
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - C Peckitt
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - J Giralt
- Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B Glimelius
- Akademiska Sjukhuset Uppsala, Uppsala, Sweden
| | - S Roselló Keränen
- Institute of Health Research Hospital Clinic of Valencia, University of Valencia, Valencia, Spain
| | - A Wotherspoon
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - G Brown
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - D Tait
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - J Oates
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
| | - I Chau
- The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom
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Aitken K, Jouin A, Mirabel X, Tait D, Nutting C, Hawkins M. Evaluating Small Bowel Dose–Volume Tolerance Limits for SBRT Using a Preoperative Rectal Radiation Therapy Model: Are We Setting the Bar Too High? Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.141] [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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Lange S, Rozario N, Hall J, Higgins R, Tait D, Naumann R. Is robotic hysterectomy really less painful than traditional laparoscopy? Gynecol Oncol 2013. [DOI: 10.1016/j.ygyno.2013.04.438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tait D, Haase G, Hartmann R, Jelinski M. Rapid determination of strontium radionuclides in plants, fodder and foodstuffs. KERNTECHNIK 2013. [DOI: 10.3139/124.100342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
The fission yield, the transfer factors in the food chain and the dose coefficient are large for the nuclear fission product Sr-90. The surveillance of Sr-90 in the food chain is therefore important in precautionary radiation protection and in assessing the radiation dose to the public especially after a nuclear incident. Prior to analysis, as it is a pure β-emitter, Sr must be separated from the sample by procedures which, for complex organic samples, are lengthy, laborious and dependent on operator skill. Ubiquitous natural radionuclides and short-lived fission products in samples contaminated with fresh fallout may interfere. Here we describe a fast, reproducible and effficient method for extracting Sr from grass, clover, maize, wholemeal rye, baby food, and total diet. The method depends on obtaining an ash free of traces of organic interferences. Sr may be separated from a dilute nitric acid leachate of such ash with a solution of dicyclohexyl-18-crown-6 in chloroform. Interfering radionuclides are removed with a special manganese (IV) oxide (active, precipitated from Merck). Sr is precipitated as carbonate then dispersed in a cocktail for liquid scintillation spectrometry. This allows simultaneous counting of Sr-89 (a short-lived β-emitter in fresh fallout) and Sr-90. The chemical yields of Sr determined with the gamma-emitting Sr-85 tracer are reproducible and greater than 75 % in all cases. The sample ashing requires 18 h and the extraction 4.0 to 4.5 h. Thus, a duplicate analysis may be completed within 2 days of receipt of the sample.
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Affiliation(s)
- D. Tait
- Federal Research Centre for Nutrition and Food, Institute of Dairy Chemistry and Technology, Hermann-Weigmann-Strasse 1, D-24103 Kiel, Germany. E-mail:
| | - G. Haase
- Federal Research Centre for Nutrition and Food, Institute of Dairy Chemistry and Technology, Hermann-Weigmann-Strasse 1, D-24103 Kiel, Germany. E-mail:
| | - R. Hartmann
- Federal Research Centre for Nutrition and Food, Institute of Dairy Chemistry and Technology, Hermann-Weigmann-Strasse 1, D-24103 Kiel, Germany. E-mail:
| | - M. Jelinski
- Federal Research Centre for Nutrition and Food, Institute of Dairy Chemistry and Technology, Hermann-Weigmann-Strasse 1, D-24103 Kiel, Germany. E-mail:
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Tait D, Haase G, Hartmann R. Fast determination of strontium radionuclides in milk with the aid of the cryptand 2.2.2. KERNTECHNIK 2013. [DOI: 10.3139/124.100215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
A rapid method for separating strontium (Sr) radionuclides from liquid milk has been improved and tested for the determination of Sr-90 in milk. The method is based on the specific extraction of Sr from the milk with cryptand 2.2.2 on a cation exchange resin (Dowex Marathon C). Decontamination from other radionuclides such as those of caesium and from chemically similar elements such as calcium and barium is efficient. At least 6 samples can be treated in one day by one person. Tests were carried out on series of six 1.0 and 0.10 litre milk samples representing respectively routine milk samples and samples for fast analysis i.e milk contaminated with fresh fallout, including Ba-140, and requiring barium separation. For the 1.0 litre samples Sr recoveries ranged from 75–85 % while for 0.10 liter samples the range was 65–80 %. Conditions for the use of Sr-85 as yield tracer to correct for the losses were established. The method minimizes the handling of hazardous reagents.
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Affiliation(s)
- D. Tait
- Federal Research Centre for Nutrition and Food, Institute of Dairy Chemistry and Technologie, Hermann-Weigmann-Strasse 1, D-24103, Kiel, Germany. (Bundesforschungsanstalt für Ernährung und Lebensmittel, Institut für Chemie und Technologie der Milch, Hermann-Weigmann-Str. 1, D-24103 Kiel)
| | - G. Haase
- Federal Research Centre for Nutrition and Food, Institute of Dairy Chemistry and Technologie, Hermann-Weigmann-Strasse 1, D-24103, Kiel, Germany. (Bundesforschungsanstalt für Ernährung und Lebensmittel, Institut für Chemie und Technologie der Milch, Hermann-Weigmann-Str. 1, D-24103 Kiel)
| | - R. Hartmann
- Federal Research Centre for Nutrition and Food, Institute of Dairy Chemistry and Technologie, Hermann-Weigmann-Strasse 1, D-24103, Kiel, Germany. (Bundesforschungsanstalt für Ernährung und Lebensmittel, Institut für Chemie und Technologie der Milch, Hermann-Weigmann-Str. 1, D-24103 Kiel)
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Aitken K, Taylor H, Wells E, Tait D, van As N, Taylor A, Lalondrelle S. PO-0751: Stereotactic body radiation therapy (SBRT) for abdominopelvic reirradiation: early results. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33057-7] [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: 11/27/2022]
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Brooks C, Lee Y, Hansen V, Tait D, Hawkins M. PO-0814: Dose escalation with simultaneous IMRT for anal cancer with minimum bowel toxicity. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33120-0] [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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Tuan J, Ha T, Chen W, Hawkins M, Tait D. Effect of Anaemia Prevention on Survival and Local Control in Oesophageal Cancers Treated with Chemoradiotherapy. Clin Oncol (R Coll Radiol) 2012; 24:454-5. [DOI: 10.1016/j.clon.2012.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 03/20/2012] [Indexed: 11/16/2022]
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Wedlake LJ, McGough C, Shaw C, Klopper T, Thomas K, Lalji A, Dearnaley DP, Blake P, Tait D, Khoo VS, Andreyev HJN. Clinical trial: Efficacy of a low or modified fat diet for the prevention of gastrointestinal toxicity in patients receiving radiotherapy treatment for pelvic malignancies. J Hum Nutr Diet 2012; 25:247-59. [PMID: 22515941 DOI: 10.1111/j.1365-277x.2012.01248.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inflammatory responses to pelvic radiotherapy can result in severe changes to normal gastrointestinal function with potentially severe long-term effects. Reduced or modified fat diets may confer benefit. METHODS This randomised controlled trial recruited patients with gynaecological, urological or lower gastrointestinal malignancy due to receive radical radiotherapy. Patients were randomised to a low fat (20% total energy from long chain triglycerides), modified fat (20% from long chain triglycerides and 20% from medium chain triglycerides) or normal fat diet (40% total energy from long chain triglycerides). The primary outcome was a difference in change in Inflammatory Bowel Disease Questionnaire--Bowel (IBDQ-B) score, from the start to end of radiotherapy. RESULTS A total of 117 patients with pelvic tumours (48% urological; 32% gastrointestinal; 20% gynaecological), with mean (SD) age: 65 (11.0) years, male:female ratio: 79:38, were randomised. The mean (SE) fall in paired IBDQ-B score was -7.3 (0.9) points, indicating a worsening toxicity. Differences between groups were not significant: P = 0.914 (low versus modified fat), P = 0.793 (low versus normal fat) and P = 0.890 (modified versus normal fat). The difference in fat intake between low and normal fat groups was 29.5 g [1109 kJ (265 kcal)] amounting to 11% (of total energy intake) compared to the planned 20% differential. Full compliance with fat prescription was only 9% in the normal fat group compared to 93% in the low fat group. CONCLUSIONS A low or modified fat diet during pelvic radiotherapy did not improve gastrointestinal symptom scores compared to a normal fat intake. An inadequate differential in fat intake between the groups may have confounded the results.
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Affiliation(s)
- L J Wedlake
- Department of Nutrition and Dietetics, The Royal Marsden NHS Foundation Trust, London, UK
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Alfa-Wali M, Allen-Mersh T, Antoniou A, Tait D, Newsom-Davis T, Gazzard B, Nelson M, Bower M. Chemoradiotherapy for anal cancer in HIV patients causes prolonged CD4 cell count suppression. Ann Oncol 2012; 23:141-147. [PMID: 21444358 DOI: 10.1093/annonc/mdr050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Despite the advent of highly active antiretroviral therapy, anal cancer remains a significant health problem in human immunodeficiency virus (HIV) patients. We present the clinical features and treatment outcomes of anal cancer in 60 HIV-positive patients over a 20-year period. PATIENTS AND METHODS A prospective database of all HIV-positive individuals managed in a specialist unit since 1986 includes 11 112 patients (71 687 person-years of follow-up). Sixty patients with anal cancer were identified. Their clinicopathological and treatment details were analysed. RESULTS At anal cancer diagnosis, the mean age was 44 years (range: 28-75 years) and the median CD4 cell count was 305 mm(-3) (range: 16-1252 mm(-3)). Fifty (83%) had chemoradiotherapy (CRT). Forty-six (92%) responded, of whom 10 (22%) subsequently relapsed with locoregional (70%), metastatic disease (10%) or both (20%). The overall 5-year survival is 65% (95% confidence interval 51% to 78%). The median CD4 count fell from 289 mm(-3) before CRT to 132 mm(-3) after 3 months and to 189 mm(-3) after 1 year (P<0.05). Six patients in remission of anal cancer died of acquired immunodeficiency syndrome defining illnesses. CONCLUSIONS The management of anal cancer with CRT achieves similar outcomes as the general population. CRT is associated with significant prolonged CD4 suppression that may contribute to late deaths of patients in remission.
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Affiliation(s)
- M Alfa-Wali
- Department of Surgery and Cancer, Imperial College London, London
| | - T Allen-Mersh
- Department of Surgery and Cancer, Imperial College London, London
| | - A Antoniou
- Department of Surgery and Cancer, Imperial College London, London; Department of Surgery, Institute of Cancer Research, London
| | - D Tait
- Department of Clinical Oncology, Royal Marsden Hospital
| | - T Newsom-Davis
- Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK
| | - B Gazzard
- Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK
| | - M Nelson
- Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK
| | - M Bower
- Department of Surgery and Cancer, Imperial College London, London; Departments of Oncology; HIV Medicine, Chelsea and Westminster Hospital, London, UK.
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Poston GJ, Tait D, O'Connell S, Bennett A, Berendse S. Diagnosis and management of colorectal cancer: summary of NICE guidance. BMJ 2011. [PMID: 22074710 DOI: 10.1136/bmj.d6751bmj.d6751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- G J Poston
- Aintree University Hospital, Liverpool L9 7AL, UK.
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Affiliation(s)
- G J Poston
- Aintree University Hospital, Liverpool L9 7AL, UK.
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Tanna H, Ayub N, Rha J, Tait D, Dubis A, Stepien K, Carroll J. Evaluation of a broadband OCT light source for retinal layer segmentation and image quality. J Vis 2010. [DOI: 10.1167/8.17.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Saleem A, Jackson A, Mukherjee S, Stones N, Crosby T, Tait D, Price P. Radiotherapy in the management of unresectable locally advanced pancreatic cancer: a survey of the current UK practice of clinical oncologists. Clin Oncol (R Coll Radiol) 2010; 22:257-60. [PMID: 20223645 DOI: 10.1016/j.clon.2010.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2009] [Revised: 01/28/2010] [Accepted: 02/10/2010] [Indexed: 10/19/2022]
Abstract
A survey was conducted by the Academic Clinical Oncology and Radiobiology Research Network (ACORRN) to evaluate current radiotherapy practice and to inform future research needs in patients with locally advanced pancreatic cancer. A clear need for a co-ordinated multicentre approach, given the limited number of patients who may qualify for such UK trials, was identified. Such trials should incorporate evidence-based treatment protocols and appropriate quality assurance procedures to ensure delivery of the highest standards of radiation-based therapy within, and without, clinical trials.
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Affiliation(s)
- A Saleem
- University of Manchester Academic Radiation Oncology, The Christie NHS Foundation Trust, Manchester, UK.
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Davey A, Tait D, Lennard C, Wallace A. Developing an effective partnership between ‘persons having specialized knowledge’ and those involved in legal deliberations. Sci Justice 2010. [DOI: 10.1016/j.scijus.2009.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Hawkins M, Bedford J, Warrington A, Coolens C, Tait D. VMAT Compared with Gated Highly Conformal Optimization for Dose Escalation in Partial Liver Radiotherapy. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Chong I, Hawkins M, O'Neill B, Thomas K, McNair H, Hansen V, Aitken A, Tait D. QUANTIFICATION OF ORGAN MOTION DURING CHEMO-RADIATION OF RECTAL CANCER USING CONE BEAM CT (MEASURE STUDY). Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)73068-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hawkins M, Bedford J, Warrington A, Tait D. VMAT PLANNING AND DELIVERY FOR DISTAL OESOPHAGEAL MALIGNANCIES. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)73112-2] [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: 11/16/2022]
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Abstract
This audit was conducted to measure waiting times for systemic cancer therapy across the United Kingdom. All patients, aged 16 years or older, commencing their first course of systemic therapy between 13 November and 19 November 2006 were eligible for inclusion. Data on 936 patients from 81 hospital sources were collected. Systemic therapy is largely given in compliance with national waiting time targets. In terms of the Joint Council for Clinical Oncology (JCCO) targets, 84% of patients commence treatment within 21 days and 98% of patients complied with the Department of Health target that treatment should follow within 31 days of the decision being agreed with the patient. Only 76% complied with the Department of Health 62-day target from GP referral to first definitive treatment. However, the date of urgent referral by the GP was not submitted for most patients in our survey, leaving a sample of only 84 out of 936 patients (9% of total) suitable for this analysis. There was only a 3- to 5-day difference between the waiting times for systemic therapy for patients categorised as urgent compared with routine. Locally agreed definitions had little impact on patients' priority for treatment. This audit has established a baseline measurement of waiting times for systemic therapy across the United Kingdom. The continuing introduction of novel therapies is likely to have a significant effect on the service and we recommend that service managers model the likely impact on resource requirements. In addition, urgent treatment should be clearly defined as that required within 24 h (maximum 48 h) to avoid the risk of clinical deterioration, particularly in patients with acute leukaemia, lymphoma or germ cell tumour.
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Affiliation(s)
- M V Williams
- The Royal College of Radiologists, 38 Portland Place, London, W1B 1JQ UK.
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Somaiah N, Warrington J, Taylor H, Ahmad R, Tait D, Glees J. High Dose Spatially Fractionated Radiotherapy (SFR) using a Megavoltage GRID in Advanced Lung Tumors: Preliminary Experience in UK. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hawkins M, Tait D. Locally Advanced Non-Metastatic Pancreatic Cancer — Can We Do More? Clin Oncol (R Coll Radiol) 2008; 20:532-4. [DOI: 10.1016/j.clon.2008.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 04/10/2008] [Accepted: 04/13/2008] [Indexed: 12/18/2022]
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Martin S, Mannino M, Rostom A, Tait D, Donovan E, Eagle S, Haviland J, Yarnold J. Acute toxicity and 2-year adverse effects of 30 Gy in five fractions over 15 days to whole breast after local excision of early breast cancer. Clin Oncol (R Coll Radiol) 2008; 20:502-5. [PMID: 18556186 DOI: 10.1016/j.clon.2008.04.020] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 04/23/2008] [Accepted: 04/24/2008] [Indexed: 12/17/2022]
Abstract
AIMS A pilot study was undertaken with the aim of documenting acute skin reactions and 2-year late adverse effects of a five-fraction course of adjuvant whole breast radiotherapy delivered over 15 days after local tumour excision of early breast cancer. MATERIALS AND METHODS Thirty women with early invasive breast cancer aged>or=50 years with a pathological tumour size<3 cm, complete microscopic resection, negative axillary node status and no requirement for cytotoxic therapy were prescribed 30 Gy in five fractions over 15 days to the whole breast using tangential 6-10 MV X-ray beams and three-dimensional dose compensation with written informed consent. Post-surgical baseline photographs of the breasts were taken, and acute skin erythema and moist desquamation were each scored weekly for 7 weeks using four-point graded scales (grade 0=none, 1=mild, 2=moderate, 3=severe). This was followed by an annual clinical assessment, including repeat photographs at 2 years. RESULTS Nine patients (30%, 95% confidence interval 14.7-49.4%) developed grade 2 erythema, with the remaining 21 patients developing milder degrees of reaction. Four (13.3%, 95% confidence interval 3.7-30.7) patients developed moist desquamation, grade 1 in three women and grade 2 in the fourth. At 2 years after treatment, 23/30 (77%) patients scored no change in photographic breast appearance compared with the pre-treatment baseline; seven (23%, 95% confidence interval 9.9-42.3) scored a mild change in breast appearance, and none developed a marked change. After a mean follow-up of 3.1 years (standard deviation 0.37, range 2.1-3.9 years) there have been no ipsilateral local tumour relapses. CONCLUSIONS Further evaluation of a five-fraction regimen of adjuvant whole breast radiotherapy in a phase III randomised trial is justified, including a regimen delivered in a total of 5 days.
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Affiliation(s)
- S Martin
- Department of Radiotherapy, Royal Marsden Hospital, Downs Road, Sutton, UK
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