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Iyizoba-Ebozue Z, Nicklin E, Price J, Prestwich R, Brown S, Hall E, Lilley J, Lowe M, Thomson DJ, Slevin F, Murray L, Boele F. "Why am I still suffering?": Experience of long-term fatigue and neurocognitive changes in oropharyngeal cancer survivors following (chemo)radiotherapy. Tech Innov Patient Support Radiat Oncol 2024; 30:100241. [PMID: 38510557 PMCID: PMC10951087 DOI: 10.1016/j.tipsro.2024.100241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/02/2024] [Accepted: 02/29/2024] [Indexed: 03/22/2024] Open
Abstract
Background Late effects of cancer treatment, such as neurocognitive deficits and fatigue, can be debilitating. Other than head and neck-specific functional deficits such as impairments in swallowing and speech, little is known about survivorship after oropharyngeal cancer. This study examines the lived experience of fatigue and neurocognitive deficits in survivors of oropharyngeal squamous cell cancer and impact on their daily lives. Methods This work is part of the multicentre mixed method ROC-oN study (Radiotherapy for Oropharyngeal Cancer and impact on Neurocognition), evaluating fatigue and neurocognitive function in patients following radiotherapy +/- chemotherapy for oropharyngeal cancer and impact on quality of life. Semi-structured interviews were conducted in adults treated with radiotherapy (+/-chemotherapy) for oropharyngeal squamous cell carcinoma >/=24 months from completing treatment. Reflexive thematic analysis performed. Results 21 interviews (11 men and 10 women; median age 58 years and median time post-treatment 5 years) were conducted and analysed, yielding six themes: (1) unexpected burden of fatigue, (2) noticing changes in neurocognitive function, (3) the new normal, (4) navigating changes, (5)insufficient awareness and (6)required support. Participants described fatigue that persisted beyond the acute post-treatment period and changes in neurocognitive abilities across several domains. Paid and unpaid work, emotions and mood were impacted. Participants described navigating the new normal by adopting self-management strategies and accepting external support. They reported lack of recognition of these late effects, being poorly informed and being unprepared. Follow-up services were thought to be inadequate. Conclusions Fatigue and neurocognitive impairment were frequently experienced by survivors of oropharyngeal cancer, at least two years after treatment. Patients felt ill-prepared for these late sequelae, highlighting opportunities for improvement of patient information and support services.
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Affiliation(s)
| | - Emma Nicklin
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - James Price
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Robin Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Sarah Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research
| | - Emma Hall
- The Institute of Cancer Research, London, UK
| | - John Lilley
- Department of Radiotherapy Physics, Leeds Cancer Centre, Leeds, UK
| | - Matthew Lowe
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Finbar Slevin
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Louise Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Florien Boele
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
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2
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Hudson EM, Slevin F, Biscombe K, Brown SR, Haviland JS, Murray L, Kirby AM, Thomson DJ, Sebag-Montefiore D, Hall E. Hitting the Target: Developing High-quality Evidence for Proton Beam Therapy Through Randomised Controlled Trials. Clin Oncol (R Coll Radiol) 2024; 36:70-79. [PMID: 38042671 DOI: 10.1016/j.clon.2023.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/03/2023] [Indexed: 12/04/2023]
Abstract
The National Health Service strategy for the delivery of proton beam therapy (PBT) in the UK provides a unique opportunity to deliver high-quality evidence for PBT through randomised controlled trials (RCTs). We present a summary of three UK PBT RCTs in progress, including consideration of their key design characteristics and outcome assessments, to inform and support future PBT trial development. The first three UK multicentre phase III PBT RCTs (TORPEdO, PARABLE and APPROACH), will compare PBT with photon radiotherapy for oropharyngeal squamous cell carcinoma, breast cancer and oligodendroglioma, respectively. All three studies were designed by multidisciplinary teams, which combined expertise from clinicians, clinical trialists and scientists with strong patient advocacy and guidance from national radiotherapy research networks and international collaborators. Consistent across all three studies is a focus on the reduction of long-term radiotherapy-related toxicities and an evaluation of patient-reported outcomes and health-related quality of life, which will address key uncertainties regarding the clinical benefits of PBT. Innovative translational components will provide insights into mechanisms of toxicity and help to frame the key future research questions regarding PBT. The UK radiotherapy research community is developing and delivering an internationally impactful PBT research portfolio. The combination of data from RCTs with prospectively collected data from a national PBT outcomes registry will provide an innovative, high-quality repository for PBT research and the platform to design and deliver future trials of PBT.
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Affiliation(s)
- E M Hudson
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK.
| | - F Slevin
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - K Biscombe
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - S R Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - J S Haviland
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK; Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - L Murray
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - A M Kirby
- The Royal Marsden NHS Foundation Trust & The Institute of Cancer Research, Sutton, UK
| | - D J Thomson
- The Christie NHS Foundation Trust, Manchester, UK
| | - D Sebag-Montefiore
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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3
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Thomson DJ, Slevin NJ, Baines H, Betts G, Bolton S, Evans M, Garcez K, Irlam J, Lee L, Melillo N, Mistry H, More E, Nutting C, Price JM, Schipani S, Sen M, Yang H, West CM. Randomized Phase 3 Trial of the Hypoxia Modifier Nimorazole Added to Radiation Therapy With Benefit Assessed in Hypoxic Head and Neck Cancers Determined Using a Gene Signature (NIMRAD). Int J Radiat Oncol Biol Phys 2023:S0360-3016(23)08184-1. [PMID: 38072326 DOI: 10.1016/j.ijrobp.2023.11.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/21/2023] [Accepted: 11/24/2023] [Indexed: 01/27/2024]
Abstract
PURPOSE Tumor hypoxia is an adverse prognostic factor in head and neck squamous cell carcinoma (HNSCC). We assessed whether patients with hypoxic HNSCC benefited from the addition of nimorazole to definitive intensity modulated radiation therapy (IMRT). METHODS AND MATERIALS NIMRAD was a phase 3, multicenter, placebo-controlled, double-anonymized trial of patients with HNSCC unsuitable for concurrent platinum chemotherapy or cetuximab with definitive IMRT (NCT01950689). Patients were randomized 1:1 to receive IMRT (65 Gy in 30 fractions over 6 weeks) plus nimorazole (1.2 g/m2 daily, before IMRT) or placebo. The primary endpoint was freedom from locoregional progression (FFLRP) in patients with hypoxic tumors, defined as greater than or equal to the median tumor hypoxia score of the first 50 patients analyzed (≥0.079), using a validated 26-gene signature. The planned sample size was 340 patients, allowing for signature generation in 85% and an assumed hazard ratio (HR) of 0.50 for nimorazole effectiveness in the hypoxic group and requiring 66 locoregional failures to have 80% power in a 2-tail log-rank test at the 5% significance level. RESULTS Three hundred thirty-eight patients were randomized by 19 centers in the United Kingdom from May 2014 to May 2019, with a median follow-up of 3.1 years (95% CI, 2.9-3.4). Hypoxia scores were available for 286 (85%). The median patient age was 73 years (range, 44-88; IQR, 70-76). There were 36 (25.9%) locoregional failures in the hypoxic group, in which nimorazole + IMRT did not improve FFLRP (adjusted HR, 0.72; 95% CI, 0.36-1.44; P = .35) or overall survival (adjusted HR, 0.96; 95% CI, 0.53-1.72; P = .88) compared with placebo + IMRT. Similarly, nimorazole + IMRT did not improve FFLRP or overall survival in the whole population. In total (N = 338), 73% of patients allocated nimorazole adhered to the drug for ≥50% of IMRT fractions. Nimorazole + IMRT caused more acute nausea compared with placebo + IMRT (Common Terminology Criteria for Adverse Events version 4.0 G1+2: 56.6% vs 42.4%, G3: 10.1% vs 5.3%, respectively; P < .05). CONCLUSIONS Addition of the hypoxia modifier nimorazole to IMRT for locally advanced HNSCC in older and less fit patients did not improve locoregional control or survival.
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Affiliation(s)
- David J Thomson
- The Christie NHS Foundation Trust, Manchester, United Kingdom; University of Liverpool, Liverpool, United Kingdom; Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Nick J Slevin
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Helen Baines
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Northwood, United Kingdom; Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Guy Betts
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Steve Bolton
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Mererid Evans
- Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom
| | - Kate Garcez
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Joely Irlam
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Lip Lee
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Hitesh Mistry
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom; SystemsForecastingUK Ltd, Lancaster, United Kingdom
| | - Elisabet More
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | | | - James M Price
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Stefano Schipani
- Beatson West of Scotland Cancer Centre and University of Glasgow, Glasgow, United Kingdom
| | - Mehmet Sen
- Leeds Teaching Hospital NHS Trust, Leeds, United Kingdom
| | - Huiqi Yang
- National Radiotherapy Trials Quality Assurance (RTTQA) Group, Northwood, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Catharine M West
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom.
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4
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Iyizoba-Ebozue Z, Prestwich R, Brown S, Hall E, Lilley J, Lowe M, Thomson DJ, Slevin F, Boele F, Murray L. Neurocognitive function following (chemo)radiotherapy for nasopharyngeal cancer and other head and neck cancers: A systematic review. Radiother Oncol 2023; 188:109863. [PMID: 37619657 DOI: 10.1016/j.radonc.2023.109863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/13/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
When radiotherapy is used in the treatment of head and neck cancers, the brain commonly receives incidental doses of radiotherapy with potential for neurocognitive changes and subsequent impact on quality of life. This has not been widely investigated to date. A systematic search of MEDLINE, EMBASE, Psycinfo Info and the Cochrane Central Register of Controlled Trials (CENTRAL) electronic databases was conducted. Of 2077 records screened, 20 were eligible comprising 1308 patients. There were no randomised studies and 73.3% of included patients were from single center studies. IMRT was delivered in 72.6% of patients, and chemotherapy used in 61%. There was considerable heterogeneity in methods. Narrative synthesis was therefore carried out. Most studies demonstrated inferior neurocognitive outcomes when compared to control groups at 12 months and beyond radiotherapy. Commonly affected neurocognitive domains were memory and language which appeared related to radiation dose to hippocampus, temporal lobe, and cerebellum. Magnetic Resonance Imaging could be valuable in the detection of early microstructural and functional changes, which could be indicative of future neurocognitive changes. In studies investigating quality of life, the presence of neurocognitive impairment was associated with inferior quality of life outcomes. (Chemo)radiotherapy for head and neck cancer appears to be associated with a risk of long-term neurocognitive impairment. Few studies were identified, with substantial variation in methodology, thus limiting conclusions. High quality large prospective head and neck cancer studies using standardised, sensitive, and reliable neurocognitive tests are needed.
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Affiliation(s)
| | - Robin Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK
| | - Sarah Brown
- Leeds Cancer Research UK Clinical Trials Unit, Leeds Institute of Clinical Trials Research
| | - Emma Hall
- The Institute of Cancer Research, London, UK
| | - John Lilley
- Department of Radiotherapy Physics, Leeds Cancer Centre, Leeds, UK
| | - Matthew Lowe
- Department of Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
| | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Finbar Slevin
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Florien Boele
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - Louise Murray
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, UK; Leeds Institute of Medical Research, University of Leeds, Leeds, UK.
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5
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Yan Z, Ratiu BP, Zhang W, Abouzaid O, Ebert M, Reed GT, Thomson DJ, Li Q. Lateral Tunnel Epitaxy of GaAs in Lithographically Defined Cavities on 220 nm Silicon-on-Insulator. Cryst Growth Des 2023; 23:7821-7828. [PMID: 37937193 PMCID: PMC10626574 DOI: 10.1021/acs.cgd.3c00633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/24/2023] [Indexed: 11/09/2023]
Abstract
Current heterogeneous Si photonics usually bond III-V wafers/dies on a silicon-on-insulator (SOI) substrate in a back-end process, whereas monolithic integration by direct epitaxy could benefit from a front-end process where III-V materials are grown prior to the fabrication of passive optical circuits. Here we demonstrate a front-end-of-line (FEOL) processing and epitaxy approach on Si photonics 220 nm (001) SOI wafers to enable positioning dislocation-free GaAs layers in lithographically defined cavities right on top of the buried oxide layer. Thanks to the defect confinement in lateral growth, threading dislocations generated from the III-V/Si interface are effectively trapped within ∼250 nm of the Si surface. This demonstrates the potential of in-plane co-integration of III-Vs with Si on mainstream 220 nm SOI platform without relying on thick, defective buffer layers. The challenges associated with planar defects and coalescence into larger membranes for the integration of on-chip optical devices are also discussed.
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Affiliation(s)
- Zhao Yan
- School of
Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, U.K.
| | | | - Weiwei Zhang
- Optoelectronics
Research Centre, University of Southampton, Southampton SO17 1BJ, U.K.
| | - Oumaima Abouzaid
- School of
Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, U.K.
| | - Martin Ebert
- Optoelectronics
Research Centre, University of Southampton, Southampton SO17 1BJ, U.K.
| | - Graham T. Reed
- Optoelectronics
Research Centre, University of Southampton, Southampton SO17 1BJ, U.K.
| | - David J. Thomson
- Optoelectronics
Research Centre, University of Southampton, Southampton SO17 1BJ, U.K.
| | - Qiang Li
- School of
Physics and Astronomy, Cardiff University, Cardiff CF24 3AA, U.K.
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6
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Naderi E, Aguado-Barrera ME, Schack LMH, Dorling L, Rattay T, Fachal L, Summersgill H, Martínez-Calvo L, Welsh C, Dudding T, Odding Y, Varela-Pazos A, Jena R, Thomson DJ, Steenbakkers RJHM, Dennis J, Lobato-Busto R, Alsner J, Ness A, Nutting C, Gómez-Caamaño A, Eriksen JG, Thomas SJ, Bates AM, Webb AJ, Choudhury A, Rosenstein BS, Taboada-Valladares B, Herskind C, Azria D, Dearnaley DP, de Ruysscher D, Sperk E, Hall E, Stobart H, Chang-Claude J, De Ruyck K, Veldeman L, Altabas M, De Santis MC, Farcy-Jacquet MP, Veldwijk MR, Sydes MR, Parliament M, Usmani N, Burnet NG, Seibold P, Symonds RP, Elliott RM, Bultijnck R, Gutiérrez-Enríquez S, Mollà M, Gulliford SL, Green S, Rancati T, Reyes V, Carballo A, Peleteiro P, Sosa-Fajardo P, Parker C, Fonteyne V, Johnson K, Lambrecht M, Vanneste B, Valdagni R, Giraldo A, Ramos M, Diergaarde B, Liu G, Leal SM, Chua MLK, Pring M, Overgaard J, Cascallar-Caneda LM, Duprez F, Talbot CJ, Barnett GC, Dunning AM, Vega A, Andreassen CN, Langendijk JA, West CML, Alizadeh BZ, Kerns SL. Large-scale meta-genome-wide association study reveals common genetic factors linked to radiation-induced acute toxicities across cancer types. JNCI Cancer Spectr 2023; 7:pkad088. [PMID: 37862240 PMCID: PMC10653584 DOI: 10.1093/jncics/pkad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/18/2023] [Accepted: 10/18/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND This study was designed to identify common genetic susceptibility and shared genetic variants associated with acute radiation-induced toxicity across 4 cancer types (prostate, head and neck, breast, and lung). METHODS A genome-wide association study meta-analysis was performed using 19 cohorts totaling 12 042 patients. Acute standardized total average toxicity (STATacute) was modelled using a generalized linear regression model for additive effect of genetic variants, adjusted for demographic and clinical covariates (rSTATacute). Linkage disequilibrium score regression estimated shared single-nucleotide variation (SNV-formerly SNP)-based heritability of rSTATacute in all patients and for each cancer type. RESULTS Shared SNV-based heritability of STATacute among all cancer types was estimated at 10% (SE = 0.02) and was higher for prostate (17%, SE = 0.07), head and neck (27%, SE = 0.09), and breast (16%, SE = 0.09) cancers. We identified 130 suggestive associated SNVs with rSTATacute (5.0 × 10‒8 < P < 1.0 × 10‒5) across 25 genomic regions. rs142667902 showed the strongest association (effect allele A; effect size ‒0.17; P = 1.7 × 10‒7), which is located near DPPA4, encoding a protein involved in pluripotency in stem cells, which are essential for repair of radiation-induced tissue injury. Gene-set enrichment analysis identified 'RNA splicing via endonucleolytic cleavage and ligation' (P = 5.1 × 10‒6, P = .079 corrected) as the top gene set associated with rSTATacute among all patients. In silico gene expression analysis showed that the genes associated with rSTATacute were statistically significantly up-regulated in skin (not sun exposed P = .004 corrected; sun exposed P = .026 corrected). CONCLUSIONS There is shared SNV-based heritability for acute radiation-induced toxicity across and within individual cancer sites. Future meta-genome-wide association studies among large radiation therapy patient cohorts are worthwhile to identify the common causal variants for acute radiotoxicity across cancer types.
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Affiliation(s)
- Elnaz Naderi
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Miguel E Aguado-Barrera
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Line M H Schack
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Gødstrup Hospital, Herning, Denmark
- NIDO | Centre for Research and Education, Gødstrup Hospital, Herning, Denmark
| | - Leila Dorling
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tim Rattay
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Laura Fachal
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Holly Summersgill
- Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Laura Martínez-Calvo
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ceilidh Welsh
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Tom Dudding
- Bristol Dental School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Yasmin Odding
- Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ana Varela-Pazos
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Rajesh Jena
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - David J Thomson
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Ramón Lobato-Busto
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Andy Ness
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Chris Nutting
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
| | - Antonio Gómez-Caamaño
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Jesper G Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Steve J Thomas
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Amy M Bates
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Adam J Webb
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - Barry S Rosenstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Begona Taboada-Valladares
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - David Azria
- Fédération Universitaire d’Oncologie Radiothérapie d’Occitanie Méditérranée, Département d’Oncologie Radiothérapie, ICM Montpellier, INSERM U1194 IRCM, University of Montpellier, Montpellier, France
| | - David P Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Dirk de Ruysscher
- MAASTRO Clinic, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Hilary Stobart
- Patient Advocate, Independent Cancer Patients’ Voice, London, UK
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kim De Ruyck
- Departments of Basic Medical Sciences and Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Manuel Altabas
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Marie-Pierre Farcy-Jacquet
- Fédération Universitaire d’Oncologie Radiothérapie d’Occitanie Méditérranée, Département d’Oncologie Radiothérapie, CHU Carémeau, Nîmes, France
| | - Marlon R Veldwijk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Matthew Parliament
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Paul Symonds
- Cancer Research Centre, University of Leicester, Leicester, UK
| | - Rebecca M Elliott
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology, Vall d’Hebron Hospital Campus, Barcelona, Spain
| | - Meritxell Mollà
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sarah L Gulliford
- Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Sheryl Green
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tiziana Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Victoria Reyes
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ana Carballo
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Paula Peleteiro
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Paloma Sosa-Fajardo
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Chris Parker
- Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Kerstie Johnson
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | | | - Ben Vanneste
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Riccardo Valdagni
- Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alexandra Giraldo
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Mónica Ramos
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Brenda Diergaarde
- Department of Human Genetics, School of Public Health, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Temerty Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Suzanne M Leal
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY, USA
- Taub Institute for Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Programme, Singapore
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Luis M Cascallar-Caneda
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Fréderic Duprez
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Christopher J Talbot
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Gillian C Barnett
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Ana Vega
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Grupo de Medicina Xenómica, Centro de Investigación Biomédica en Red de Enfermedades Raras, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Christian Nicolaj Andreassen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Catharine M L West
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust Hospital, Manchester, UK
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah L Kerns
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA
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7
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Thomson DJ, Henson C, Huang SH, McDowell LJ, Mierzwa M, Wilke C, Margalit DN. The Interplay Between Radiation Dose, Volume, and Systemic Therapy. Int J Radiat Oncol Biol Phys 2023; 116:967-971. [PMID: 37453792 DOI: 10.1016/j.ijrobp.2023.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 02/20/2023] [Indexed: 07/18/2023]
Affiliation(s)
- David J Thomson
- The Christie NHS Foundation Trust, Manchester, United Kingdom.
| | - Christina Henson
- Department of Radiation Oncology, Stephenson Cancer Center, University of Oklahoma, Oklahoma City, Oklahoma
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Lachlan J McDowell
- Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Australia
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Christopher Wilke
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Danielle N Margalit
- Dana-Farber/Brigham and Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
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8
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Murray LJ, Appelt AL, Ajithkumar T, Bedford JL, Burnet NG, Lalondrelle S, Manolopoulos S, O'Cathail SM, Robinson M, Short SC, Slevin F, Thomson DJ. Re-irradiation: From Cell Lines to Patients, Filling the (Science) Gap in the Market. Clin Oncol (R Coll Radiol) 2023; 35:318-322. [PMID: 36842937 DOI: 10.1016/j.clon.2023.01.023] [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: 10/27/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Affiliation(s)
- L J Murray
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - A L Appelt
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - T Ajithkumar
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - J L Bedford
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - N G Burnet
- The Christie NHS Foundation Trust, Manchester, UK
| | - S Lalondrelle
- The Institute of Cancer Research, London, UK; The Royal Marsden Hospital, Sutton, UK
| | - S Manolopoulos
- Northern Centre for Cancer Care, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Cumberland Infirmary, Carlisle, UK
| | - S M O'Cathail
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK; Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Robinson
- Oxford Institute for Radiation Oncology, Department of Oncology, University of Oxford, Old Road Campus Research Building, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - S C Short
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - F Slevin
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - D J Thomson
- The Christie NHS Foundation Trust, Manchester, UK; The University of Liverpool, Liverpool, UK
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9
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Thomson DJ, Cruickshank C, Baines H, Banner R, Beasley M, Betts G, Bulbeck H, Charlwood F, Christian J, Clarke M, Donnelly O, Foran B, Gillies C, Griffin C, Homer JJ, Langendijk JA, Lee LW, Lester J, Lowe M, McPartlin A, Miles E, Nutting C, Palaniappan N, Prestwich R, Price JM, Roberts C, Roe J, Shanmugasundaram R, Simões R, Thompson A, West C, Wilson L, Wolstenholme J, Hall E. TORPEdO: A phase III trial of intensity-modulated proton beam therapy versus intensity-modulated radiotherapy for multi-toxicity reduction in oropharyngeal cancer. Clin Transl Radiat Oncol 2023; 38:147-154. [PMID: 36452431 PMCID: PMC9702982 DOI: 10.1016/j.ctro.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/18/2022] [Indexed: 11/23/2022] Open
Abstract
•There is a lack of prospective level I evidence for the use of PBT for most adult cancers including oropharyngeal squamous cell carcinoma (OPSCC).•TORPEdO is the UK's first PBT clinical trial and aims to determine the benefits of PBT for OPSCC.•Training and support has been provided before and during the trial to reduce variations of contouring and radiotherapy planning.•There is a strong translational component within TORPEdO. Imaging and physics data along with blood, tissue collection will inform future studies in refining patient selection for IMPT.
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Affiliation(s)
| | | | - Helen Baines
- Radiotherapy Trials QA Group (RTTQA), The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Russell Banner
- Swansea Bay University Health Board, Swansea, United Kingdom
| | | | - Guy Betts
- Manchester University NHS Foundation Trust. Manchester, United Kingdom
| | - Helen Bulbeck
- Brainstrust – The Brain Cancer People, Cowes, United Kingdom
| | | | - Judith Christian
- Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Matthew Clarke
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Olly Donnelly
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Bernadette Foran
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Callum Gillies
- University College Hospitals London NHS Foundation Trust, London, United Kingdom
| | - Clare Griffin
- The Institute of Cancer Research, London, United Kingdom
| | - Jarrod J. Homer
- Manchester University NHS Foundation Trust. Manchester, United Kingdom
| | - Johannes A. Langendijk
- University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Lip Wai Lee
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - James Lester
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Matthew Lowe
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Elizabeth Miles
- Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, United Kingdom
| | - Christopher Nutting
- The Institute of Cancer Research, London, United Kingdom
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | | | - Robin Prestwich
- The Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - James M. Price
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- The University of Manchester, Manchester, United Kingdom
| | - Clare Roberts
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Justin Roe
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Imperial College, London, United Kingdom
| | | | - Rita Simões
- Radiotherapy Trials QA Group (RTTQA), Mount Vernon Hospital, Northwood, United Kingdom
| | - Anna Thompson
- University College Hospitals London NHS Foundation Trust, London, United Kingdom
| | - Catharine West
- The University of Manchester, Manchester, United Kingdom
| | - Lorna Wilson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Jane Wolstenholme
- Health Economics Research Centre, University of Oxford, United Kingdom
| | - Emma Hall
- The Institute of Cancer Research, London, United Kingdom
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Georgiev GV, Cao W, Zhang W, Ke L, Thomson DJ, Reed GT, Nedeljkovic M, Mashanovich GZ. Near-IR & Mid-IR Silicon Photonics Modulators. Sensors (Basel) 2022; 22:9620. [PMID: 36559988 PMCID: PMC9783169 DOI: 10.3390/s22249620] [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] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 06/17/2023]
Abstract
As the silicon photonics field matures and a data-hungry future looms ahead, new technologies are required to keep up pace with the increase in capacity demand. In this paper, we review current developments in the near-IR and mid-IR group IV photonic modulators that show promising performance. We analyse recent trends in optical and electrical co-integration of modulators and drivers enabling modulation data rates of 112 GBaud in the near infrared. We then describe new developments in short wave infrared spectrum modulators such as employing more spectrally efficient PAM-4 coding schemes for modulations up to 40 GBaud. Finally, we review recent results at the mid infrared spectrum and application of the thermo-optic effect for modulation as well as the emergence of new platforms based on germanium to tackle the challenges of modulating light in the long wave infrared spectrum up to 10.7 μm with data rates of 225 MBaud.
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11
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Naderi E, Schack LMH, Welsh C, Sim AYL, Aguado-Barrera ME, Dudding T, Summersgil H, Martínez-Calvo L, Ong EHW, Odding Y, Varela-Pazos A, Steenbakkers RJHM, Crijns APG, Jena R, Pring M, Dennis J, Lobato-Busto R, Alsner J, Ness A, Nutting C, Thomson DJ, Gómez-Caamaño A, Eriksen JG, Thomas SJ, Bates AM, Overgaard J, Cascallar-Caneda LM, Duprez F, Barnett GC, Dorling L, Chua MLK, Vega A, West CML, Langendijk JA, Nicolaj Andreassen C, Alizadeh BZ. Meta-GWAS identifies the heritability of acute radiation-induced toxicities in head and neck cancer. Radiother Oncol 2022; 176:138-148. [PMID: 36191651 DOI: 10.1016/j.radonc.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE We aimed to the genetic components and susceptibility variants associated with acute radiation-induced toxicities (RITs) in patients with head and neck cancer (HNC). MATERIALS AND METHODS We performed the largest meta-GWAS of seven European cohorts (n = 4,042). Patients were scored weekly during radiotherapy for acute RITs including dysphagia, mucositis, and xerostomia. We analyzed the effect of variants on the average burden (measured as area under curve, AUC) per each RIT, and standardized total average acute toxicity (STATacute) score using a multivariate linear regression. We tested suggestive variants (p < 1.0x10-5) in discovery set (three cohorts; n = 2,640) in a replication set (four cohorts; n = 1,402). We meta-analysed all cohorts to calculate RITs specific SNP-based heritability, and effect of polygenic risk scores (PRSs), and genetic correlations among RITS. RESULTS From 393 suggestive SNPs identified in discovery set; 37 were nominally significant (preplication < 0.05) in replication set, but none reached genome-wide significance (pcombined < 5 × 10-8). In-silico functional analyses identified "3'-5'-exoribonuclease activity" (FDR = 1.6e-10) for dysphagia, "inositol phosphate-mediated signalling" for mucositis (FDR = 2.20e-09), and "drug catabolic process" for STATacute (FDR = 3.57e-12) as the most enriched pathways by the RIT specific suggestive genes. The SNP-based heritability (±standard error) was 29 ± 0.08 % for dysphagia, 9 ± 0.12 % (mucositis) and 27 ± 0.09 % (STATacute). Positive genetic correlation was rg = 0.65 (p = 0.048) between dysphagia and STATacute. PRSs explained limited variation of dysphagia (3 %), mucositis (2.5 %), and STATacute (0.4 %). CONCLUSION In HNC patients, acute RITs are modestly heritable, sharing 10 % genetic susceptibility, when PRS explains < 3 % of their variance. We identified numerus suggestive SNPs, which remain to be replicated in larger studies.
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Affiliation(s)
- Elnaz Naderi
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands; Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands.
| | - Line M H Schack
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Oncology, Regional Hospital West Jutland, Gødstrup, Denmark
| | - Ceilidh Welsh
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Adelene Y L Sim
- Division of Radiation Oncology, Dept of Head and Neck and Thoracic Cancers, Duke-NUS Medical School, Singapore, Singapore; Division of Medical Sciences, National Cancer Centre, Singapore
| | - Miguel E Aguado-Barrera
- Fundación Pública Galega Medicina Xenómica (FPGMX), Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tom Dudding
- Bristol Dental School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Holly Summersgil
- Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Laura Martínez-Calvo
- Fundación Pública Galega Medicina Xenómica (FPGMX), Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Enya H W Ong
- Division of Medical Sciences, National Cancer Centre, Singapore
| | - Yasmin Odding
- University Hospitals Bristol and Weston, Bristol, UK
| | - Ana Varela-Pazos
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Anne P G Crijns
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Rajesh Jena
- Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Ramón Lobato-Busto
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Andy Ness
- Bristol Dental School, University of Bristol, Bristol, UK
| | | | - David J Thomson
- Christie Hospital NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Antonio Gómez-Caamaño
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Jesper G Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Steve J Thomas
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Amy M Bates
- Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Luis M Cascallar-Caneda
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Fréderic Duprez
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium; Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Gillian C Barnett
- Department of Oncology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Leila Dorling
- Centre for Cancer Genetic Epidemiology, University of Cambridge, Strangeways Research Laboratory, Cambridge, UK
| | - Melvin L K Chua
- Division of Radiation Oncology, Dept of Head and Neck and Thoracic Cancers, Duke-NUS Medical School, Singapore, Singapore; Division of Radiation Oncology, National Cancer Centre, Singapore
| | - Ana Vega
- Fundación Pública Galega Medicina Xenómica (FPGMX), Santiago de Compostela, Spain; Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Catharine M L West
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust Hospital, Manchester, UK
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, the Netherlands
| | - Christian Nicolaj Andreassen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, Groningen, the Netherlands.
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12
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Price JM, Mistry HB, Betts G, Cheadle EJ, Dixon L, Garcez K, Illidge T, Iyizoba-Ebozue Z, Lee LW, McPartlin A, Prestwich RJ, Papageorgiou S, Pritchard DJ, Sykes A, West CM, Thomson DJ. Pretreatment Lymphocyte Count Predicts Benefit From Concurrent Chemotherapy With Radiotherapy in Oropharyngeal Cancer. J Clin Oncol 2022; 40:2203-2212. [PMID: 35385334 PMCID: PMC9273368 DOI: 10.1200/jco.21.01991] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE There is a need to refine the selection of patients with oropharyngeal squamous cell carcinoma (OPSCC) for treatment de-escalation. We investigated whether pretreatment absolute lymphocyte count (ALC) predicted overall survival (OS) benefit from the addition of concurrent chemotherapy to radical radiotherapy. PATIENTS AND METHODS This was an observational study of consecutive OPSCCs treated by curative-intent radiotherapy, with or without concurrent chemotherapy (n = 791) with external, independent validation from a separate institution (n = 609). The primary end point was OS at 5 years. Locoregional control (LRC) was assessed using competing risk regression as a secondary end point. Previously determined prognostic factors were used in a multivariable Cox proportional hazards model to assess the prognostic importance of ALC and the interaction between ALC and cisplatin chemotherapy use. RESULTS Pretreatment ALC was prognostic for 5-year OS on multivariable analysis (hazard ratio [HR] 0.64; 95% CI, 0.42 to 0.98; P = .04). It also predicted benefit from the use of concurrent cisplatin chemotherapy, with a significant interaction between cisplatin chemotherapy and pretreatment ALC (likelihood ratio test, P = .04): higher ALC count reduced the 5-year OS benefit compared with radiotherapy alone (HR 2.53; 95% CI, 1.03 to 6.19; P = .043). This was likely driven by an effect on LRC up to 5 years (interaction subdistribution HR 2.29; 95% CI, 0.68 to 7.71; P = .094). An independent validation cohort replicated the OS (HR 2.53; 95% CI, 0.98 to 6.52; P = .055) and LRC findings (interaction subdistribution HR 3.43; 95% CI, 1.23 to 9.52; P = .018). CONCLUSION For OPSCC, the pretreatment ALC is prognostic for OS and also predicts benefit from the addition of cisplatin chemotherapy to radiotherapy. These findings require prospective evaluation, and could inform the selection of good prognosis patients for a de-escalation trial.
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Affiliation(s)
- James M. Price
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Hitesh B. Mistry
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Guy Betts
- Department of Histopathology, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Eleanor J. Cheadle
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Lynne Dixon
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Kate Garcez
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Tim Illidge
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | | | - Lip Wai Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Andrew McPartlin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Savvas Papageorgiou
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - Dylan J. Pritchard
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, United Kingdom
| | - Andrew Sykes
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Catharine M. West
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
| | - David J. Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom
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13
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McDowell L, Chua MLK, Beadle BM, Ma DJ, Mierzwa M, Thomson DJ, Margalit DN. A Bit More Here and a Little Less There: The Trials (and Tribulations) of Adjuvant and Neoadjuvant Head and Neck Studies in 2021. Int J Radiat Oncol Biol Phys 2022; 113:243-251. [PMID: 35569469 DOI: 10.1016/j.ijrobp.2022.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/09/2022] [Indexed: 11/28/2022]
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14
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Price JM, West CM, Dixon LM, Iyizoba-Ebozue Z, Garcez K, Lee L, McPartlin A, Slevin F, Sykes A, Prestwich RJD, Thomson DJ. Similar long-term swallowing outcomes for accelerated, mildly-hypofractionated radiotherapy compared to conventional fractionation in oropharynx cancer: a multi-centre study. Radiother Oncol 2022; 172:111-117. [PMID: 35595173 DOI: 10.1016/j.radonc.2022.05.013] [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: 02/09/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE There is renewed interest in hypofractionated radiotherapy, but limited data and a lack of consensus to support use for head and neck cancer. In this multicentre analysis we compared outcomes for patients with oropharynx squamous cell carcinoma (OPSCC) treated with conventional and accelerated, mildly hypofractionated radiotherapy without chemotherapy. MATERIALS AND METHODS A multi-centre, observational study of consecutive OPSCCs treated between 2015 and 2018. Patients underwent curative-intent radiotherapy (oropharynx and bilateral neck) using conventionally fractionated (70 Gy in 35 fractions over 7 weeks, n = 97) or accelerated, mildly hypofractionated (65-66 Gy in 30 fractions over 6 weeks, n = 136) radiotherapy without chemotherapy. Locoregional control (LRC) and overall survival (OS) were compared. Patients alive and cancer-free at a minimum of 2 years post-radiotherapy (n = 151, 65%) were sent an MD Anderson Dysphagia Inventory (MDADI) questionnaire to assess swallow function. RESULTS LRC and OS were similar across schedules (p = 0.78 and 0.95 respectively, log-rank test). Enteral feeding rates during radiotherapy appeared higher in the 7-week group though this did not reach statistical significance (59% vs 48%, p = 0.08). Feeding rates were similar at 1 year post radiotherapy for both groups (10% vs 6%, p = 0.27). 107 patients returned MDADI questionnaires (71%); there were no differences between the 6- and 7-week groups for median global (60.0 vs 60.0, p = 0.99) and composite (65.8 vs 64.2, p = 0.44) MDADI scores. CONCLUSION Patients with OPSCC treated with radiotherapy alone have similar swallowing outcomes, LRC and OS following accelerated, mild hypofractionation and standard fractionation schedules, supporting its use as a standard-of-care option for patients unsuitable for concurrent chemotherapy.
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Affiliation(s)
- J M Price
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - C M West
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - L M Dixon
- Weston Park Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Z Iyizoba-Ebozue
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, United Kingdom
| | - K Garcez
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - L Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - A McPartlin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - F Slevin
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, United Kingdom
| | - A Sykes
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - R J D Prestwich
- Department of Clinical Oncology, Leeds Cancer Centre, Leeds, United Kingdom
| | - D J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, The Christie NHS Foundation Trust, Manchester, United Kingdom.
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15
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Burnet NG, Mee T, Gaito S, Kirkby NF, Aitkenhead AH, Anandadas CN, Aznar MC, Barraclough LH, Borst G, Charlwood FC, Clarke M, Colaco RJ, Crellin AM, Defourney NN, Hague CJ, Harris M, Henthorn NT, Hopkins KI, Hwang E, Ingram SP, Kirkby KJ, Lee LW, Lines D, Lingard Z, Lowe M, Mackay RI, McBain CA, Merchant MJ, Noble DJ, Pan S, Price JM, Radhakrishna G, Reboredo-Gil D, Salem A, Sashidharan S, Sitch P, Smith E, Smith EAK, Taylor MJ, Thomson DJ, Thorp NJ, Underwood TSA, Warmenhoven JW, Wylie JP, Whitfield G. Estimating the percentage of patients who might benefit from proton beam therapy instead of X-ray radiotherapy. Br J Radiol 2022; 95:20211175. [PMID: 35220723 PMCID: PMC10993980 DOI: 10.1259/bjr.20211175] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES High-energy Proton Beam Therapy (PBT) commenced in England in 2018 and NHS England commissions PBT for 1.5% of patients receiving radical radiotherapy. We sought expert opinion on the level of provision. METHODS Invitations were sent to 41 colleagues working in PBT, most at one UK centre, to contribute by completing a spreadsheet. 39 responded: 23 (59%) completed the spreadsheet; 16 (41%) declined, arguing that clinical outcome data are lacking, but joined six additional site-specialist oncologists for two consensus meetings. The spreadsheet was pre-populated with incidence data from Cancer Research UK and radiotherapy use data from the National Cancer Registration and Analysis Service. 'Mechanisms of Benefit' of reduced growth impairment, reduced toxicity, dose escalation and reduced second cancer risk were examined. RESULTS The most reliable figure for percentage of radical radiotherapy patients likely to benefit from PBT was that agreed by 95% of the 23 respondents at 4.3%, slightly larger than current provision. The median was 15% (range 4-92%) and consensus median 13%. The biggest estimated potential benefit was from reducing toxicity, median benefit to 15% (range 4-92%), followed by dose escalation median 3% (range 0 to 47%); consensus values were 12 and 3%. Reduced growth impairment and reduced second cancer risk were calculated to benefit 0.5% and 0.1%. CONCLUSIONS The most secure estimate of percentage benefit was 4.3% but insufficient clinical outcome data exist for confident estimates. The study supports the NHS approach of using the evidence base and developing it through randomised trials, non-randomised studies and outcomes tracking. ADVANCES IN KNOWLEDGE Less is known about the percentage of patients who may benefit from PBT than is generally acknowledged. Expert opinion varies widely. Insufficient clinical outcome data exist to provide robust estimates. Considerable further work is needed to address this, including international collaboration; much is already underway but will take time to provide mature data.
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Affiliation(s)
- Neil G Burnet
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
| | - Thomas Mee
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Simona Gaito
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Norman F Kirkby
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Adam H Aitkenhead
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
- Christie Medical Physics and Engineering, The Christie NHS
Foundation Trust, Wilmslow Road,
Manchester, United Kingdom
| | - Carmel N Anandadas
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
| | - Marianne C Aznar
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Lisa H Barraclough
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
| | - Gerben Borst
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Frances C Charlwood
- Christie Medical Physics and Engineering, The Christie NHS
Foundation Trust, Wilmslow Road,
Manchester, United Kingdom
| | - Matthew Clarke
- Christie Medical Physics and Engineering, The Christie NHS
Foundation Trust, Wilmslow Road,
Manchester, United Kingdom
| | - Rovel J Colaco
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Adrian M Crellin
- NHS England National Clinical Lead Proton Beam Therapy, Leeds
Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds and St James's
Institute of Oncology, Leeds Teaching Hospitals NHS Trust, Beckett
Street, Leeds, LS9 7TF, UK, Leeds,
United Kingdom
| | - Noemie N Defourney
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Christina J Hague
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
| | - Margaret Harris
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
| | - Nicholas T Henthorn
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Kirsten I Hopkins
- International Atomic Energy Agency, Vienna International
Centre, Vienna,
Austria
| | - E Hwang
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
- Department of Radiation Oncology, Sydney West Radiation
Oncology Network, Crown Princess Mary Cancer Centre,
Sydney, New South Wales, Australia and
Institute of Medical Physics, School of Physics, University of Sydney,
Sydney, New South Wales, Australia
| | - Sam P Ingram
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
- Christie Medical Physics and Engineering, The Christie NHS
Foundation Trust, Wilmslow Road,
Manchester, United Kingdom
| | - Karen J Kirkby
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Lip W Lee
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
| | - David Lines
- Christie Medical Physics and Engineering, The Christie NHS
Foundation Trust, Wilmslow Road,
Manchester, United Kingdom
| | - Zoe Lingard
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Matthew Lowe
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
- Christie Medical Physics and Engineering, The Christie NHS
Foundation Trust, Wilmslow Road,
Manchester, United Kingdom
| | - Ranald I Mackay
- Christie Medical Physics and Engineering, The Christie NHS
Foundation Trust, Wilmslow Road,
Manchester, United Kingdom
| | - Catherine A McBain
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
| | - Michael J Merchant
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - David J Noble
- Department of Clinical Oncology, Edinburgh Cancer Centre,
Western General Hospital,
Edinburgh, United Kingdom
| | - Shermaine Pan
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - James M Price
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | | | - David Reboredo-Gil
- Christie Medical Physics and Engineering, The Christie NHS
Foundation Trust, Wilmslow Road,
Manchester, United Kingdom
| | - Ahmed Salem
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | | | - Peter Sitch
- Christie Medical Physics and Engineering, The Christie NHS
Foundation Trust, Wilmslow Road,
Manchester, United Kingdom
| | - Ed Smith
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
- Proton Clinical Outcomes Unit, The Christie NHS Foundation
Trust, Manchester, United
Kingdom
| | - Edward AK Smith
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
- Christie Medical Physics and Engineering, The Christie NHS
Foundation Trust, Wilmslow Road,
Manchester, United Kingdom
| | - Michael J Taylor
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - David J Thomson
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - Nicola J Thorp
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
| | - Tracy SA Underwood
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - John W Warmenhoven
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
| | - James P Wylie
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
| | - Gillian Whitfield
- The Christie NHS Foundation Trust, Wilmslow Rd,
Manchester, United Kingdom
- Division of Cancer Sciences, University of Manchester,
Manchester Cancer Research Centre, Manchester Academic Health Science
Centre, Manchester, United
Kingdom
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16
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Yu X, Chen X, Milosevic MM, Shen W, Topley R, Chen B, Yan X, Cao W, Thomson DJ, Saito S, Peacock AC, Muskens OL, Reed GT. Ge Ion Implanted Photonic Devices and Annealing for Emerging Applications. Micromachines 2022; 13:mi13020291. [PMID: 35208415 PMCID: PMC8880043 DOI: 10.3390/mi13020291] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/16/2022]
Abstract
Germanium (Ge) ion implantation into silicon waveguides will induce lattice defects in the silicon, which can eventually change the crystal silicon into amorphous silicon and increase the refractive index from 3.48 to 3.96. A subsequent annealing process, either by using an external laser or integrated thermal heaters can partially or completely remove those lattice defects and gradually change the amorphous silicon back into the crystalline form and, therefore, reduce the material’s refractive index. Utilising this change in optical properties, we successfully demonstrated various erasable photonic devices. Those devices can be used to implement a flexible and commercially viable wafer-scale testing method for a silicon photonics fabrication line, which is a key technology to reduce the cost and increase the yield in production. In addition, Ge ion implantation and annealing are also demonstrated to enable post-fabrication trimming of ring resonators and Mach–Zehnder interferometers and to implement nonvolatile programmable photonic circuits.
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Affiliation(s)
- Xingshi Yu
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
| | - Xia Chen
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
| | - Milan M. Milosevic
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
| | - Weihong Shen
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
- State Key Laboratory of Advanced Optical Communication Systems and Networks, Shanghai Jiao Tong University, Shanghai 200240, China
| | - Rob Topley
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
| | | | - Xingzhao Yan
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
| | - Wei Cao
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
| | - David J. Thomson
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
| | - Shinichi Saito
- Electronics and Computer Science, University of Southampton, Southampton SO17 1BJ, UK;
| | - Anna C. Peacock
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
| | - Otto L. Muskens
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
| | - Graham T. Reed
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, UK; (X.Y.); (X.C.); (M.M.M.); (W.S.); (R.T.); (X.Y.); (W.C.); (D.J.T.); (A.C.P.); (O.L.M.)
- Correspondence:
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17
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Cardenas CE, Blinde SE, Mohamed ASR, Ng SP, Raaijmakers C, Philippens M, Kotte A, Al-Mamgani AA, Karam I, Thomson DJ, Robbins J, Newbold K, Fuller CD, Terhaard C, On Behalf Of The, Bahig H, Blanchard P, Dehnad H, Doornaert P, Elhalawani H, Frank SJ, Garden A, Gunn GB, Hamming-Vrieze O, Kamal M, Kasperts N, Lee LW, McDonald BA, McPartlin A, Meheissen MA, Morrison WH, Navran A, Nutting CM, Pameijer F, Phan J, Poon I, Rosenthal DI, Smid EJ, Sykes AJ. Comprehensive Quantitative Evaluation of Variability in MR-guided Delineation of Oropharyngeal Gross Tumor Volumes and High-risk Clinical Target Volumes: An R-IDEAL Stage 0 Prospective Study. Int J Radiat Oncol Biol Phys 2022; 113:426-436. [PMID: 35124134 DOI: 10.1016/j.ijrobp.2022.01.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Tumor and target volume manual delineation remains a challenging task in head-and-neck cancer radiotherapy. The purpose of this study was to conduct a multi-institutional evaluation of manual delineations of gross tumor volume (GTV), high-risk clinical target volume (CTV), parotids, and submandibular glands on treatment simulation MR scans of oropharyngeal cancer (OPC) patients. METHODS Pre-treatment T1-weighted (T1w), T1-weighted with gadolinium contrast (T1w+C) and T2-weighted (T2w) MRI scans were retrospectively collected for 4 OPC patients under an IRB-approved protocol. The scans were provided to twenty-six radiation oncologists from seven international cancer centers who participated in this delineation study. In addition, patients' clinical history and physical examination findings, along with a medical photographic image and radiological results, were provided. The contours were compared using overlap/distance metrics using both STAPLE and pair-wise comparisons. Lastly, participants completed a brief questionnaire to assess participants' experience and CTV delineation institutional practices. RESULTS Large variability was measured between observers' delineations for GTVs and CTVs. The mean Dice Similarity Coefficient values across all physicians' delineations for GTVp, GTVn, CTVp, and CTVn were 0.77, 0.67, 0.77, and 0.69, respectively, for STAPLE comparison and 0.67, 0.60, 0.67, and 0.58, respectively, for pair-wise analysis. Normal tissue contours were defined more consistently when considering overlap/distance metrics. The median radiation oncology clinical experience was 7 years. The median experience delineating on MRI was 3.5 years. The GTV-to-CTV margin used was 10 mm for six of seven participant institutions. One institution used 8 mm and three participants (from three different institutions) used a margin of 5 mm. CONCLUSION The data from this study suggests that appropriate guidelines, contouring quality assurance sessions, and training are still needed for the adoption of MR-based treatment planning for head-and-neck cancers. Such efforts should play a critical role in reducing delineation variation and ensure standardization of target design across clinical practices.
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Affiliation(s)
- Carlos E Cardenas
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Sanne E Blinde
- Department of Radiation Oncology, Klinikum Kassel, Kassel, Germany
| | - Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Australia
| | - Cornelis Raaijmakers
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle Philippens
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alexis Kotte
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Abrahim A Al-Mamgani
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Jared Robbins
- Department of Radiation Oncology, University of Arizona, Tucson, Arizona, USA
| | - Kate Newbold
- Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
| | - Chris Terhaard
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - On Behalf Of The
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Blanchard
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Homan Dehnad
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Patricia Doornaert
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hesham Elhalawani
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Adam Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Mona Kamal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Nicolien Kasperts
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lip Wai Lee
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Brigid A McDonald
- Department of Radiation Oncology, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrew McPartlin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Mohamed Am Meheissen
- Alexandria Clinical Oncology Department, Alexandria University, Alexandria, Egypt
| | - William H Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Arash Navran
- Department of Radiation Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Frank Pameijer
- Department of Radiology, Division of Imaging & Oncology, University Medical Center, Utrecht, The Netherlands
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ian Poon
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Science Centre, University of Toronto, Toronto, ON, Canada
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ernst J Smid
- Department of Radiotherapy, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrew J Sykes
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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18
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Iyizoba-Ebozue Z, Fleming JC, Prestwich RJD, Thomson DJ. Management of sinonasal cancers: Survey of UK practice and literature overview. Eur J Surg Oncol 2021; 48:32-43. [PMID: 34840009 DOI: 10.1016/j.ejso.2021.11.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/31/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Sinonasal malignancy is a rare and heterogenous disease, with limited evidence to guide management. This report summarises the findings of a UK survey and expert workshop discussion which took place to inform design of a proposed UK trial to assess proton beam therapy versus intensity-modulated radiation therapy. METHOD A multidisciplinary working group constructed an online survey to assess current approaches within the UK to surgical and non-surgical practice. Head and neck clinical oncologists, ear nose and throat (ENT) and oral-maxillofacial (OMF) surgeons were invited to participate in the 42-question survey in September 2020. The Royal College of Radiologists Consensus model was adopted in establishing categories to indicate strength of response. An expert panel conducted a virtual workshop in November 2020 to discuss areas of disagreement. RESULTS A survey was sent to 140 UK-based clinicians with 63 responses (45% response rate) from 30 centres, representing a broad geographical spread. Participants comprised 35 clinical oncologists (56%) and 29 surgeons (44%; 20 ENT and 9 OMF surgeons). There were variations in preferred sequence and combination of treatment modalities for locally advanced maxillary squamous cell carcinoma and sinonasal undifferentiated carcinoma. There was discordant surgical management of the orbit, dura, and neck. There was lack of consensus for radiotherapy in post-operative dose fractionation, target volume delineation, use of multiple dose levels and treatment planning approach to organs-at-risk. CONCLUSION There was wide variation across UK centres in the management of sinonasal carcinomas. There is need to standardise UK practice and develop an evidence base for treatment.
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Affiliation(s)
| | - Jason C Fleming
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool Cancer Research Centre, Liverpool
| | | | - David J Thomson
- The Christie NHS Foundation Trust, Manchester and Division of Cancer Sciences, University of Manchester, UK.
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Pant B, Zhang W, Ebert M, Yan X, Du H, Banakar M, Tran DT, Qi Y, Rowe D, Jeyaselvan V, Littlejohns CG, Reed GT, Thomson DJ. Study into the spread of heat from thermo-optic silicon photonic elements. Opt Express 2021; 29:36461-36468. [PMID: 34809057 DOI: 10.1364/oe.426748] [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] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/29/2021] [Indexed: 06/13/2023]
Abstract
Phase modulators based upon the thermo-optic effect are used widely in silicon photonics for low speed applications such as switching and tuning. The dissipation of the heat produced to drive the device to the surrounding silicon is a concern as it can dictate how compact and tightly packed components can be without concerns over thermal crosstalk. In this paper we study through modelling and experiment, on various silicon on insulator photonic platforms, how close waveguides can be placed together without significant thermal crosstalk from adjacent devices.
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20
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Mierzwa M, Beadle BM, Chua MLK, Ma DJ, Thomson DJ, Margalit DN. Something for Everyone From Low-Risk to High-Risk: 5 Recent Studies to Improve Treatment and Surveillance for All Patients With Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2021; 111:1-8. [PMID: 34348102 DOI: 10.1016/j.ijrobp.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 11/18/2022]
Affiliation(s)
| | | | - Melvin L K Chua
- Divisions of Radiation Oncology and Medical Sciences, National Cancer Centre Singapore, Singapore; Duke-NUS Medical School, Singapore
| | | | - David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Danielle N Margalit
- Brigham & Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
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21
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Lin A, Chang JHC, Grover RS, Hoebers FJP, Parvathaneni U, Patel SH, Thariat J, Thomson DJ, Langendijk JA, Frank SJ. PTCOG Head and Neck Subcommittee Consensus Guidelines on Particle Therapy for the Management of Head and Neck Tumors. Int J Part Ther 2021; 8:84-94. [PMID: 34285938 PMCID: PMC8270078 DOI: 10.14338/ijpt-20-00071.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/30/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Radiation therapy is a standard modality in the treatment for cancers of the head and neck, but is associated with significant short- and long-term side effects. Proton therapy, with its unique physical characteristics, can deliver less dose to normal tissues, resulting in fewer side effects. Proton therapy is currently being used for the treatment of head and neck cancer, with increasing clinical evidence supporting its use. However, barriers to wider adoption include access, cost, and the need for higher-level evidence. Methods The clinical evidence for the use of proton therapy in the treatment of head and neck cancer are reviewed here, including indications, advantages, and challenges. Results The Particle Therapy Cooperative Group Head and Neck Subcommittee task group provides consensus guidelines for the use of proton therapy for head and neck cancer. Conclusion This report can be used as a guide for clinical use, to understand clinical trials, and to inform future research efforts.
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Affiliation(s)
| | | | - Ryan S Grover
- University of California-San Diego, San Diego, CA, USA
| | - Frank J P Hoebers
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | | | - Juliette Thariat
- Radiation Oncology Department, François Baclesse Center/ARCHADE, Normandy University, Caen, France
| | - David J Thomson
- The Christie NHS Foundation Trust, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Steven J Frank
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Delaney M, Zeimpekis I, Du H, Yan X, Banakar M, Thomson DJ, Hewak DW, Muskens OL. Nonvolatile programmable silicon photonics using an ultralow-loss Sb 2Se 3 phase change material. Sci Adv 2021; 7:eabg3500. [PMID: 34134978 PMCID: PMC8208718 DOI: 10.1126/sciadv.abg3500] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/30/2021] [Indexed: 05/14/2023]
Abstract
The next generation of silicon-based photonic processors and neural and quantum networks need to be adaptable, reconfigurable, and programmable. Phase change technology offers proven nonvolatile electronic programmability; however, the materials used to date have shown prohibitively high optical losses, which are incompatible with integrated photonic platforms. Here, we demonstrate the capability of the previously unexplored material Sb2Se3 for ultralow-loss programmable silicon photonics. The favorable combination of large refractive index contrast and ultralow losses seen in Sb2Se3 facilitates an unprecedented optical phase control exceeding 10π radians in a Mach-Zehnder interferometer. To demonstrate full control over the flow of light, we introduce nanophotonic digital patterning as a previously unexplored conceptual approach with a footprint orders of magnitude smaller than state-of-the-art interferometer meshes. Our approach enables a wealth of possibilities in high-density reconfiguration of optical functionalities on silicon chip.
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Affiliation(s)
- Matthew Delaney
- Zepler Institute, Faculty of Engineering and Physical Sciences, University of Southampton, SO17 1BJ Southampton, UK
- Physics and Astronomy, Faculty of Engineering and Physical Sciences, University of Southampton, SO17 1BJ Southampton, UK
| | - Ioannis Zeimpekis
- Zepler Institute, Faculty of Engineering and Physical Sciences, University of Southampton, SO17 1BJ Southampton, UK
| | - Han Du
- Zepler Institute, Faculty of Engineering and Physical Sciences, University of Southampton, SO17 1BJ Southampton, UK
| | - Xingzhao Yan
- Zepler Institute, Faculty of Engineering and Physical Sciences, University of Southampton, SO17 1BJ Southampton, UK
| | - Mehdi Banakar
- Zepler Institute, Faculty of Engineering and Physical Sciences, University of Southampton, SO17 1BJ Southampton, UK
| | - David J Thomson
- Zepler Institute, Faculty of Engineering and Physical Sciences, University of Southampton, SO17 1BJ Southampton, UK
| | - Daniel W Hewak
- Zepler Institute, Faculty of Engineering and Physical Sciences, University of Southampton, SO17 1BJ Southampton, UK
| | - Otto L Muskens
- Physics and Astronomy, Faculty of Engineering and Physical Sciences, University of Southampton, SO17 1BJ Southampton, UK.
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Cao W, Liu S, Littlejohns CG, Thomson DJ, Nedeljkovic M, Zhang W, Li K, Banakar M, Tran Y, Yan X, Du H, Ren Z, Gardes F, Reed GT, Mashanovich GZ. High-speed silicon Michelson interferometer modulator and streamlined IMDD PAM-4 transmission of Mach-Zehnder modulators for the 2 μm wavelength band. Opt Express 2021; 29:14438-14451. [PMID: 33985167 DOI: 10.1364/oe.418285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
We demonstrate high-speed silicon modulators optimized for operating at the wavelength of 2 μm. The Mach-Zehnder interferometer (MZI) carrier-depletion modulator with 2 mm phase shifter has a single-arm modulation efficiency (Vπ ·Lπ) of 2.89 V·cm at 4 V reverse bias. Using a push-pull configuration it operates at a data rate of 25 Gbit/s OOK with an extinction ratio of 6.25 dB. We also proposed a mathematically-analysed streamlined IMDD PAM-4 scheme and successfully demonstrated a 25 Gbit/s datarate PAM-4 with the same 2 mm modulator. A Michelson interferometer carrier-depletion modulator with 0.5 mm phase shift length has also been shown with modulation efficiency (Vπ ·Lπ) of 1.36 V·cm at 4 V reverse bias and data rate of 20 Gbit/s OOK. The Michelson interferometer modulator performs similarly to a Mach-Zehnder modulator with twice the phase shifter length.
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Thomson DJ. Reduced Dose and Volume Elective Nodal Radiation Therapy for Head and Neck Cancer: Challenging the Paradigm. Int J Radiat Oncol Biol Phys 2021; 109:941-943. [PMID: 33610303 DOI: 10.1016/j.ijrobp.2020.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/03/2020] [Accepted: 11/05/2020] [Indexed: 12/16/2022]
Affiliation(s)
- David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.
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25
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Feng Y, Thomson DJ, Mashanovich GZ, Yan J. Performance analysis of a silicon NOEMS device applied as an optical modulator based on a slot waveguide. Opt Express 2020; 28:38206-38222. [PMID: 33379638 DOI: 10.1364/oe.411933] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/01/2020] [Indexed: 06/12/2023]
Abstract
In this paper, we analyse the performance of a silicon nano-opto-electro-mechanical system (NOEMS) applied as an optical modulator, based on a suspended slot waveguide driven by electrostatic forces. The analysis is carried out with the help of the finite element analysis (FEA) method involving the influences from Casimir force, optical force and electrostatic force. The performance of the modulator are analysed from aspects of actuating modes, actuating voltage, modulating frequency, effective index, phase change, and energy consumption using the FEA method. Simulation results show that a suspended slot modulator has the advantages of low actuation voltage, low power consumption, as well as large effective index and phase change compared with modulators based upon other approaches. The performance of such a modulator can fill the performance gap between the carrier-based approach and micro-opto-electro-mechanical system (MOEMS) approach for modulation.
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Xu X, Thomson DJ, Yan J. Optimisation and scaling effect of dual-waveguide optical trapping in the SOI platform. Opt Express 2020; 28:33285-33297. [PMID: 33114996 DOI: 10.1364/oe.403151] [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] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
Optical trapping has potential applications in biological manipulation, particle trapping, Raman spectroscopy, and quantum optomechanics. Among the various optical trapping schemes, on-chip dual-waveguide traps combine benefits of stable trapping and mass production. However, no systematic research has been conducted to optimise on-chip dual-waveguide traps so that the trapping capability is maximised. Here, a numerical simulation of an on-chip silicon on insulator (SOI) dual-waveguide optical trap based on Lumerical FDTD Solutions is carried out to optimise the on-chip dual-waveguide trap. It was found that the waveguide thickness is a crucial parameter when designing a dual-waveguide trap, and its optical trapping capability largely depends on the distance between the two waveguides. We show that the optimal waveguide thickness to achieve the maximum trapping capability generally increases with the gap distance, accompanied by a periodic feature due to the interference and the resonant effects within the gap. This optimal waveguide thickness and gap distance are analysed to have clear scaling effects over the input optical wavelength, which paves the way for the design and optimisation of dual-waveguide traps for various applications.
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Thomson DJ, Palma D, Guckenberger M, Balermpas P, Beitler JJ, Blanchard P, Brizel D, Budach W, Caudell J, Corry J, Corvo R, Evans M, Garden AS, Giralt J, Gregoire V, Harari PM, Harrington K, Hitchcock YJ, Johansen J, Kaanders J, Koyfman S, Langendijk JA, Le QT, Lee N, Margalit D, Mierzwa M, Porceddu S, Soong YL, Sun Y, Thariat J, Waldron J, Yom SS. Practice recommendations for risk-adapted head and neck cancer radiotherapy during the COVID-19 pandemic: An ASTRO-ESTRO consensus statement. Radiother Oncol 2020; 151:314-321. [PMID: 32730830 PMCID: PMC7384409 DOI: 10.1016/j.radonc.2020.04.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Because of the unprecedented disruption of health care services caused by the COVID-19 pandemic, the American Society of Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) identified an urgent need to issue practice recommendations for radiation oncologists treating head and neck cancer (HNC) in a time of limited resources and heightened risk for patients and staff. METHODS AND MATERIALS A panel of international experts from ASTRO, ESTRO, and select Asia-Pacific countries completed a modified rapid Delphi process. Topics and questions were presented to the group, and subsequent questions were developed from iterative feedback. Each survey was open online for 24 hours, and successive rounds started within 24 hours of the previous round. The chosen cutoffs for strong agreement (≥80%) and agreement (≥66%) were extrapolated from the RAND methodology. Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. The panel developed treatment recommendations for 5 HNC cases. RESULTS In total, 29 of 31 of those invited (94%) accepted, and after a replacement 30 of 30 completed all 3 surveys (100% response rate). There was agreement or strong agreement across a number of practice areas, including treatment prioritization, whether to delay initiation or interrupt radiation therapy for intercurrent SARS-CoV-2 infection, approaches to treatment (radiation dose-fractionation schedules and use of chemotherapy in each pandemic scenario), management of surgical cases in event of operating room closures, and recommended adjustments to outpatient clinic appointments and supportive care. CONCLUSIONS This urgent practice recommendation was issued in the knowledge of the very difficult circumstances in which our patients find themselves at present, navigating strained health care systems functioning with limited resources and at heightened risk to their health during the COVID-19 pandemic. The aim of this consensus statement is to ensure high-quality HNC treatments continue, to save lives and for symptomatic benefit.
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Affiliation(s)
- David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, and the Division of Cancer Sciences, The University of Manchester, UK
| | - David Palma
- Division of Radiation Oncology, Western University, London, Canada
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - David Brizel
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina
| | - Wilfred Budach
- Department of Radiation Oncology, University Hospital Düsseldorf, Germany
| | - Jimmy Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - June Corry
- Department Radiation Oncology Genesiscare, St Vincent's Hospital, Melbourne, Australia
| | - Renzo Corvo
- Department of Radiation Oncology, Ospedale Policlinico San Martino and University, Genoa, Italy
| | - Mererid Evans
- Department of Clinical Oncology, Velindre University NHS Trust, Cardiff, Wales, UK
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jordi Giralt
- Department of Radiation Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Vincent Gregoire
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin
| | - Kevin Harrington
- Division of Radiotherapy and Imaging, Institute for Cancer Research, London, UK
| | - Ying J Hitchcock
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah
| | - Jorgen Johansen
- Department of Oncology, Odense University Hospital, Department of Oncology, Denmark
| | - Johannes Kaanders
- Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Shlomo Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - J A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Danielle Margalit
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Sandro Porceddu
- Department of Radiation Oncology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, University of Normandy, Caen, France
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
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Thomson DJ, Yom SS, Saeed H, El Naqa I, Ballas L, Bentzen SM, Chao ST, Choudhury A, Coles CE, Dover L, Guadagnolo BA, Guckenberger M, Hoskin P, Jabbour SK, Katz MS, Mukherjee S, Rembielak A, Sebag-Montefiore D, Sher DJ, Terezakis SA, Thomas TV, Vogel J, Estes C. Radiation Fractionation Schedules Published During the COVID-19 Pandemic: A Systematic Review of the Quality of Evidence and Recommendations for Future Development. Int J Radiat Oncol Biol Phys 2020; 108:379-389. [PMID: 32798063 PMCID: PMC7834196 DOI: 10.1016/j.ijrobp.2020.06.054] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022]
Abstract
PURPOSE Numerous publications during the COVID-19 pandemic recommended the use of hypofractionated radiation therapy. This project assessed aggregate changes in the quality of the evidence supporting these schedules to establish a comprehensive evidence base for future reference and highlight aspects for future study. METHODS AND MATERIALS Based on a systematic review of published recommendations related to dose fractionation during the COVID-19 pandemic, 20 expert panelists assigned to 14 disease groups named and graded the highest quality of evidence schedule(s) used routinely for each condition and also graded all COVID-era recommended schedules. The American Society for Radiation Oncology quality of evidence criteria were used to rank the schedules. Process-related statistics and changes in distributions of quality ratings of the highest-rated versus recommended COVID-19 era schedules were described by disease groups and for specific clinical scenarios. RESULTS From January to May 2020 there were 54 relevant publications, including 233 recommended COVID-19-adapted dose fractionations. For site-specific curative and site-specific palliative schedules, there was a significant shift from established higher-quality evidence to lower-quality evidence and expert opinions for the recommended schedules (P = .022 and P < .001, respectively). For curative-intent schedules, the distribution of quality scores was essentially reversed (highest levels of evidence "pre-COVID" vs "in-COVID": high quality, 51.4% vs 4.8%; expert opinion, 5.6% vs 49.3%), although there was variation in the magnitude of shifts between disease sites and among specific indications. CONCLUSIONS A large number of publications recommended hypofractionated radiation therapy schedules across numerous major disease sites during the COVID-19 pandemic, which were supported by a lower quality of evidence than the highest-quality routinely used dose fractionation schedules. This work provides an evidence-based assessment of these potentially practice-changing recommendations and informs individualized decision-making and counseling of patients. These data could also be used to support radiation therapy practices in the event of second waves or surges of the pandemic in new regions of the world.
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Affiliation(s)
- David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
| | - Hina Saeed
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Issam El Naqa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Leslie Ballas
- Department of Radiation Oncology, University of Southern California, Los Angeles, California
| | - Soren M Bentzen
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
| | - Samuel T Chao
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Ananya Choudhury
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | - Charlotte E Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Laura Dover
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | | | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter Hoskin
- Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom; Mount Vernon Cancer Centre, Northwood, and University of Manchester, Manchester, United Kingdom
| | - Salma K Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, New Jersey
| | - Matthew S Katz
- Department of Radiation Medicine, Lowell General Hospital, Lowell, Massachusetts
| | | | - Agata Rembielak
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| | | | - David J Sher
- Department of Radiation Oncology, University of Texas - Southwestern, Dallas, Texas
| | | | - Toms V Thomas
- Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jennifer Vogel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University, Baltimore, Maryland
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Zhang W, Ebert M, Chen B, Reynolds JD, Yan X, Du H, Banakar M, Tran DT, Debnath K, Littlejohns CG, Saito S, Thomson DJ. Integration of low loss vertical slot waveguides on SOI photonic platforms for high efficiency carrier accumulation modulators. Opt Express 2020; 28:23143-23153. [PMID: 32752315 DOI: 10.1364/oe.397044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
Silicon accumulation type modulators offer prospects of high power efficiency, large bandwidth and high voltage phase linearity making them promising candidates for a number of advanced electro-optic applications. A significant challenge in the realisation of such a modulator is the fabrication of the passive waveguide structure which requires a thin dielectric layer to be positioned within the waveguide, i.e. slotted waveguides. Simultaneously, the fabricated slotted waveguide should be integrated with conventional rib waveguides with negligible optical transition losses. Here, successful integration of polysilicon and silicon slot waveguides enabling a low propagation loss 0.4-1.2 dB/mm together with an ultra-small optical mode conversion loss 0.04 dB between rib and slot waveguides is demonstrated. These fabricated slot waveguide with dielectric thermal SiO2 layer thicknesses around 6 nm, 8 nm and 10 nm have been characterized under transmission electron microscopy allowing for strong carrier accumulation effects for MOS-capacitor electro-optic modulators.
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Thomson DJ, Yom SS. In Reply to Gupta et al. Int J Radiat Oncol Biol Phys 2020; 107:854. [PMID: 32589992 PMCID: PMC7218371 DOI: 10.1016/j.ijrobp.2020.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/20/2022]
Affiliation(s)
- David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester and the Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California
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Thomson DJ, Palma D, Guckenberger M, Balermpas P, Beitler JJ, Blanchard P, Brizel D, Budach W, Caudell J, Corry J, Corvo R, Evans M, Garden AS, Giralt J, Gregoire V, Harari PM, Harrington K, Hitchcock YJ, Johansen J, Kaanders J, Koyfman S, Langendijk JA, Le QT, Lee N, Margalit D, Mierzwa M, Porceddu S, Soong YL, Sun Y, Thariat J, Waldron J, Yom SS. Practice Recommendations for Risk-Adapted Head and Neck Cancer Radiation Therapy During the COVID-19 Pandemic: An ASTRO-ESTRO Consensus Statement. Int J Radiat Oncol Biol Phys 2020; 107:618-627. [PMID: 32302681 PMCID: PMC7194855 DOI: 10.1016/j.ijrobp.2020.04.016] [Citation(s) in RCA: 133] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE Because of the unprecedented disruption of health care services caused by the COVID-19 pandemic, the American Society of Radiation Oncology (ASTRO) and the European Society for Radiotherapy and Oncology (ESTRO) identified an urgent need to issue practice recommendations for radiation oncologists treating head and neck cancer (HNC) in a time of limited resources and heightened risk for patients and staff. METHODS AND MATERIALS A panel of international experts from ASTRO, ESTRO, and select Asia-Pacific countries completed a modified rapid Delphi process. Topics and questions were presented to the group, and subsequent questions were developed from iterative feedback. Each survey was open online for 24 hours, and successive rounds started within 24 hours of the previous round. The chosen cutoffs for strong agreement (≥80%) and agreement (≥66%) were extrapolated from the RAND methodology. Two pandemic scenarios, early (risk mitigation) and late (severely reduced radiation therapy resources), were evaluated. The panel developed treatment recommendations for 5 HNC cases. RESULTS In total, 29 of 31 of those invited (94%) accepted, and after a replacement 30 of 30 completed all 3 surveys (100% response rate). There was agreement or strong agreement across a number of practice areas, including treatment prioritization, whether to delay initiation or interrupt radiation therapy for intercurrent SARS-CoV-2 infection, approaches to treatment (radiation dose-fractionation schedules and use of chemotherapy in each pandemic scenario), management of surgical cases in event of operating room closures, and recommended adjustments to outpatient clinic appointments and supportive care. CONCLUSIONS This urgent practice recommendation was issued in the knowledge of the very difficult circumstances in which our patients find themselves at present, navigating strained health care systems functioning with limited resources and at heightened risk to their health during the COVID-19 pandemic. The aim of this consensus statement is to ensure high-quality HNC treatments continue, to save lives and for symptomatic benefit.
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Affiliation(s)
- David J Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, and the Division of Cancer Sciences, The University of Manchester, UK
| | - David Palma
- Division of Radiation Oncology, Western University, London, Canada
| | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Panagiotis Balermpas
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Pierre Blanchard
- Department of Radiation Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - David Brizel
- Department of Radiation Oncology, Duke Cancer Institute, Durham, North Carolina
| | - Wilfred Budach
- Department of Radiation Oncology, University Hospital Düsseldorf, Germany
| | - Jimmy Caudell
- Department of Radiation Oncology, Moffitt Cancer Center, Tampa, Florida
| | - June Corry
- Department Radiation Oncology Genesiscare, St Vincent's Hospital, Melbourne, Australia
| | - Renzo Corvo
- Department of Radiation Oncology, Ospedale Policlinico San Martino and University, Genoa, Italy
| | - Mererid Evans
- Department of Clinical Oncology, Velindre University NHS Trust, Cardiff, Wales, UK
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jordi Giralt
- Department of Radiation Oncology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Vincent Gregoire
- Department of Radiation Oncology, Centre Leon Berard, Lyon, France
| | - Paul M Harari
- Department of Human Oncology, University of Wisconsin, Madison, Wisconsin
| | - Kevin Harrington
- Division of Radiotherapy and Imaging, Institute for Cancer Research, London, UK
| | - Ying J Hitchcock
- Department of Radiation Oncology, Huntsman Cancer Hospital, University of Utah, Salt Lake City, Utah
| | - Jorgen Johansen
- Department of Oncology, Odense University Hospital, Department of Oncology, Denmark
| | - Johannes Kaanders
- Department of Radiation Oncology, Radboudumc, Nijmegen, The Netherlands
| | - Shlomo Koyfman
- Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
| | - J A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Quynh-Thu Le
- Department of Radiation Oncology, Stanford University, Palo Alto, California
| | - Nancy Lee
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Danielle Margalit
- Department of Radiation Oncology, Dana-Farber/Brigham & Women's Cancer Center, Harvard Medical School, Boston, Massachusetts
| | - Michelle Mierzwa
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Sandro Porceddu
- Department of Radiation Oncology, Princess Alexandra Hospital, University of Queensland, Brisbane, Australia
| | - Yoke Lim Soong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
| | - Ying Sun
- Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, PR China
| | - Juliette Thariat
- Department of Radiation Oncology, Centre François Baclesse, University of Normandy, Caen, France
| | - John Waldron
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
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Mehanna H, Hardman JC, Shenson JA, Abou-Foul AK, Topf MC, AlFalasi M, Chan JYK, Chaturvedi P, Chow VLY, Dietz A, Fagan JJ, Godballe C, Golusiński W, Homma A, Hosal S, Iyer NG, Kerawala C, Koh YW, Konney A, Kowalski LP, Kraus D, Kuriakose MA, Kyrodimos E, Lai SY, Leemans CR, Lennon P, Licitra L, Lou PJ, Lyons B, Mirghani H, Nichols AC, Paleri V, Panizza BJ, Parente Arias P, Patel MR, Piazza C, Rischin D, Sanabria A, Takes RP, Thomson DJ, Uppaluri R, Wang Y, Yom SS, Zhu YM, Porceddu SV, de Almeida JR, Simon C, Holsinger FC. Recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic: an international consensus. Lancet Oncol 2020; 21:e350-e359. [PMID: 32534633 PMCID: PMC7289563 DOI: 10.1016/s1470-2045(20)30334-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice. We completed a modified Delphi consensus process of three rounds with 40 international experts in head and neck cancer surgical, radiation, and medical oncology, representing 35 international professional societies and national clinical trial groups. Endorsed by 39 societies and professional bodies, these consensus practice recommendations aim to decrease inconsistency of practice, reduce uncertainty in care, and provide reassurance for clinicians worldwide for head and neck surgical oncology in the context of the COVID-19 pandemic and in the setting of acute severe resource constraint and high risk of infection to patients and staff.
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Affiliation(s)
- Hisham Mehanna
- Institute for Head and Neck Studies and Education, University of Birmingham, Birmingham, UK.
| | - John C Hardman
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Jared A Shenson
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Ahmad K Abou-Foul
- Department of Otolaryngology and Head and Neck Surgery, Walsall Manor Hospital, Walsall, UK
| | - Michael C Topf
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
| | - Mohammad AlFalasi
- Department of Otolaryngology, United Arab Emirates University, Alain, United Arab Emirates
| | - Jason Y K Chan
- Department of Otorhinolaryngology and Head and Neck Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region, China
| | - Pankaj Chaturvedi
- Department of Otorhinolaryngology and Head and Neck Surgery, Tata Memorial Hospital, Mumbai, India
| | - Velda Ling Yu Chow
- Department of Surgery, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Andreas Dietz
- Department of Ear, Nose and Throat Surgery, University of Leipzig, Leipzig, Germany
| | - Johannes J Fagan
- Division of Otolaryngology, University of Cape Town, Cape Town, South Africa
| | - Christian Godballe
- Department of Otorhinolaryngology-Head and Neck Surgery, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Wojciech Golusiński
- Department of Head and Neck Surgery, Poznan University of Medical Sciences, Greater Poland Cancer Centre, Poznan, Poland
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Sefik Hosal
- Department of Otolaryngology-Head and Neck Surgery, Atilim University Faculty of Medicine, Ankara, Turkey
| | - N Gopalakrishna Iyer
- Department of Head and Neck Surgery, National Cancer Centre and Singapore General Hospital, Singapore
| | - Cyrus Kerawala
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Yoon Woo Koh
- Department of Otorhinolaryngology, Yonsei University, Seoul, South Korea
| | - Anna Konney
- Department of Otolaryngology, Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, School of Medical Science, Kumasi, Ghana
| | - Luiz P Kowalski
- Department of Head and Neck Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil; Department of Head and Neck Surgery and Otorhinolaryngology, A C Camargo Cancer Center, Sao Paulo, Brazil
| | - Dennis Kraus
- Department of Otolaryngology-Head and Neck Surgery, Zucker School of Medicine, Northwell Health Cancer Institute, New York, NY, USA
| | - Moni A Kuriakose
- Department of Otolaryngology-Head and Neck Surgery, Cochin Cancer Research Centre, Cochin, India
| | - Efthymios Kyrodimos
- First Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Stephen Y Lai
- Department of Head and Neck Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - C Rene Leemans
- Department of Otolaryngology and Head and Neck Surgery, Amsterdam University Medical Centre, Cancer Center Amsterdam, VU University, Amsterdam, Netherlands
| | - Paul Lennon
- Department of Otolaryngology and Head and Neck Surgery, St James's Hospital and The Royal Victoria Eye and Ear Hospital, Dublin, Ireland
| | - Lisa Licitra
- Foundation IRCCS, Division of Medical Oncology, National Institute of Cancer of Milan, University of Milan, Milan, Italy
| | - Pei-Jen Lou
- Department of Otolaryngology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Bernard Lyons
- Department of Otolaryngology Head and Neck Surgery, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Haitham Mirghani
- Department of Otolaryngology and Head and Neck Surgery, Hôpital Européen Georges-Pompidou, Assistance Publique-Hôpitaux de Paris, Université Paris Descartes, Paris, France
| | - Anthonny C Nichols
- Department of Otolaryngology-Head and Neck Surgery and Department of Oncology, University of Western Ontario, London, ON, Canada
| | - Vinidh Paleri
- Head and Neck Unit, The Royal Marsden National Health Service Foundation Trust, London, UK
| | - Benedict J Panizza
- Department of Otolaryngology-Head and Neck Surgery, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Pablo Parente Arias
- Department of Otolaryngology and Head and Neck Surgery, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Mihir R Patel
- Department of Otolaryngology and Head and Neck Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Cesare Piazza
- Department of Otorhinolaryngology, Maxillofacial and Thyroid Surgery, National Institute of Cancer of Milan, University of Milan, Milan, Italy
| | - Danny Rischin
- Department of Medical Oncology, Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia-Hospital Universitario San Vicente Fundación, Medellin, Colombia; CEXCA Centro de Excelencia en Enfermedades de Cabeza y Cuello, Medellin, Colombia
| | - Robert P Takes
- Department of Otolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, Netherlands
| | - David J Thomson
- Department of Clinical Oncology, The Christie National Health Service Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - Ravindra Uppaluri
- Division of Otolaryngology-Head and Neck Surgery, Dana-Farber and Brigham and Women's Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Yu Wang
- Department of Head and Neck Surgery, Fudan University, Shanghai Cancer Center, Shanghai, China
| | - Sue S Yom
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Yi-Ming Zhu
- Department of Head and Neck Surgery, National Cancer Center-Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sandro V Porceddu
- Department of Cancer Services, Princess Alexandra Hospital and Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - John R de Almeida
- Department of Otolaryngology-Head and Neck Surgery and Department of Surgical Oncology, University Health Network, Toronto, ON, Canada; Department of Otolaryngology-Head and Neck Surgery, Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Chrisian Simon
- Department of Otolaryngology and Head and Neck Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - F Christopher Holsinger
- Division of Head and Neck Surgery, Department of Otolaryngology, Stanford University, Palo Alto, CA, USA
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Chen X, Milosevic MM, Runge AFJ, Yu X, Khokhar AZ, Mailis S, Thomson DJ, Peacock AC, Saito S, Reed GT. Silicon erasable waveguides and directional couplers by germanium ion implantation for configurable photonic circuits. Opt Express 2020; 28:17630-17642. [PMID: 32679968 DOI: 10.1364/oe.394871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/05/2020] [Indexed: 06/11/2023]
Abstract
A novel technique for realization of configurable/one-time programmable (OTP) silicon photonic circuits is presented. Once the proposed photonic circuit is programmed, its signal routing is retained without the need for additional power consumption. This technology can potentially enable a multi-purpose design of photonic chips for a range of different applications and performance requirements, as it can be programmed for each specific application after chip fabrication. Therefore, the production costs per chip can be reduced because of the increase in production volume, and rapid prototyping of new photonic circuits is enabled. Essential building blocks for the configurable circuits in the form of erasable directional couplers (DCs) were designed and fabricated, using ion implanted waveguides. We demonstrate permanent switching of optical signals between the drop port and through the port of the DCs using a localized post-fabrication laser annealing process. Proof-of-principle demonstrators in the form of generic 1×4 and 2×2 programmable switching circuits were fabricated and subsequently programmed.
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34
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Burnet NG, Mackay RI, Smith E, Chadwick AL, Whitfield GA, Thomson DJ, Lowe M, Kirkby NF, Crellin AM, Kirkby KJ. Proton beam therapy: perspectives on the National Health Service England clinical service and research programme. Br J Radiol 2020; 93:20190873. [PMID: 31860337 PMCID: PMC7066938 DOI: 10.1259/bjr.20190873] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/05/2019] [Accepted: 12/16/2019] [Indexed: 12/19/2022] Open
Abstract
The UK has an important role in the evaluation of proton beam therapy (PBT) and takes its place on the world stage with the opening of the first National Health Service (NHS) PBT centre in Manchester in 2018, and the second in London coming in 2020. Systematic evaluation of the role of PBT is a key objective. By September 2019, 108 patients had started treatment, 60 paediatric, 19 teenagers and young adults and 29 adults. Obtaining robust outcome data is vital, if we are to understand the strengths and weaknesses of current treatment approaches. This is important in demonstrating when PBT will provide an advantage and when it will not, and in quantifying the magnitude of benefit.The UK also has an important part to play in translational PBT research, and building a research capability has always been the vision. We are perfectly placed to perform translational pre-clinical biological and physical experiments in the dedicated research room in Manchester. The nature of DNA damage from proton irradiation is considerably different from X-rays and this needs to be more fully explored. A better understanding is needed of the relative biological effectiveness (RBE) of protons, especially at the end of the Bragg peak, and of the effects on tumour and normal tissue of PBT combined with conventional chemotherapy, targeted drugs and immunomodulatory agents. These experiments can be enhanced by deterministic mathematical models of the molecular and cellular processes of DNA damage response. The fashion of ultra-high dose rate FLASH irradiation also needs to be explored.
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Affiliation(s)
| | | | - Ed Smith
- The Christie NHS Foundation Trust, Manchester, and University of Manchester, M20 4BX, UK
| | - Amy L Chadwick
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, and The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | - Gillian A Whitfield
- The Christie NHS Foundation Trust, Manchester, and University of Manchester, M20 4BX, UK
| | - David J Thomson
- The Christie NHS Foundation Trust, Manchester, and University of Manchester, M20 4BX, UK
| | | | - Norman F Kirkby
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, and The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
| | | | - Karen J Kirkby
- Division of Cancer Sciences, University of Manchester, Manchester Cancer Research Centre, Manchester Academic Health Science Centre, and The Christie NHS Foundation Trust, Manchester, M20 4BX, UK
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Du H, Zhang X, Littlejohns CG, Tran DT, Yan X, Banakar M, Wei C, Thomson DJ, Reed GT. Nonconservative Coupling in a Passive Silicon Microring Resonator. Phys Rev Lett 2020; 124:013606. [PMID: 31976699 DOI: 10.1103/physrevlett.124.013606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Indexed: 06/10/2023]
Abstract
The authors report on nonconservative coupling in a passive silicon microring between its clockwise and counterclockwise resonance modes. The coupling coefficient is adjustable using a thermo-optic phase shifter. The resulting resonance of the supermodes due to nonconservative coupling is predicted in theory and demonstrated in experiments. This Letter paves the way for fundamental studies of on-chip lasers and quantum photonics, and their potential applications.
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Affiliation(s)
- H Du
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - X Zhang
- Department of Electrical Engineering, Pennsylvania State University, University Park, Pennsylvania 16802, USA
| | - C G Littlejohns
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
- Silicon Technologies Centre of Excellence, Nanyang Technological University, 639798 Singapore
| | - D T Tran
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - X Yan
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - M Banakar
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - C Wei
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - D J Thomson
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - G T Reed
- Optoelectronics Research Centre, University of Southampton, Southampton SO17 1BJ, United Kingdom
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Thomson DJ, Zhang W, Li K, Debnath K, Liu S, Chen B, Husain MK, Meng F, Khokhar AZ, Byers J, Ebert M, Reynolds JD, Banakar M, Mastronardi L, Littlejohns CG, Gardes FY, Mashanovich GZ, Saito S, Reed GT. Silicon photonics for high data rate applications -INVITED. EPJ Web Conf 2020. [DOI: 10.1051/epjconf/202023801005] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The high speed conversion of signals between the optical and electrical domains is crucial for many key applications of silicon photonics. Electro-optic modulators integrated with electronic drive amplifiers are typically used to convert an electrical signal to the optical domain. Design of these individual elements is important to achieve high performance, however a true optimisation requires careful co-design of the photonic and electronic components considering the properties of each other. Here we present our recent results in this area together with a MOSCAP type modulator with the potential for high speed, high efficiency and highly linear modulation.
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Pant B, Zhang W, Tran D, Banakar M, Du H, Yan X, Littlejohns CG, Reed GT, Thomson DJ. Enhanced efficiency thermo-optic phase-shifter by using multi-mode-interference device. EPJ Web Conf 2020. [DOI: 10.1051/epjconf/202023801007] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
We demonstrate a method for power reduction in thermo-optic based Mach-Zehnder interferometer (MZI) by using the multimode region of a 2x2 Multi-Mode-Interferometer (MMI) as the modulation region. The light is circulated through the same multimode region twice and therefore utilizes the already present change in temperature leading to additional phase change, and an increase in efficiency. Power saving of 29.6% compared to a conventional thermo-optic phase shifter using single mode waveguides has been experimentally demonstrated. The reported devices show minimal insertion loss penalty compared to generic devices and do not add any additional fabrication complexity. Such an approach could also be applied to higher speed devices, for example those employing free carrier effects.
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Zhang Z, Chen X, Cheng Q, Khokhar AZ, Yan X, Huang B, Chen H, Liu H, Li H, Thomson DJ, Reed GT. High-efficiency apodized bidirectional grating coupler for perfectly vertical coupling. Opt Lett 2019; 44:5081-5084. [PMID: 31613269 DOI: 10.1364/ol.44.005081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
We propose and experimentally demonstrate an apodized bidirectional grating coupler for high-efficiency, perfectly vertical coupling. Through grating apodization, the coupling efficiency (CE) can be notably improved, and the parasitic reflections can be minimized. For ease of fabrication, subwavelength gratings are introduced, which are also beneficial for the coupling performance. Simulation shows a record CE of 72%. We found that the coupler is quite robust to the variation of incidence mode field diameter and fiber misalignment. A CE of -1.8 dB is experimentally measured with a 1-dB bandwidth of 37 nm.
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Petra R, Oo SZ, Tarazona A, Cernansky R, Reynolds SA, Khokhar AZ, Mittal V, Thomson DJ, Politi A, Mashanovich GZ, Reed GT, Chong HMH. HWCVD a-Si:H interlayer slope waveguide coupler for multilayer silicon photonics platform. Opt Express 2019; 27:15735-15749. [PMID: 31163765 DOI: 10.1364/oe.27.015735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
We present interlayer slope waveguides, designed to guide light from one level to another in a multi-layer silicon photonics platform. The waveguide is fabricated from hydrogenated amorphous silicon (a-Si:H) film, deposited using hot-wire chemical vapor deposition (HWCVD) at a temperature of 230°C. The interlayer slope waveguide is comprises of a lower level input waveguide and an upper level output waveguide, connected by a waveguide on a slope, with vertical separation to isolate other crossing waveguides. Measured loss of 0.17 dB/slope was obtained for waveguide dimensions of 600 nm waveguide width (w) and 400 nm core thickness (h) at a wavelength of 1550 nm and for transverse electric (TE) mode polarization.
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Du H, Zhang W, Littlejohns CG, Stankovic S, Yan X, Tran DT, Sharp GJ, Gardes FY, Thomson DJ, Sorel M, Mashanovich GZ, Reed GT. Ultra-sharp asymmetric Fano-like resonance spectrum on Si photonic platform. Opt Express 2019; 27:7365-7372. [PMID: 30876301 DOI: 10.1364/oe.27.007365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 02/09/2019] [Indexed: 06/09/2023]
Abstract
In this paper, we report the generation of an ultra-sharp asymmetric resonance spectrum through Fano-like interference. This generation is accomplished by weakly coupling a high-quality factor (Q factor) Fabry-Pérot (FP) cavity and a low-Q factor FP cavity through evanescent waves. The high-Q FP cavity is formed by Sagnac loop mirrors, whilst the low-Q one is built by partially transmitting Sagnac loop reflectors. The working principle has been analytically established and numerically modelled by using temporal coupled-mode-theory (CMT), and verified using a prototype device fabricated on the 340 nm silicon-on-insulator (SOI) platform, patterned by deep ultraviolet (DUV) lithography. Pronounced asymmetric resonances with slopes up to 0.77 dB/pm have been successfully measured, which, to the best of our knowledge, is higher than the results reported in state-of-the-art devices in on-chip integrated Si photonic studies. The established theoretical analysis method can provide excellent design guidelines for devices with Fano-like resonances. The design principle can be applied to ultra-sensitive sensing, ultra-high extinction ratio switching, and more applications.
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Nedeljkovic M, Littlejohns CG, Khokhar AZ, Banakar M, Cao W, Penades JS, Tran DT, Gardes FY, Thomson DJ, Reed GT, Wang H, Mashanovich GZ. Silicon-on-insulator free-carrier injection modulators for the mid-infrared. Opt Lett 2019; 44:915-918. [PMID: 30768019 DOI: 10.1364/ol.44.000915] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Abstract
Experimental demonstrations of silicon-on-insulator waveguide-based free-carrier effect modulators operating at 3.8 μm are presented. PIN diodes are used to inject carriers into the waveguides, and are configured to (a) use free-carrier electroabsorption to create a variable optical attenuator with 34 dB modulation depth and (b) use free-carrier electrorefraction with the PIN diodes acting as phase shifters in a Mach-Zehnder interferometer, achieving a VπLπ of 0.052 V·mm and a DC modulation depth of 22 dB. Modulation is demonstrated at data rates up to 125 Mbit/s.
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Hagan DE, Nedeljkovic M, Cao W, Thomson DJ, Mashanovich GZ, Knights AP. Experimental quantification of the free-carrier effect in silicon waveguides at extended wavelengths. Opt Express 2019; 27:166-174. [PMID: 30645364 DOI: 10.1364/oe.27.000166] [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] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/12/2018] [Indexed: 06/09/2023]
Abstract
We examine the electro-optic effect at wavelengths ranging from 1.31 to 2.02 μm for: (1) an Electronic Variable Optical Attenuator (EVOA); and (2) a Micro-Ring Resonator (MRR). For the EVOA, simulations were performed to ascertain the relationship between free-carrier concentration and optical attenuation, and are in agreement with our observation of an increase in attenuation with increasing wavelength. MRRs were fabricated for use around wavelengths of 2 μm to explore the sensitivity of operation to bus-to-ring coupling gap and p-n junction offset. Trends observed in the experiment are replicated by simulation, calibrated using the observations of the EVOA operation. The previously proposed efficiency increase of operation around 2 μm compared to more traditional wavelengths is demonstrated. Future development of devices for these wavelengths, supported by amplification using Thulium Doped Fiber Amplifier (TDFA) technology, is a promising route to aid in the alleviation of increasing demands on communication networks.
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Byers J, Debnath K, Arimoto H, Husain MK, Sotto M, Li Z, Liu F, Ibukuro K, Khokhar A, Kiang K, Boden SA, Thomson DJ, Reed GT, Saito S. Silicon slot fin waveguide on bonded double-SOI for a low-power accumulation modulator fabricated by an anisotropic wet etching technique. Opt Express 2018; 26:33180-33191. [PMID: 30645474 DOI: 10.1364/oe.26.033180] [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] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/13/2018] [Indexed: 06/09/2023]
Abstract
We propose a new low VπL, fully-crystalline, accumulation modulator design based on a thin horizontal gate oxide slot fin waveguide, on bonded double Silicon-on-Insulator (SOI). A combination of anisotropic wet etching and the mirrored crystal alignment of the top and bottom SOI layers allows us for the first time to selectively pattern the bottom layer from above. Simulations presented herein show a VπL = 0.17Vcm. Fin-waveguides and passive Mach-Zehnder Interferometer (MZI) devices with fin-waveguide phase shifters have been fabricated, with the fin-waveguides having a transmission loss of 5.8dB/mm and a 13.5nm thick internal gate oxide slot.
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Chen B, Yu X, Chen X, Milosevic MM, Thomson DJ, Khokhar AZ, Saito S, Muskens OL, Reed GT. Real-time monitoring and gradient feedback enable accurate trimming of ion-implanted silicon photonic devices. Opt Express 2018; 26:24953-24963. [PMID: 30469603 DOI: 10.1364/oe.26.024953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/11/2018] [Indexed: 06/09/2023]
Abstract
Fabrication errors pose significant challenges on silicon photonics, promoting post-fabrication trimming technologies to ensure device performance. Conventional approaches involve multiple trimming and characterization steps, impacting overall fabrication complexity. Here we demonstrate a highly accurate trimming method combining laser annealing of germanium implanted silicon waveguide and real-time monitoring of device performance. Direct feedback of the trimming process is facilitated by a differential spectroscopic technique based on photomodulation. The resonant wavelength trimming accuracy is better than 0.15 nm for ring resonators with 20-µm radius. We also realize operating point trimming of Mach-Zehnder interferometers with germanium implanted arms. A phase shift of 1.2π is achieved by annealing a 7-μm implanted segment.
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Demirtzioglou I, Lacava C, Bottrill KRH, Thomson DJ, Reed GT, Richardson DJ, Petropoulos P. Frequency comb generation in a silicon ring resonator modulator. Opt Express 2018; 26:790-796. [PMID: 29401959 DOI: 10.1364/oe.26.000790] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/12/2017] [Indexed: 06/07/2023]
Abstract
We report on the generation of an optical comb of highly uniform in power frequency lines (variation less than 0.7 dB) using a silicon ring resonator modulator. A characterization involving the measurement of the complex transfer function of the ring is presented and five frequency tones with a 10-GHz spacing are produced using a dual-frequency electrical input at 10 and 20 GHz. A comb shape comparison is conducted for different modulator bias voltages, indicating optimum operation at a small forward-bias voltage. A time-domain measurement confirmed that the comb signal was highly coherent, forming 20.3-ps-long pulses.
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Chen B, Bruck R, Traviss D, Khokhar AZ, Reynolds S, Thomson DJ, Mashanovich GZ, Reed GT, Muskens OL. Hybrid Photon-Plasmon Coupling and Ultrafast Control of Nanoantennas on a Silicon Photonic Chip. Nano Lett 2018; 18:610-617. [PMID: 29272140 DOI: 10.1021/acs.nanolett.7b04861] [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] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Hybrid integration of nanoplasmonic devices with silicon photonic circuits holds promise for a range of applications in on-chip sensing, field-enhanced and nonlinear spectroscopy, and integrated nanophotonic switches. Here, we demonstrate a new regime of photon-plasmon coupling by combining a silicon photonic resonator with plasmonic nanoantennas. Using principles from coherent perfect absorption, we make use of standing-wave light fields to maximize the photon-plasmon interaction strength. Precise placement of the broadband antennas with respect to the narrowband photonic racetrack modes results in controlled hybridization of only a subset of these modes. By combining antennas into groups of radiating dipoles with opposite phase, far-field scattering is effectively suppressed. We achieve ultrafast tuning of photon-plasmon hybridization including reconfigurable routing of the standing-wave input between two output ports. Hybrid photonic-plasmonic resonators provide conceptually new approaches for on-chip integrated nanophotonic devices.
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Affiliation(s)
- Bigeng Chen
- Physics and Astronomy, Faculty of Physical Sciences and Engineering, University of Southampton , Southampton SO17 1BJ, U.K
| | - Roman Bruck
- Physics and Astronomy, Faculty of Physical Sciences and Engineering, University of Southampton , Southampton SO17 1BJ, U.K
| | - Daniel Traviss
- Physics and Astronomy, Faculty of Physical Sciences and Engineering, University of Southampton , Southampton SO17 1BJ, U.K
| | - Ali Z Khokhar
- Optoelectronics Research Centre, Faculty of Physical Sciences and Engineering, University of Southampton , Southampton SO17 1BJ, U.K
| | - Scott Reynolds
- Optoelectronics Research Centre, Faculty of Physical Sciences and Engineering, University of Southampton , Southampton SO17 1BJ, U.K
| | - David J Thomson
- Optoelectronics Research Centre, Faculty of Physical Sciences and Engineering, University of Southampton , Southampton SO17 1BJ, U.K
| | - Goran Z Mashanovich
- Optoelectronics Research Centre, Faculty of Physical Sciences and Engineering, University of Southampton , Southampton SO17 1BJ, U.K
| | - Graham T Reed
- Optoelectronics Research Centre, Faculty of Physical Sciences and Engineering, University of Southampton , Southampton SO17 1BJ, U.K
| | - Otto L Muskens
- Physics and Astronomy, Faculty of Physical Sciences and Engineering, University of Southampton , Southampton SO17 1BJ, U.K
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Lowe NM, Bernstein JM, Mais K, Garcez K, Lee LW, Sykes A, Thomson DJ, Homer JJ, West CM, Slevin NJ. Taxane, platinum and 5-FU prior to chemoradiotherapy benefits patients with stage IV neck node-positive head and neck cancer and a good performance status. J Cancer Res Clin Oncol 2017; 144:389-401. [PMID: 29222650 DOI: 10.1007/s00432-017-2553-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/27/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE The benefit of adding docetaxel, cisplatin and 5-fluorouracil (TPF) induction chemotherapy to chemoradiotherapy (CRT) in head and neck squamous cell carcinoma (HNSCC) remains uncertain. We aimed to investigate whether ICT is well tolerated when given with prophylactic treatment against predicted adverse effects and which patients benefit most. METHODS A single-centre audit identified 132 HNSCC patients with stage IVa/b neck node-positive disease, prescribed TPF followed by CRT. TPF involved three cycles of docetaxel (75 mg/m2 IV) and cisplatin (75 mg/m2 IV) on day 1 plus 5-FU (750 mg/m2 IV) on days 2-5. Planned CRT was 66 Gy in 30 fractions of intensity-modulated radiotherapy with concurrent cisplatin (100 mg/m2 IV) at the beginning of week 1 and 4 (days 1 and 22). All patients received prophylactic antibiotics and granulocyte colony-stimulating factor. RESULTS Median follow-up was 39.5 months. 92.4% of patients completed three cycles of TPF; 95.5% of patients started chemoradiotherapy. Grade 3/4 adverse events were low (febrile neutropenia 3.0%), with no toxicity-related deaths. 3-year overall survival was 67.2%; disease-specific survival was 78.7%; locoregional control was 78.3%. Distant metastases rate was 9.8% (3.0% in those without locoregional recurrence). Good performance status (p = 0.002) and poor tumour differentiation (p = 0.018) were associated with improved overall survival on multivariate analysis. CONCLUSION With prophylactic antibiotics and granulocyte colony-stimulating factor TPF was well tolerated with good survival outcomes. TPF should remain a treatment option for stage IV neck node-positive patients with a good performance status. The use of tumour grade to aid patient selection for TPF warrants investigation.
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Affiliation(s)
- Natalie M Lowe
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, University of Manchester, Wilmslow Road, Manchester, England, M20 4BX, UK. .,Head and Neck Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, England, M20 4BX, UK.
| | - Jonathan M Bernstein
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, University of Manchester, Wilmslow Road, Manchester, England, M20 4BX, UK.,Department of Otolaryngology-Head and Neck Surgery, The Royal Marsden NHS Foundation Trust, The Royal Marsden, Fulham Road, London, SW3 6JJ, UK
| | - Kathleen Mais
- Head and Neck Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, England, M20 4BX, UK
| | - Kate Garcez
- Head and Neck Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, England, M20 4BX, UK
| | - Lip W Lee
- Head and Neck Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, England, M20 4BX, UK
| | - Andrew Sykes
- Head and Neck Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, England, M20 4BX, UK
| | - David J Thomson
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, University of Manchester, Wilmslow Road, Manchester, England, M20 4BX, UK.,Head and Neck Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, England, M20 4BX, UK
| | - Jarrod J Homer
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, University of Manchester, Wilmslow Road, Manchester, England, M20 4BX, UK.,University Department of Otolaryngology-Head & Neck Surgery, Manchester Academic Health Science Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Oxford Road, Manchester, England, M13 9WL, UK
| | - Catharine M West
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, University of Manchester, Wilmslow Road, Manchester, England, M20 4BX, UK
| | - Nicholas J Slevin
- Translational Radiobiology Group, Division of Cancer Sciences, Manchester Academic Health Science Centre, NIHR Manchester Biomedical Research Centre, The Christie NHS Foundation Trust, University of Manchester, Wilmslow Road, Manchester, England, M20 4BX, UK.,Head and Neck Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, England, M20 4BX, UK
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Pérez D, Gasulla I, Crudgington L, Thomson DJ, Khokhar AZ, Li K, Cao W, Mashanovich GZ, Capmany J. Author Correction: Multipurpose silicon photonics signal processor core. Nat Commun 2017; 8:1925. [PMID: 29185445 PMCID: PMC5707383 DOI: 10.1038/s41467-017-01529-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Change History: A correction to this article has been published and is linked from the HTML version of this article.
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Affiliation(s)
- Daniel Pérez
- ITEAM Research Institute, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Ivana Gasulla
- ITEAM Research Institute, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain
| | - Lee Crudgington
- Optoelectronics Research Centre, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - David J Thomson
- Optoelectronics Research Centre, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Ali Z Khokhar
- Optoelectronics Research Centre, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Ke Li
- Optoelectronics Research Centre, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Wei Cao
- Optoelectronics Research Centre, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Goran Z Mashanovich
- Optoelectronics Research Centre, University of Southampton, Highfield, Southampton, SO17 1BJ, UK.,School of Electrical Engineering, University of Belgrade, Belgrade, 11120, Serbia
| | - José Capmany
- ITEAM Research Institute, Universitat Politècnica de València, Camino de Vera s/n, 46022, Valencia, Spain.
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Lacava C, Cardea I, Demirtzioglou I, Khoja AE, Ke L, Thomson DJ, Ruan X, Zhang F, Reed GT, Richardson DJ, Petropoulos P. 49.6 Gb/s direct detection DMT transmission over 40 km single mode fibre using an electrically packaged silicon photonic modulator. Opt Express 2017; 25:29798-29811. [PMID: 29221016 DOI: 10.1364/oe.25.029798] [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] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 11/03/2017] [Indexed: 06/07/2023]
Abstract
We present the characterization of a silicon Mach-Zehnder modulator with electrical packaging and show that it exhibits a large third-order intermodulation spurious-free dynamic range (> 100 dB Hz2/3). This characteristic renders the modulator particularly suitable for the generation of high spectral efficiency discrete multi-tone signals and we experimentally demonstrate a single-channel, direct detection transmission system operating at 49.6 Gb/s, exhibiting a baseband spectral efficiency of 5 b/s/Hz. Successful transmission is demonstrated over various lengths of single mode fibre up to 40 km, without the need of any amplification or dispersion compensation.
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Affiliation(s)
- D J Thomson
- Department of General Medicine, John Radcliffe Hospital, Oxford, UK
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