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Hardcastle N, Josipovic M, Clementel E, Hernandez V, Smyth G, Gober M, Wilke L, Eaton D, Josset S, Lazarakis S, Saez J, Vieillevigne L, Jornet N, Mancosu P. Recommendation on the technical and dosimetric data to be included in stereotactic body radiation therapy clinical trial publications based on a systematic review. Radiother Oncol 2024; 190:110042. [PMID: 38043902 DOI: 10.1016/j.radonc.2023.110042] [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: 05/12/2023] [Revised: 11/26/2023] [Accepted: 11/27/2023] [Indexed: 12/05/2023]
Abstract
The results of phase II and III trials on Stereotactic Body Radiation Therapy (SBRT) increased adoption of SBRT worldwide. The ability to replicate clinical trial outcomes in routine practice depends on the capability to reproduce technical and dosimetric procedures used in the clinical trial. In this systematic review, we evaluated if peer-reviewed publications of clinical trials in SBRT reported sufficient technical data to ensure safe and robust implementation in real world clinics. Twenty papers were selected for inclusion, and data was extracted by a working group of medical physicists created following the ESTRO 2021 physics workshop. A large variability in technical and dosimetric data were observed, with frequent lack of required information for reproducing trial procedures. None of the evaluated studies were judged completely reproducible from a technical perspective. A list of recommendations has been provided by the group, based on the analysis and consensus process, to ensure an adequate reproducibility of technical parameters in primary SBRT clinical trials. Future publications should consider these recommendations to assist transferability of the clinical trial in real world practice.
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Affiliation(s)
- Nicholas Hardcastle
- Physical Sciences, Peter MacCallum Cancer Centre & Sir Peter MacCallum, Department of Oncology, University of Melbourne, Australia
| | - Mirjana Josipovic
- Department of Oncology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet (RH), Blegdamsvej 9, 2100 Copenhagen, Denmark; Department of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Enrico Clementel
- European Organisation for the Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Victor Hernandez
- Department of Medical Physics, Hospital Sant Joan de Reus, IISPV, 43204 Tarragona, Spain
| | - Gregory Smyth
- The London Radiotherapy Centre, HCA Healthcare UK, London, UK
| | - Manuela Gober
- Department of Radiation Oncology, Medical University of Vienna, Austria
| | - Lotte Wilke
- Department of Radiation Oncology, University Hospital Zurich, 8091 Zurich, Switzerland
| | | | - Stéphanie Josset
- Department of Medical Physics, Institut de Cancerologie de l'Ouest, 44805 Saint-Herblain, France
| | - Smaro Lazarakis
- Physical Sciences, Peter MacCallum Cancer Centre & Sir Peter MacCallum, Department of Oncology, University of Melbourne, Australia
| | - Jordi Saez
- Department of Radiation Oncology, Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Laure Vieillevigne
- Department of Medical Physics, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse, F-31059 Toulouse, France
| | - Núria Jornet
- Servei de Radiofísica i Radioprotecció, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Pietro Mancosu
- Medical Physics Unit, Radiotherapy Department, IRCCS Humanitas Research Hospital, Rozzano-Milano, Italy
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Adjogatse D, Michaelidou A, Sanchez Nieto B, Kozarski R, Sassoon I, Evans M, Rackley T, Shah S, Eaton D, Pike L, Curry S, Gould SM, Thomas C, Kong A, Petkar I, Reis-Ferreira M, Connor S, Barrington SF, Lei M, Guerrero Urbano T. Protocol letter: Intra-treatment Image Guided Adaptive Radiotherapy Dose-escalation Study (InGReS) - A Phase 1 multicentre feasibility study. Radiother Oncol 2023; 183:109645. [PMID: 36997123 DOI: 10.1016/j.radonc.2023.109645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 03/30/2023]
Affiliation(s)
- Delali Adjogatse
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Andriana Michaelidou
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Robert Kozarski
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Isabel Sassoon
- Computer Science Department, Brunel University London, Uxbridge, UK
| | - Mererid Evans
- Department of Oncology, Velindre University NHS Trust, Cardiff, UK
| | - Thomas Rackley
- Department of Oncology, Velindre University NHS Trust, Cardiff, UK
| | - Simon Shah
- Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - David Eaton
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lucy Pike
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Sorcha Curry
- King's College and Guy's and St Thomas' Hospital PET Centre, London, UK
| | - Sarah-May Gould
- King's College and Guy's and St Thomas' Hospital PET Centre, London, UK
| | - Christopher Thomas
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Medical Physics, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Anthony Kong
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Imran Petkar
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Miguel Reis-Ferreira
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephen Connor
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; Department of Radiology Guy's and St Thomas' NHS Foundation Trust, London, UK; Department of Neuroradiology, King's College Hospital, London UK
| | - Sally Fiona Barrington
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK; King's College and Guy's and St Thomas' Hospital PET Centre, London, UK
| | - Mary Lei
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Teresa Guerrero Urbano
- Department of Clinical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's College London, Faculty of Dentistry, Oral and Craniofacial Sciences, London, UK
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Li Z, Eaton D, Davidsen J. Short-term forecasting of Mmax during hydraulic fracturing. Sci Rep 2022; 12:12509. [PMID: 35869089 PMCID: PMC9307812 DOI: 10.1038/s41598-022-15365-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 06/22/2022] [Indexed: 11/12/2022] Open
Abstract
Previous studies of injection-induced earthquake sequences have shown that the maximum magnitude (Mmax) of injection-induced seismicity increases with the net injected volume (V); however, different proposed seismic-hazard paradigms predict significantly different values of Mmax. Using injection and seismicity data from two project areas in northeastern British Columbia, Canada, where hydraulic fracturing induced seismicity was observed, we test the predictive power and robustness of three existing and one novel method to estimate Mmax. Due to their vastly different values of seismogenic index (Σ), these two project areas represent end-member cases of seismogenic response. Our novel method progressively adjusts the Mmax forecast under the assumption that each recorded event embodies an incremental release of fluid-induced stress. The results indicate that our method typically provides the lowest upper bound of the tested methods and it is less sensitive to site-specific calibration parameters such as Σ. This makes the novel method appealing for operational earthquake forecasting schemes as a real-time mitigation strategy to manage the risks of induced seismicity.
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Pearson M, Butterworth V, Misson‐Yates S, Naeem M, Gonzalez Vaz R, Eaton D, Greener T. Application of failure mode and effects analysis to validate a novel hybrid Linac QC program that integrates automated and conventional QC testing. J Appl Clin Med Phys 2022; 23:e13798. [PMID: 36453139 PMCID: PMC9797170 DOI: 10.1002/acm2.13798] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 09/01/2022] [Accepted: 09/09/2022] [Indexed: 12/05/2022] Open
Abstract
A hybrid quality control (QC) program was developed that integrates automated and conventional Linac QC, realizing the benefits of both automated and conventional QC, increasing efficiency and maintaining independent measurement methods. Failure mode and effects analysis (FMEA) was then applied in order to validate the program prior to clinical implementation. The hybrid QC program consists of automated QC with machine performance check and DailyQA3 array on the TrueBeam Linac, and Delta4 volumetric modulated arc therapy (VMAT) standard plan measurements, alongside conventional monthly QC at a reduced frequency. The FMEA followed the method outlined in TG-100. Process maps were created for each treatment type at our center: VMAT, stereotactic body radiotherapy (SBRT), conformal, and palliative. Possible failure modes were established by evaluating each stage in the process map. The FMEA followed semiquantitative methods, using data from our QC records from eight Linacs over 3 years for the occurrence estimates, and simulation of failure modes in the treatment planning system, with scoring surveys for severity and detectability. The risk priority number (RPN) was calculated from the product of the occurrence, severity, and detectability scores and then normalized to the maximum and ranked to determine the most critical failure modes. The highest normalized RPN values (100, 90) were found to be for MLC position dynamic for both VMAT and SBRT treatments. The next highest score was 35 for beam position for SBRT, and the majority of scores were less than 20. Overall, these RPN scores for the hybrid Linac QC program indicated that it would be acceptable, but the high RPN score associated with the dynamic MLC failure mode indicates that it would be valuable to perform more rigorous testing of the MLC. The FMEA proved to be a useful tool in validating hybrid QC.
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Affiliation(s)
- Michael Pearson
- Medical Physics DepartmentGuy's and St Thomas' HospitalLondonUK
| | | | - Sarah Misson‐Yates
- Medical Physics DepartmentGuy's and St Thomas' HospitalLondonUK,School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Marium Naeem
- Medical Physics DepartmentGuy's and St Thomas' HospitalLondonUK
| | | | - David Eaton
- Medical Physics DepartmentGuy's and St Thomas' HospitalLondonUK,School of Biomedical Engineering & Imaging SciencesKing's College LondonLondonUK
| | - Tony Greener
- Medical Physics DepartmentGuy's and St Thomas' HospitalLondonUK
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Khan M, Sandhu N, Naeem M, Ealden R, Pearson M, Ali A, Honey I, Webster A, Eaton D, Ntentas G. Implementation of a comprehensive set of optimised CBCT protocols and validation through imaging quality and dose audit. Br J Radiol 2022; 95:20220070. [PMID: 36000497 PMCID: PMC9793481 DOI: 10.1259/bjr.20220070] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Cone-beam computed tomography (CBCT) for radiotherapy treatment verification has increased in frequency; therefore, it is crucial to optimise image quality and radiation dose to patients. The aim of this study was to implement optimised CBCT protocols for the Varian TrueBeams for most tumour sites in adult patients. METHODS A combination of patient size-specific CBCT protocols from the literature and developed in-house was used. Scans taken before and after optimisation were compared by senior radiographers and physicists to evaluate how changes affected image quality and clinical usability for online image registration. The change in dose for each new CBCT protocol was compared to the Varian default. A clinical audit was performed following implementation to evaluate the changes in imaging dose for all patients receiving a CBCT during that period. RESULTS Ten CBCT protocols were introduced including head and neck and patient-size-specific thorax and pelvis/abdomen protocols. Scans from 102 patients with images before and after optimisation were assessed, none of the scans showed image quality changes compromising clinical usability and for some image quality was improved. Between November 2020 and June 2021, 1185 patients had CBCTs using the new protocols. The imaging dose was reduced for 52% of patients, remained the same for 37% and increased for 12%. CONCLUSIONS This study showed that substantial dose reductions and image quality improvements can be achieved with simple changes in the default settings of the Varian TrueBeam CBCT without affecting the radiographers' confidence in online image registration. ADVANCES IN KNOWLEDGE This study represents a comprehensive assessment and optimisation of CBCT protocols for most sites, validated on a large cohort of patients.
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Affiliation(s)
- Marina Khan
- Department of Radiotherapy, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Navneet Sandhu
- Department of Medical Physics, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Marium Naeem
- Department of Medical Physics, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Rebecca Ealden
- Department of Medical Physics, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Michael Pearson
- Department of Medical Physics, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Abdirzak Ali
- Department of Radiotherapy, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Ian Honey
- Department of Medical Physics, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
| | - Amanda Webster
- Department of Radiotherapy, University College Hospital, London, UK
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Garvey S, Faul J, Cormican L, Eaton D, Judge EP. Symptomatic unilateral idiopathic giant bullous emphysema : a case report. BMC Pulm Med 2022; 22:341. [PMID: 36085045 PMCID: PMC9463853 DOI: 10.1186/s12890-022-02135-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Idiopathic Giant Bullous Emphysema (or Vanishing Lung Syndrome) is a rare condition which is usually associated with male gender, active smoking and underlying emphysematous disease. We present an unusual case of a giant bulla occurring in the absence of these risk factors.
Case presentation A 54-year-old woman presented to the respiratory outpatient clinic with gradually worsening left sided chest discomfort, which was most marked during a recent flight. She had no significant dyspnoea or other symptoms. She had a remote 5-pack-year smoking history. Chest X-Ray revealed a large hyperlucent area in the left upper lobe. CT Thorax found this to be an isolated bulla occupying more than one-third of the hemithorax. The remaining lung parenchyma was normal. A diagnosis of Idiopathic Giant Bullous Emphysema was made. The patient was referred for VATS (Video-assisted thoracoscopic surgery) bullectomy which was carried out without complication. Her symptoms resolved completely following the operation. Conclusions This is an unusual case of a solitary giant bulla occurring without major risk factors or underlying lung disease. VATS bullectomy was shown to be an effective therapeutic option, allowing re-expansion of compressed lung tissue and complete resolution of symptoms.
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7
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Hennessy MM, Moorthy A, Frizelle H, Griffin M, Reidy B, Eaton D, Carton E. Complications of an uncovered metallic tracheal stent managed by veno-venous extracorporeal membrane oxygenation: a case report. BJA Open 2022; 2:100011. [PMID: 37588269 PMCID: PMC10430833 DOI: 10.1016/j.bjao.2022.100011] [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] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/11/2022] [Indexed: 08/18/2023]
Abstract
Airway stents are primarily inserted for the management of airway obstruction associated with an inoperable malignancy and are rarely indicated in benign disease. We outline the complications associated with tracheal stents and describe the use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) to facilitate open tracheal surgery in an apnoeic patient who had an uncovered metallic tracheal stent left in place for an inappropriately long period. Computerised tomography imaging of the neck and thorax provided information for operative planning and described of the stent in addition to the extensive granulation tissue at the distal end of the stent. Veno-venous extracorporeal membrane oxygenation was used to facilitate open tracheal surgery, removal of the tracheal stent and formation of a surgical tracheostomy. Prolonged use of an uncovered metallic airway stent in younger patients with benign disease may lead to the stent being difficult to remove. There may be an accumulation of granulation tissue with the risk of airway obstruction.
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Affiliation(s)
| | - A. Moorthy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - H. Frizelle
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - M. Griffin
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - B. Reidy
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - D. Eaton
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - E. Carton
- Mater Misericordiae University Hospital, Dublin, Ireland
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Nugent TS, Aladaileh M, Donlon NE, Murphy N, Eaton D. Endobronchial valve use in COVID-19 related pneumothorax and persistent air leak. Ann R Coll Surg Engl 2022; 104:e137-e138. [PMID: 34730417 PMCID: PMC9773871 DOI: 10.1308/rcsann.2021.0197] [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] [Indexed: 11/22/2022] Open
Abstract
Pneumothoraces may occur rarely in coronavirus (COVID-19) patients, often resulting from a combination of fibrotic parenchymal changes and prolonged high-pressure ventilation. Very few studies have been published describing the management of pneumothorax in the novel COVID-19 pneumonia patients. Although chest drain insertion represents the first line of treatment, a persistent pneumothorax and air leak requiring intervention could be managed by a thoracoscopic procedure or, as is the case here, by endobronchial valve insertion. Endobronchial valve insertion is a minimally invasive technique that provides a treatment option in patients with severe parenchymal COVID-19 related lung disease. As far as the authors are aware this is the first report of the use of endobronchial valves in a COVID-19 patient.
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Affiliation(s)
| | | | | | - N Murphy
- Beacon Hospital, Dublin, Ireland
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Heiden B, Eaton D, Chang S, Yan Y, Schoen M, Meyers B, Kozower B, Puri V. Comparison of National Comprehensive Cancer Network and American College of Surgeons Commission on Cancer Lymph Node Sampling Guidelines for Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2022. [DOI: 10.1016/j.ijrobp.2021.10.171] [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: 10/19/2022]
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10
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Behrouzi R, Moon S, Eaton D. 327P Predictors of progression-free survival in patients with metastatic breast cancer receiving palbociclib with letrozole. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.610] [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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Humbert-Vidan L, Patel V, Begum R, McGovern M, Eaton D, Kong A, Petkar I, Reis Ferreira M, Lei M, King A, Guerrero Urbano T. PH-0387 Mandible osteoradionecrosis: a dosimetric study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07318-7] [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: 10/20/2022]
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Eaton D, Bass G, Booker P, Byrne J, Duane S, Frame J, Grattan M, Thomas R, Thorp N, Nisbet A. PO-1307: IPEM Code of Practice for high-energy photon dosimetry based on the NPL dose calibration service. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01325-6] [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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Eaton D. SP-0249: Radiosurgery: potentials and pitfalls. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00273-5] [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: 11/15/2022]
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Pearson M, Eaton D, Greener T. Long-term experience of MPC across multiple TrueBeam linacs: MPC concordance with conventional QC and sensitivity to real-world faults. J Appl Clin Med Phys 2020; 21:224-235. [PMID: 32790139 PMCID: PMC7484877 DOI: 10.1002/acm2.12950] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/11/2020] [Accepted: 05/16/2020] [Indexed: 11/12/2022] Open
Abstract
Machine Performance Check (MPC) is an automated Quality Control (QC) tool that is integrated into the TrueBeam and Halcyon linear accelerators (Linacs), utilizing the imaging systems to verify the Linac beam and geometry. This work compares the concordance of daily MPC results with conventional QC tests over a 3-year period for eight Linacs in order to assess the sensitivity of MPC in detecting faults. The MPC output measurements were compared with the monthly ionization chamber measurements for 6 and 10 MV photon beams and 6, 9, 12, 16, and 18 MeV electron beams. All 6 MV Beam and Geometry (6MVBG) MPC test failures were analyzed to determine the failure rate and the number of true and false negative results, using the conventional QC record as the reference. The concordance between conventional QC test failures and MPC test failures was investigated. The mean agreement across 1933 MPC output and monthly comparison chamber measurements for all beam energies was 0.2%, with 97.8% within 1.5%, and a maximum difference of 2.9%. Of the 5000-6000 MPC individual test parameter results for the 6MVBG test, the highest failure rate was BeamOutputChange (0.5%), then BeamCenterShift (0.3%), and was ≤ 0.1% for the remaining parameters. There were 50 true negative and 27 false negative out of tolerance MPC results, with false negatives resolved by repeating MPC or by independent measurement. The analysis of conventional QC failures demonstrated that MPC detected all failures, except occasions when MPC reported output within tolerance, a result of the MPC-chamber response variation. The variation in MPC output versus chamber measurement indicates MPC is appropriate for daily output constancy but not for the measurement of absolute output. The comparison of the 6MVBG results and conventional records provides evidence that MPC is a sensitive method of performing beam and mechanical checks in a clinical setting.
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Affiliation(s)
- Michael Pearson
- Medical Physics Department, Guys and St Thomas' Hospital, London, SE1 9RT, United Kingdom
| | - David Eaton
- Medical Physics Department, Guys and St Thomas' Hospital, London, SE1 9RT, United Kingdom
| | - Tony Greener
- Medical Physics Department, Guys and St Thomas' Hospital, London, SE1 9RT, United Kingdom
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Growcott S, Dembrey T, Patel R, Eaton D, Cameron A. Inter-Observer Variability in Target Volume Delineations of Benign and Metastatic Brain Tumours for Stereotactic Radiosurgery: Results of a National Quality Assurance Programme. Clin Oncol (R Coll Radiol) 2020; 32:13-25. [DOI: 10.1016/j.clon.2019.06.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/21/2019] [Indexed: 11/28/2022]
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16
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Corrie PG, Marshall A, Nathan PD, Lorigan P, Gore M, Tahir S, Faust G, Kelly CG, Marples M, Danson SJ, Marshall E, Houston SJ, Board RE, Waterston AM, Nobes JP, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Westwell S, Casasola R, Chao D, Maraveyas A, Patel PM, Ottensmeier CH, Farrugia D, Humphreys A, Eccles B, Young G, Barker EO, Harman C, Weiss M, Myers KA, Chhabra A, Rodwell SH, Dunn JA, Middleton MR, Nathan P, Lorigan P, Dziewulski P, Holikova S, Panwar U, Tahir S, Faust G, Thomas A, Corrie P, Sirohi B, Kelly C, Middleton M, Marples M, Danson S, Lester J, Marshall E, Ajaz M, Houston S, Board R, Eaton D, Waterston A, Nobes J, Loo S, Gray G, Stubbings H, Gore M, Harries M, Kumar S, Goodman A, Dalgleish A, Martin-Clavijo A, Marsden J, Westwell S, Casasola R, Chao D, Maraveyas A, Marshall E, Patel P, Ottensmeier C, Farrugia D, Humphreys A, Eccles B, Dega R, Herbert C, Price C, Brunt M, Scott-Brown M, Hamilton J, Hayward RL, Smyth J, Woodings P, Nayak N, Burrows L, Wolstenholme V, Wagstaff J, Nicolson M, Wilson A, Barlow C, Scrase C, Podd T, Gonzalez M, Stewart J, Highley M, Wolstenholme V, Grumett S, Goodman A, Talbot T, Nathan K, Coltart R, Gee B, Gore M, Farrugia D, Martin-Clavijo A, Marsden J, Price C, Farrugia D, Nathan K, Coltart R, Nathan K, Coltart R. Adjuvant bevacizumab for melanoma patients at high risk of recurrence: survival analysis of the AVAST-M trial. Ann Oncol 2019; 29:1843-1852. [PMID: 30010756 PMCID: PMC6096737 DOI: 10.1093/annonc/mdy229] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background Bevacizumab is a recombinant humanised monoclonal antibody to vascular endothelial growth factor shown to improve survival in advanced solid cancers. We evaluated the role of adjuvant bevacizumab in melanoma patients at high risk of recurrence. Patients and methods Patients with resected AJCC stage IIB, IIC and III cutaneous melanoma were randomised to receive either adjuvant bevacizumab (7.5 mg/kg i.v. 3 weekly for 1 year) or standard observation. The primary end point was detection of an 8% difference in 5-year overall survival (OS) rate; secondary end points included disease-free interval (DFI) and distant metastasis-free interval (DMFI). Tumour and blood were analysed for prognostic and predictive markers. Results Patients (n=1343) recruited between 2007 and 2012 were predominantly stage III (73%), with median age 56 years (range 18–88 years). With 6.4-year median follow-up, 515 (38%) patients had died [254 (38%) bevacizumab; 261 (39%) observation]; 707 (53%) patients had disease recurrence [336 (50%) bevacizumab, 371 (55%) observation]. OS at 5 years was 64% for both groups [hazard ratio (HR) 0.98; 95% confidence interval (CI) 0.82–1.16, P = 0.78). At 5 years, 51% were disease free on bevacizumab versus 45% on observation (HR 0.85; 95% CI 0.74–0.99, P = 0.03), 58% were distant metastasis free on bevacizumab versus 54% on observation (HR 0.91; 95% CI 0.78–1.07, P = 0.25). Forty four percent of 682 melanomas assessed had a BRAFV600 mutation. In the observation arm, BRAF mutant patients had a trend towards poorer OS compared with BRAF wild-type patients (P = 0.06). BRAF mutation positivity trended towards better OS with bevacizumab (P = 0.21). Conclusions Adjuvant bevacizumab after resection of high-risk melanoma improves DFI, but not OS. BRAF mutation status may predict for poorer OS untreated and potential benefit from bevacizumab. Clinical Trial Information ISRCTN 81261306; EudraCT Number: 2006-005505-64
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Affiliation(s)
- P G Corrie
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
| | - A Marshall
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - P D Nathan
- Medical Oncology, Mount Vernon Hospital, Northwood, UK
| | - P Lorigan
- Department of Medical Oncology, Christie Hospital, Manchester, UK
| | - M Gore
- Royal Marsden Hospital NHS Trust, London, UK
| | - S Tahir
- Oncology Research, Broomfield Hospital, Chelmsford, UK
| | - G Faust
- Oncology Department, Leicester Royal Infirmary, Leicester, UK
| | - C G Kelly
- Sir Bobby Robson Cancer Trials Research Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - M Marples
- Leeds Cancer Centre, St James's University Hospital, Leeds, UK
| | - S J Danson
- Weston Park Hospital, Academic Unit of Clinical Oncology, Sheffield, UK
| | - E Marshall
- Cancer & Palliative Care, St. Helen's Hospital, St. Helens, UK
| | - S J Houston
- Oncology Department, Royal Surrey County Hospital, Guildford, UK
| | - R E Board
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - A M Waterston
- Clinical Trials Unit, Beatson WOS Cancer Centre, Glasgow, UK
| | - J P Nobes
- Department of Clinical Oncology, Norfolk & Norwich University Hospital, Norwich, UK
| | - M Harries
- Guy's & St. Thomas' Hospital, Guy's Cancer Centre, London, UK
| | - S Kumar
- Velindre Cancer Centre, Cardiff, UK
| | - A Goodman
- Exeter Oncology Centre, Royal Devon and Exeter Hospital, Exeter, UK
| | - A Dalgleish
- St George's Hospital, Cancer Centre, London, UK
| | | | - S Westwell
- Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK
| | - R Casasola
- Cancer Centre, Ninewells Hospital, Dundee, UK
| | - D Chao
- Royal Free Hospital, London, UK
| | | | - P M Patel
- Academic Unit of Clinical Oncology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C H Ottensmeier
- CRUK and NIHR Southampton Experimental Cancer Medicine Centre, Southampton University Hospitals NHS Foundation Trust, Southampton, UK
| | - D Farrugia
- Oncology Centre, Cheltenham General Hospital, Cheltenham, UK
| | - A Humphreys
- Oncology Department, James Cook University Hospital, Middlesbrough, UK
| | - B Eccles
- Oncology Department, Poole Hospital, Dorset, UK
| | - G Young
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - E O Barker
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - C Harman
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M Weiss
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - K A Myers
- Department of Oncology, University of Oxford, Oxford, UK; Experimental Cancer Medicine Centre, Oxford, UK
| | - A Chhabra
- Cambridge Cancer Centre, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - J A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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Johnstone RI, Guerrero-Urbano T, Michaelidou A, Greener T, Miles E, Eaton D, Thomas C. Guidance on the use of MRI for treatment planning in radiotherapy clinical trials. Br J Radiol 2019; 93:20190161. [PMID: 31724876 DOI: 10.1259/bjr.20190161] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The aim of this article is to propose meaningful guidance covering the technical and safety issues involved when designing or conducting radiotherapy clinical trials that use MRI for treatment planning. The complexity of imaging requirements will depend on the trial aims, design and MRI methods used.The use of MRI within the RT pathway is becoming more prevalent and clinically appropriate as access to MRI increases, treatment planning systems become more versatile and potential indications for MRI-planning in RT are documented. Novel MRI-planning opportunities are often initiated and validated within clinical trials.The guidance in this document is intended to assist researchers designing RT clinical trials involving MRI, so that they may provide sufficient information about the appropriate methods to be used for image acquisition, post-processing and quality assurance such that participating sites complete MRI to consistent standards. It has been produced in collaboration with the National Radiotherapy Trials Quality Assurance Group (RTTQA).As the use of MRI in RT is developed, it is highly recommended for researchers writing clinical trial protocols to include imaging guidance as part of their clinical trial documentation covering the trial-specific requirements for MRI procedures. Many of the considerations and recommendations in this guidance may well apply to MR-guided treatment machines, where clinical trials will be crucial. Similarly, many of these recommendations will apply to the general use of MRI in RT, outside of clinical trials.This document contains a large number of recommendations, not all of which will be relevant to any particular trial. Designers of RT clinical trials must therefore take this into account. They must also use their own judgement as to the appropriate compromise between accessibility of the trial and its technical rigour.
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Affiliation(s)
- Robert I Johnstone
- Medical Physics Department, Guys & St Thomas' NHS Foundation Trust, London, UK
| | | | | | - Tony Greener
- Medical Physics Department, Guys & St Thomas' NHS Foundation Trust, London, UK
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, London, UK
| | - David Eaton
- Medical Physics Department, Guys & St Thomas' NHS Foundation Trust, London, UK.,National Radiotherapy Trials Quality Assurance Group, Mount Vernon Hospital, London, UK
| | - Christopher Thomas
- Medical Physics Department, Guys & St Thomas' NHS Foundation Trust, London, UK.,Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Pike LC, Thomas CM, Guerrero-Urbano T, Michaelidou A, Greener T, Miles E, Eaton D, Barrington SF. Guidance on the use of PET for treatment planning in radiotherapy clinical trials. Br J Radiol 2019; 92:20190180. [PMID: 31437023 PMCID: PMC6849663 DOI: 10.1259/bjr.20190180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/15/2019] [Revised: 07/16/2019] [Accepted: 08/19/2019] [Indexed: 12/22/2022] Open
Abstract
The aim of this article is to propose meaningful guidance covering the practical and technical issues involved when planning or conducting clinical trials involving positron emission tomography (PET)-guided radiotherapy. The complexity of imaging requirements will depend on the study aims, design and PET methods used. Where PET is used to adapt radiotherapy, a high level of accuracy and reproducibility is required to ensure effective and safe treatment delivery. The guidance in this document is intended to assist researchers designing clinical trials involving PET-guided radiotherapy to provide sufficient information about the appropriate methods to complete PET-CT imaging to a consistent standard at participating centres. The guidance is divided into six categories: application of PET in radiotherapy, resource requirements, quality assurance, imaging protocol design, data management and image processing. Each section provides an overview of the recent literature to support the specific recommendations. This guidance builds on previous recommendations from the National Cancer Research Institute PET Research Network and has been produced in collaboration with the National Radiotherapy Trials Quality Assurance Group.
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Affiliation(s)
- Lucy C Pike
- King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s College London, King’s Health Partners, London, UK
| | | | | | | | - Tony Greener
- Radiotherapy Physics, Guy's & St Thomas’ NHS Foundation Trust, London, UK
| | - Elizabeth Miles
- National Radiotherapy Trials QA Group, Mount Vernon Hospital, Northwood, UK
| | | | - Sally F Barrington
- King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s College London, King’s Health Partners, London, UK
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Wallner M, Eaton D, Berretta R, Wu J, Jeong M, Zhao H, Rainer P, Blass S, Von Lewinski D, Zuegner E, Zirlik A, Graier W, McKinsey T, Wolfson M, Houser S. P5996HDAC inhibition improves myofibrillar relaxation and metabolism in a feline model of HFpEF. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for about 50% of all cases of HF and there are currently no effective therapies.
Purpose
To assess the effects of histone deacetylase (HDAC) inhibition on cardiac and mitochondrial function and the plasma metabolome in a large mammalian model of slow-progressive pressure overload with features of HFpEF.
Methods
Male domestic short hair cats (n=26, aged 2mo), underwent either sham (S) procedures (n=5) or aortic constriction with a customized pre-shaped band (n=21), resulting in slow progressive pressure overload during growth. 2 months post-banding, animals were treated daily with either 10mg/kg suberoylanilide hydroxamic acid (b+SAHA) (n=8), a pan-HDAC inhibitor, or vehicle (b+veh) (n=8) for 2 months. Serial in-vivo cardiopulmonary phenotyping was performed monthly, and invasive hemodynamic and gas exchange parameters were evaluated 4 months post-banding. Ex-vivo myofibril mechanical studies and blood-based metabolomic profiling were performed. Data is presented as mean±SEM.
Results
Echocardiography at 4-months post-banding revealed that b+SAHA animals had a significant reduction in left ventricular hypertrophy (LVH) and LA size vs. b+veh animals. Left ventricular end-diastolic pressure (LVEDP) and mean pulmonary arterial pressure (mPAP) were significantly lower in b+SAHA vs. b+veh. SAHA treatment also improved ex-vivo myofibril relaxation independent of LVH and this effect correlated with in-vivo improvements of LV relaxation. Furthermore, SAHA treatment preserved lung structure, and improved lung compliance and oxygenation, reflected by a decrease in alveolar-capillary wall thickness and intrapulmonary shunt. SAHA treatment also reduced perivascular fluid cuffs around extra-alveolar vessels, suggesting attenuated alveolar-capillary stress failure. Treatment with SAHA caused an increase in both oxygen consumption in-vivo and the percentage of type 1 skeletal muscle fibers (higher oxidative capacity). SAHA also increased mRNA levels of coactivators that regulate mitochondrial function and induced metabolic reprogramming towards mitochondrial oxidation preferentially utilizing fatty acids. SAHA treated HeLa cells showed a significant increase in oxidative phosphorylation and ATP production.
Effects of SAHA
Conclusion
These results show that slow-progressive pressure overload mimics critical features of HFpEF. SAHA can improve cardiac, pulmonary, and metabolic derangements caused by chronic pressure overload. Therefore, HDAC inhibition may be an interesting therapeutic strategy to treat the ever growing HFpEF population.
Acknowledgement/Funding
NIH [HL33921 to S.R.H, HL116848, HL127240 to T.A.M]; AHA [16SFRN31400013 to T.A.M.]; Medical University of Graz [M.W.], Stadt Graz [M.W.]
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Affiliation(s)
- M Wallner
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - D Eaton
- Temple University School of Medicine, Cardiovascular Research Center, Philadelphia, United States of America
| | - R Berretta
- Temple University School of Medicine, Cardiovascular Research Center, Philadelphia, United States of America
| | - J Wu
- Temple University School of Medicine, Physiology; Thoracic Medicine and Surgery; CILR, Philadelphia, United States of America
| | - M Jeong
- University of Colorado, Anschutz Medical Campus, Aurora, United States of America
| | - H Zhao
- Temple University School of Medicine, Clinical Sciences, Philadelphia, United States of America
| | - P Rainer
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - S Blass
- Medical University of Graz, Molecular Biology and Biochemistry, Graz, Austria
| | - D Von Lewinski
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - E Zuegner
- Joanneum Research Forschungsgesellschaft mbH HEALTH, Institute for Biomedicine and Health Sciences, Graz, Austria
| | - A Zirlik
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - W Graier
- Medical University of Graz, Molecular Biology and Biochemistry, Graz, Austria
| | - T McKinsey
- University of Colorado, Anschutz Medical Campus, Aurora, United States of America
| | - M Wolfson
- Temple University School of Medicine, Physiology; Thoracic Medicine and Surgery; CILR, Philadelphia, United States of America
| | - S Houser
- Temple University School of Medicine, Cardiovascular Research Center, Philadelphia, United States of America
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Bhattacharya IS, Haviland JS, Perotti C, Eaton D, Gulliford S, Harris E, Coles CE, Kirwan CC, Bliss JM, Kirby AM. Is breast seroma after tumour resection associated with patient-reported breast appearance change following radiotherapy? Results from the IMPORT HIGH (CRUK/06/003) trial. Radiother Oncol 2019; 136:190-196. [PMID: 31015124 PMCID: PMC6598856 DOI: 10.1016/j.radonc.2019.03.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 01/29/2019] [Revised: 03/15/2019] [Accepted: 03/24/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Seroma describes a collection of serous fluid within a cavity, occurring following surgery. Seroma is associated with normal tissue effects (NTE) following breast radiotherapy, as reported by clinicians and on photographs. This study investigates the association between seroma and the NTE breast appearance change collected using patient-reported outcome measures (PROMs) in IMPORT HIGH, as well as investigating the association between breast appearance change and patient/tumour/treatment factors. METHODS Case-control methodology was used for seroma analysis within IMPORT HIGH. Cases were patients reporting moderate/marked breast appearance change and controls reported none/mild changes at year-3. One control was selected at random for each case. Seromas were graded as not visible/subtle or visible/highly visible on CT radiotherapy planning scans. Logistic regression tested associations, adjusting for patient/tumour/treatment factors. RESULTS 1078/1149 patients consented to PROMs, of whom 836 (78%) reported whether they had 3-year breast appearance change; 231 cases and 231 controls were identified. 304/462 (66%) patients received chemotherapy. Seroma prevalence was 20% (41/202) in cases and 16% (32/205) in controls, and less frequent in patients receiving adjuvant chemotherapy [10% (24/246) compared with 29% (40/138) without]. Visible seroma was not significantly associated with breast appearance change [OR 1.38 (95%CI 0.83-2.29), p = 0.219]. Larger tumour size, haematoma, current smoking and body image concerns at baseline were independent risk factors. CONCLUSIONS Seroma was not associated with patient-reported breast appearance change, but haematoma and smoking were significant risk factors. Lack of association may be related to lower prevalence of seroma compared with previous reports, perhaps reflecting patients receiving adjuvant chemotherapy in whom seroma resolves prior to radiotherapy.
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Affiliation(s)
- Indrani S Bhattacharya
- The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), United Kingdom.
| | - Joanne S Haviland
- The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), United Kingdom.
| | | | - David Eaton
- Mount Vernon Hospital, National Radiotherapy Trials QA Group, United Kingdom.
| | - Sarah Gulliford
- The Institute of Cancer Research, Radiotherapy and Imaging, United Kingdom; University College London Hospital, London, UK.
| | - Emma Harris
- The Institute of Cancer Research, Radiotherapy and Imaging, United Kingdom.
| | | | - Cliona C Kirwan
- Institute of Cancer Sciences, University of Manchester, University Hospital of South Manchester, United Kingdom.
| | - Judith M Bliss
- The Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), United Kingdom.
| | - Anna M Kirby
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, Radiotherapy and Imaging, United Kingdom.
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Bhattacharya I, Haviland J, Perotti C, Eaton D, Gulliford S, Harris E, Coles C, Kirwan C, Bliss J, Kirby A. OC-0595 Does seroma predict patient-reported adverse effects following breast radiotherapy in IMPORT HIGH? Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31015-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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McAdam K, Davis P, Ashmore L, Eaton D, Jakaj B, Eldridge A, Liu C. Influence of machine-based puffing parameters on aerosol and smoke emissions from next generation nicotine inhalation products. Regul Toxicol Pharmacol 2019; 101:156-165. [DOI: 10.1016/j.yrtph.2018.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/04/2018] [Accepted: 11/12/2018] [Indexed: 11/27/2022]
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Amos R, Bulbeck H, Burnet N, Crellin A, Eaton D, Evans P, Hall E, Hawkins M, Kirkby K, Mackay R, Sebag-Montefiore D, Sharma R. Proton Beam Therapy - the Challenges of Delivering High-quality Evidence of Clinical Benefit. Clin Oncol (R Coll Radiol) 2018; 30:280-284. [PMID: 29551566 DOI: 10.1016/j.clon.2018.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 12/11/2022]
Abstract
The use of proton beam therapy (PBT) offers the opportunity to improve greater conformality of radiotherapy treatment delivery in some patients. However, it is associated with a high capital cost and the need to build new dedicated facilities. We discuss how the global radiotherapy community can respond to the challenge of producing high-quality evidence of clinical benefit from PBT in adult patients. In the UK, the National Cancer Research Institute-funded Clinical and Radiotherapy Translational group has established the PBT Clinical Trial Strategy Group. An eight-point framework is described that can assist the development and delivery of high-quality clinical trials.
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Conibear J, Chia B, Ngai Y, Bates AT, Counsell N, Patel R, Eaton D, Faivre-Finn C, Fenwick J, Forster M, Hanna GG, Harden S, Mayles P, Moinuddin S, Landau D. Study protocol for the SARON trial: a multicentre, randomised controlled phase III trial comparing the addition of stereotactic ablative radiotherapy and radical radiotherapy with standard chemotherapy alone for oligometastatic non-small cell lung cancer. BMJ Open 2018; 8:e020690. [PMID: 29666135 PMCID: PMC5905762 DOI: 10.1136/bmjopen-2017-020690] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/02/2018] [Accepted: 02/09/2018] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Following growing evidence to support the safety, local control (LC) and potential improvement in overall survival (OS) in patients with oligometastatic non-small cell lung cancer (NSCLC) that have been treated with local ablative therapy such as stereotactic ablative radiotherapy (SABR) and stereotactic radiosurgery (SRS), we initiate the SARON trial to investigate the impact and feasibility of adding SABR/SRS and radical radiotherapy (RRT) following standard chemotherapy on OS. METHODS AND ANALYSIS SARON is a large, randomised controlled, multicentre, phase III trial for patients with oligometastatic EGFR, ALK and ROS1 mutation negative NSCLC (1-3 sites of synchronous metastatic disease, one of which must be extracranial). 340 patients will be recruited over 3 years from approximately 30 UK sites and randomised to receive either standard platinum-doublet chemotherapy only (control arm) or standard chemotherapy followed by RRT/SABR to their primary tumour and then SABR/SRS to all other metastatic sites (investigational arm). The primary endpoint is OS; the study is powered to detect an improvement in median survival from 9.9 months in the control arm to 14.3 months in the investigational arm with 85% power and two-sided 5% significance level. The secondary endpoints are LC, progression-free survival, new distant metastasis-free survival, toxicity and quality of life. An early feasibility review will take place after 50 randomised patients. Patients requiring both conventional thoracic RT to the primary and SABR to a thoracic metastasis will be included in a thoracic SABR safety substudy to assess toxicity and planning issues in this subgroup of patients more thoroughly. ETHICS AND DISSEMINATION All participants are given a SARON patient information sheet and required to give written informed consent. Results will be submitted for presentation at local and international conferences and expected to be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT02417662. SPONSOR REFERENCE UCL/13/0594.
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Affiliation(s)
| | | | - Yenting Ngai
- Cancer Research UK & UCL Cancer Trials Centre, London, UK
| | - Andrew Tom Bates
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | | - Rushil Patel
- National Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, UK
| | - David Eaton
- National Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, UK
| | - Corinne Faivre-Finn
- The University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - John Fenwick
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - Gerard G Hanna
- Centre for Cancer Research and Cell Biology, Queen’s University of Belfast, Belfast, UK
| | | | | | | | - David Landau
- Guys & St Thomas NHS Trust, London, UK
- Department of Oncology, University College London, London, UK
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Simões R, Patel E, Groom N, Lawless C, Shaw A, Paul J, Eaton D, Lester J, Landau D, Faivre-Finn C, Hatton M. PO-1068: ADSCAN: Feasibility of implementing adequate technology for a ‘pick the winner’ trial in lung cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31378-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lee J, Patel R, Clark C, Eaton D. EP-2192: Developing a national SBRT spine dosimetry audit. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)32501-5] [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: 11/25/2022]
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Abida W, Bang YJ, Carter L, Azaro A, Krebs M, Im SA, Chen Y, Buil-Bruna N, Li Y, Eaton D, Stephens C, Ross G, Pass M, Rodon J, Dean E. Abstract A094: Phase I modular study of AZD0156, a first-in-class oral selective inhibitor of ataxia telangiectasia mutated protein kinase (ATM), in combination with olaparib (AToM Study, Module 1). Clin Trials 2018. [DOI: 10.1158/1535-7163.targ-17-a094] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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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Khoo V, Hawkins M, McDonald F, Ahmed M, Kirby A, Van As N, Franks K, Syndikus I, Jain S, Tree A, Eaton D, Patel R, Goubar A, Kilburn L, Toms C, Hall E. CORE: A randomised trial of COventional care versus Radioablation (stereotactic body radiotherapy) for Extracranial oligometastases. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30219-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Daly A, Gunaratnam C, Redmond KC, Eaton D. Isolated Unilateral Pulmonary Artery Agenesis complicated by Symptomatic Aspergilloma. Ir Med J 2017; 110:656. [PMID: 29465846] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Isolated unilateral pulmonary artery agenesis is a rare diagnosis. Poor blood flow to the lung parenchyma renders the tissue susceptible to opportunistic infections. We present the unusual case of isolated unilateral pulmonary artery agenesis complicated by aspergilloma. Management options and considerations are discussed.
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Affiliation(s)
- A Daly
- Professor Eoin O'Malley National Cardiothoracic & Transplant Unit, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - C Gunaratnam
- Department of Respiratory Medicine, Beaumont Hospital, Beaumont, Dublin, Ireland
| | - K C Redmond
- Professor Eoin O'Malley National Cardiothoracic & Transplant Unit, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - D Eaton
- Professor Eoin O'Malley National Cardiothoracic & Transplant Unit, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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Díez P, Aird EGA, Sander T, Gouldstone CA, Sharpe PHG, Lee CD, Lowe G, Thomas RAS, Simnor T, Bownes P, Bidmead M, Gandon L, Eaton D, Palmer AL. A multicentre audit of HDR/PDR brachytherapy absolute dosimetry in association with the INTERLACE trial (NCT015662405). Phys Med Biol 2017; 62:8832-8849. [PMID: 28984277 DOI: 10.1088/1361-6560/aa91a9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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
A UK multicentre audit to evaluate HDR and PDR brachytherapy has been performed using alanine absolute dosimetry. This is the first national UK audit performing an absolute dose measurement at a clinically relevant distance (20 mm) from the source. It was performed in both INTERLACE (a phase III multicentre trial in cervical cancer) and non-INTERLACE brachytherapy centres treating gynaecological tumours. Forty-seven UK centres (including the National Physical Laboratory) were visited. A simulated line source was generated within each centre's treatment planning system and dwell times calculated to deliver 10 Gy at 20 mm from the midpoint of the central dwell (representative of Point A of the Manchester system). The line source was delivered in a water-equivalent plastic phantom (Barts Solid Water) encased in blocks of PMMA (polymethyl methacrylate) and charge measured with an ion chamber at 3 positions (120° apart, 20 mm from the source). Absorbed dose was then measured with alanine at the same positions and averaged to reduce source positional uncertainties. Charge was also measured at 50 mm from the source (representative of Point B of the Manchester system). Source types included 46 HDR and PDR 192Ir sources, (7 Flexisource, 24 mHDR-v2, 12 GammaMed HDR Plus, 2 GammaMed PDR Plus, 1 VS2000) and 1 HDR 60Co source, (Co0.A86). Alanine measurements when compared to the centres' calculated dose showed a mean difference (±SD) of +1.1% (±1.4%) at 20 mm. Differences were also observed between source types and dose calculation algorithm. Ion chamber measurements demonstrated significant discrepancies between the three holes mainly due to positional variation of the source within the catheter (0.4%-4.9% maximum difference between two holes). This comprehensive audit of absolute dose to water from a simulated line source showed all centres could deliver the prescribed dose to within 5% maximum difference between measurement and calculation.
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Affiliation(s)
- P Díez
- RTTQA Group, Mount Vernon Cancer Centre, Northwood, United Kingdom
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Robinson M, Eaton D, Holyoake D, Hawkins M. Four-dimensional Computed Tomography Contouring Variability in Stereotactic Body Radiotherapy of Non-resectable Biliary Tract Cancer. Clin Oncol (R Coll Radiol) 2017; 29:e137. [PMID: 28325599 DOI: 10.1016/j.clon.2017.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 02/24/2017] [Indexed: 10/19/2022]
Affiliation(s)
- M Robinson
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - D Eaton
- National Radiotherapy Trials QA group (RTTQA), Mount Vernon Hospital, Northwood, UK
| | - D Holyoake
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - M Hawkins
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
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Dimitriadis A, Thomas R, Palmer A, Eaton D, Lee J, Patel R, Silvestre Patallo I, Nisbet A, Clark C. OC-0540: A national cranial stereotactic radiosurgery end-to-end dosimetry audit. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30980-5] [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: 11/27/2022]
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McNamara C, Cullen P, Rackauskas M, Kelly R, O'Sullivan KE, Galvin J, Eaton D. Left cardiac sympathetic denervation: case series and technical report. Ir J Med Sci 2017; 186:607-613. [PMID: 28238200 DOI: 10.1007/s11845-017-1577-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 07/22/2016] [Accepted: 02/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left cardiac sympathetic denervation (LCSD) is a surgical procedure that has been shown to have an antiarrhythmic and antifibrillatory effect. Evidence indicating its antiarrhythmic effect has been available for over 100 years. It involves the removal of the lower half of the stellate ganglion and T2-T4 of the sympathetic ganglia and is carried out as either a unilateral or bilateral procedure. With advancements in thoracic surgery, it can be safely performed via a minimally invasive Video-Assisted Thoracoscopic Surgery (VATS) approach resulting in significantly less morbidity and a shortened inpatient stay. LCSD provides a valuable treatment option for patients with life-threatening channelopathies and cardiomyopathies. AIMS AND METHODS This case series reports the preliminary paediatric and adult experience in the Republic of Ireland with LCSD and describes five cases recently treated in addition to an outline of the operative procedure employed. Of the five cases included, two were paediatric cases and three were adult cases. RESULTS One of the paediatric patients had a diagnosis of the rare catecholaminergic polymorphic ventricular tachycardia (CPVT) and the other a diagnosis of long-QT syndrome. Both paediatric patients experienced excellent outcomes. Of the three adult patients, two benefitted greatly and remain well at follow-up (one inappropriate sinus tachycardia and one CPVT). One patient with idiopathic ventricular fibrillation unfortunately passed away from intractable VF despite all attempts at resuscitation. CONCLUSION In this case series, we highlight that LCSD provides a critical adjunct to existing medical therapies and should be considered for all patients with life-threatening refractory arrhythmias especially those patients on maximal medical therapy.
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Affiliation(s)
- C McNamara
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
| | - P Cullen
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
| | - M Rackauskas
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
| | - R Kelly
- Department of Cardiothoracic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
| | - K E O'Sullivan
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland
| | - J Galvin
- Department of Cardiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - D Eaton
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Eccles St., Dublin 7, Ireland.
- Department of Cardiothoracic Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
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Brown R, Frohlich S, Redmond K, Eaton D. 150: Experience of Carina/Y-stent use in management of central airway obstruction. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30200-3] [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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Khoo V, Ahmed M, McDonald F, Kirby A, Van As N, Hawkins M, Syndikis I, Franks K, Jain S, Tree A, Eaton D, Patel R, Braidley MY, Kilburn L, Toms C, Hall E. 122: CORE: A randomised trial of COnventional care versus Radioablation (stereotactic body radiotherapy) for Extracranial oligometastases. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30172-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Eaton D. A Nervous State: Violence, Remedies, and Reverie in Colonial Congo. Nancy Rose Hunt, Durham: Duke University Press, 2016, 353 pp. Med Anthropol Q 2016. [DOI: 10.1111/maq.12354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fischhendler I, Feitelson E, Eaton D. The Short-Term and Long-Term Ramifications of Linkages Involving Natural Resources: The US – Mexico Transboundary Water Case. ACTA ACUST UNITED AC 2016. [DOI: 10.1068/c3v] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Issue linkage is often recommended as a strategy for enhancing cooperation. Lately it has been suggested that this strategy could also be applied to the management of transboundary natural resources. The authors examine the viability of this suggestion. They argue that in the case of natural resources such a linkage may have both short-term and long-term implications. Essentially, by constraining the options available to the various parties, such linkages limit ability to adapt management regimes to changes in the environment; thereby, they limit the ability to address environmental stresses and crises. These negative implications may be redressed by mechanisms that will allow the parties to adapt the linkage to new conditions and by tactics that reduce the political cost of a linkage strategy. The authors focus on the negotiation process concerning US–Mexico transboundary water, which was based on a long-term spatial linkage combining the waters of the Colorado River and those of the Rio Grande. This spatial linkage was advanced by a short-term issue linkage, in which the Mexican government supported the establishment of the United Nations in return for the US federal government's willingness to accept the spatial linkage. These linkages were found to have both short-term and long-term adverse implications. The short-term implications were delays in negotiations, inconsistency in the legal doctrines held by the different parties during the negotiation, and a threat to sovereignty. The main long-term implication identified is the current inability of Mexico to adapt the linkage in response to the ten-year drought along the Rio Grande, as manifest in the inability of Mexico to meet its water obligations to the USA along the Rio Grande. This has resulted in a controversy between Mexico and the USA, and between the Mexican federal government and the Mexican border states. It is suggested that flexibility provisions be included when linkages involving natural resources are advanced, so that the necessary adaptations in regimes management will be allowed for without necessitating a renegotiation of the treaty.
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Affiliation(s)
- Itay Fischhendler
- Department of Geography, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem 91905, Israel
| | - Eran Feitelson
- Department of Geography, The Hebrew University of Jerusalem, Mount Scopus, Jerusalem 91905, Israel
| | - David Eaton
- Lyndon B Johnson School of Public Affairs, The University of Texas at Austin, PO Box Y, Austin Texas, USA
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Gwynne S, Jones G, Maggs R, Eaton D, Miles E, Staffurth J, Nixon L, Ray R, Lewis G, Crosby T, Spezi E. Prospective review of radiotherapy trials through implementation of standardized multicentre workflow and IT infrastructure. Br J Radiol 2016; 89:20160020. [PMID: 27245136 PMCID: PMC5124880 DOI: 10.1259/bjr.20160020] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/03/2016] [Accepted: 05/31/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE: We sought to develop a process that would allow us to perform a prospective review of outlining in trials using expert reviewers based in multiple centres. METHODS: We implemented a specific information technology infrastructure and workflow that could serve all organizations involved in the radiotherapy quality assurance (RTQA) process. RESULTS: Data were processed and packaged in the computational environment for radiotherapy research (CERR) binary format and securely transmitted to the expert reviewer at the designated remote organization. It was opened and reviewed using the distributed CERR-compiled application, and a standardized report was sent to the respective centre. Centres were expected to correct any unacceptable deviations and resubmit outlining for approval prior to commencing treatment. 75% of reviews were completed and fed back to centres within 3 working days. There were no delays in treatment start date. CONCLUSION: Our distributed RTQA review approach provides a method of prospective outlining review at multiple centres, without compromising the quality, delaying the start of treatment or the need for significant additional infrastructure resources. Future progress in the area of prospective individual case review will need to be supported by additional resources for clinician time to undertake the reviews. ADVANCES IN KNOWLEDGE: Trial groups around the world have formulated different approaches to address the need for the prospective review of radiotherapy (RT) data with clinical trials, in line with available resources. We report a UK solution that has allowed the workload for outlining review to be distributed across a wider group of volunteer reviewers without the need for any additional infrastructure costs and has already been adopted within the UK RT trials community.
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Affiliation(s)
- Sarah Gwynne
- South West Wales Cancer Centre, Swansea, UK
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
| | - Gareth Jones
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- Velindre Cancer Centre, Cardiff, UK
| | - Rhydian Maggs
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- Velindre Cancer Centre, Cardiff, UK
| | - David Eaton
- Radiotherapy Physics, Mount Vernon Hospital, Northwood, UK
- NCRI RTTQA Team, Mount Vernon Hospital, Northwood, UK
| | | | - John Staffurth
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Lisette Nixon
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- Wales Cancer Trials Unit, Cardiff University, Cardiff, UK
| | - Ruby Ray
- Institute of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Geraint Lewis
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- Velindre Cancer Centre, Cardiff, UK
| | | | - Emiliano Spezi
- NISCHR Cardiff RTTQA Centre, Cardiff, UK
- School of Engineering, Cardiff University, Cardiff, UK
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Eaton D, Robinson M, Patel R, Hawkins M. EP-1941: Assessment of variation in planning benchmark case for ABC-07 trial of liver SBRT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)33192-9] [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: 10/21/2022]
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Robinson M, Eaton D, Patel R, Holyoake D, Hawkins M. EP-1720: Impact of contouring variability on tumour control and normal tissue toxicity in liver SBRT. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32971-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Sarcoidosis is a common multisystem granulomatous condition of unknown aetiology, predominantly involving the respiratory system. Tracheal stenosis has been described but we believe that we present the first case of a tracheo-oesophageal fistula secondary to chronic sarcoidosis. A 57-year-old woman with sarcoidosis, a known tracheal stricture and a Polyflex(®) stent in situ presented with stridor. Bronchoscopy confirmed in-stent stenosis, by exuberant granulation tissue. The stent was removed and the granulation tissue was resected accordingly. Postoperatively, the patient was noticed to have an incessant cough and video fluoroscopy raised the suspicion of a tracheo-oesophageal fistula. A repeat bronchoscopy demonstrated marked granulation tissue, accompanied by a fistulous connection with the oesophagus at the mid-lower [middle of the lower] third of the trachea. Three Polyflex(®) stents were sited across the entire length of the trachea. Sarcoidosis presents with varying clinical manifestations and disease progression. Tracheal involvement appears to be a rare phenomenon and usually results in stenosis. To date, there has been little or no documented literature describing the formation of a tracheo-oesophageal fistula resulting from sarcoidosis. Early reports documented the presence of sarcoidosis induced weakening in the tracheal wall, a process termed tracheal dystonia. Weaknesses are more apparent in the membranous aspect of the trachea. Despite the rare nature of such pathology, this case report highlights the need to consider the presence of a tracheo-oesophageal fistula in sarcoidosis patients presenting with repeat aspiration in the absence of an alternate pathology.
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Affiliation(s)
- A Darr
- Dudley Group NHS Foundation Trust , UK
| | - S Mohamed
- University Hospitals Birmingham NHS Foundation Trust , UK
| | - D Eaton
- Heart of England NHS Foundation Trust , UK
| | - M S Kalkat
- Heart of England NHS Foundation Trust , UK
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Gough A, Wood A, McCarthy J, Nolke L, DG H, Redmond K, Eaton D, Javadpour H, Egan J. 100 Lung Transplants Delivered in Ireland. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Daly A, Kilgarrif S, Eaton D, Murray J, Lawlor L, Redmond K. 29: CT guided wire localisation of suspicious pulmonary lesions; a review of 10 patients. Lung Cancer 2015. [DOI: 10.1016/s0169-5002(15)50029-9] [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: 10/24/2022]
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Riddell P, Redmond K, Eaton D, Nolke L, Javadpour S, Healy D, McCarthy J, Egan J. P246 Lung Transplantation For Patients With Idiopathic Pulmonary Fibrosis And Asymptomatic Coronary Artery Disease. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.374] [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: 11/04/2022]
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Woolf D, Williams N, Bakshi R, Madani S, Fawcitt S, Eaton D, Pigott K, Short S, Keshtgar M. Biological Dosimetry With γ-H2AX Foci Using Radiation Therapy for Breast Cancer as a Model. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.823] [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: 10/24/2022]
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Eaton D, Hu M, Allen M, Peterson R, Packer CS. Pulmonary disease in ZDSD, a rat model of metabolic syndrome (697.1). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.697.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- David Eaton
- Biology Purdue UniversityWest LafayetteINUnited States
| | - Miriam Hu
- Carmel High School Carmel INUnited States
| | - Matthew Allen
- Anatomy & Cell Biology Indiana University School of MedicineIndianapolisINUnited States
| | | | - C Subah Packer
- Cellular & Integrative Physiology Indiana University School of MedicineIndianapolisINUnited States
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Rogers V, Eaton D, Rajesh P, Steyn R, Bishay E, Naidu B, Khalil H, Djearaman M, Kalkat M. 121 * MANAGEMENT OF MALIGNANT CHEST WALL TUMOURS: A MULTIDISCIPLINARY APPROACH IMPROVES OUTCOMES. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.121] [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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48
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Eaton D, Beeson J, Maiwand O, Anikin V. AOS7 Role of cryotherapy in multidisciplinary management of endobronchial metastases. Eur J Cancer 2012. [DOI: 10.1016/j.ejca.2012.02.024] [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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Eaton D, Duck S, Gonzalez R, Keshtgar M. Radiation safety of intra-operative breast radiotherapy with INTRABEAM - experience from the TARGIT randomised controlled trial. Eur J Surg Oncol 2011. [DOI: 10.1016/j.ejso.2011.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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50
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Estall VJ, Eaton D, Burton KE, Jefferies SJ, Jena R, Burnet NG. Intensity-modulated radiotherapy plan optimisation for skull base lesions: practical class solutions for dose escalation. Clin Oncol (R Coll Radiol) 2010; 22:313-20. [PMID: 20181465 DOI: 10.1016/j.clon.2010.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2009] [Revised: 12/19/2009] [Accepted: 02/03/2010] [Indexed: 11/29/2022]
Abstract
AIMS To identify practical intensity-modulated radiotherapy planning solutions when attempting dose escalation in the skull base. MATERIALS AND METHODS Twenty cases of skull base meningioma were re-planned using a variation of beam number (three, five, seven and nine), beam arrangement (coplanar vs non-coplanar) and multileaf collimator (MLC) width (2.5 mm vs 10 mm) to 60 Gy/30 fractions. Plan quality and planning target volume coverage was assessed using planning target volume V(95%), equivalent uniform dose (EUD) and integral dose. RESULTS Critical structures were maintained below clinical tolerance levels. The 2.5 mm MLC achieved an average improvement in V(95%) by 22.8% (P=0.0003), EUD by 3.7 Gy (P=0.002) and reduced the integral dose by 13.4 Gy (P=0.0001). V(95%) and the integral dose improved with five vs three beams and seven vs five beams, but did not change with nine vs seven beams. There was no effect of beam number on EUD. There was no difference in V(95%) (P=0.54), integral dose (P=0.44) or EUD (P=0.47) for beam arrangement used. Segments per plan increased by a factor of 1.5 with each addition of two beams to a plan, and by a factor of 2.5 for 2.5 mm MLC plans vs 10 mm MLC plans. CONCLUSIONS We present evidence-based planning solutions for skull base intensity-modulated radiotherapy, and show that 2.5 mm MLC and five to seven beams can achieve safe dose escalation up to 60 Gy. This must be balanced with an increase in segmentation, which will increase treatment times.
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Affiliation(s)
- V J Estall
- PeterMac Cancer Centre, East Melbourne, VIC, Australia.
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