The Christie School of Oncology: Christie Research Publications Repository
Not a member yet
16373 research outputs found
Sort by
Quality of life outcomes in vestibular schwannoma: a prospective analysis of treatment modalities
No full textOBJECTIVE: Management options for vestibular schwannoma include microsurgery (MS), stereotactic radiosurgery (SRS), and watch, wait, and rescan (WWR). This study aimed to evaluate changes in patient and disease-specific quality of life (QoL) outcomes over time, comparing each treatment modality in a matched cohort. METHODS: A prospective cohort study recruited adult patients with sporadic vestibular schwannomas ≤ 3 cm in size undergoing treatment between January 2012 and April 2022 in a single tertiary referral center. Questionnaires were completed at diagnosis and ≥ 12 months posttreatment to assess patient-reported changes in QoL (Hearing, Dizziness, Tinnitus Handicap Inventories; Penn Acoustic Neuroma QoL questionnaire (PANQOL) and the Short Form-36 QoL questionnaire (SF-36)). RESULTS: In total, 124 patients returned completed questionnaires (MS: 42, SRS: 42, WWR 40). The SRS group had a clinically significant deterioration in their hearing scores posttreatment (p = 0.002). Dizziness scores worsened in the MS and WWR groups posttreatment; this did not reach clinical significance. Hearing deterioration was identified in the WWR group over time using the PANQOL domain (p = 0.012). The SF-36 questionnaire showed a significant deterioration in physical functioning, role limitations, and component summary for SRS patients posttreatment (p = 0.0018, p = 0.0032, p = 0.0308). No other significant differences were seen in disease-specific or general QoL domains when comparing treatment strategies. CONCLUSION: Outcomes in similar disease-specific domains were not consistent across questionnaires. All three treatment modalities appear to result in comparable long-term disease-specific QoL outcomes. These findings will enable evidence-based patient counseling to inform decision-making
Evaluating participant experiences and tolerability with MR linac imaging
No full textINTRODUCTION: Magnetic Resonance Image Guided Radiotherapy (MRIgRT) integrates MRI with a linear accelerator to enable adaptive treatment delivery. While technical feasibility is well established, patient experience during MR Linac imaging, especially outside treatment sessions, remains underexplored. This study evaluates tolerability, pre-scan anxiety, coping ability, willingness for future scans, and scan-induced symptoms in patients and non-patient volunteers. MATERIALS AND METHODS: Participants who successfully underwent MR Linac imaging between November 2017 and December 2023 completed a bespoke MR Linac Participant Experience Questionnaire, developed by the PRIMER study team and informed by MRI patient experience literature. The questionnaire assessed pre-scan anxiety, coping, willingness for future scans, and scan-related symptoms using Likert-scale responses. Descriptive analyses summarised responses by participant group and anatomical site. RESULTS: In total, 447 participants (319 patients; 128 non-patient volunteers) completed MR Linac imaging and the questionnaire. Overall tolerability was high, with 65 % strongly disagreeing they felt anxious prior to scanning and most participants reporting good coping ability. Variability was observed across anatomical sites: Participants undergoing head and neck, brain, and oligometastatic bone scans reported higher pre-scan anxiety, with coping difficulties most frequently reported by the head and neck group. Non-patient volunteers reported more physiological symptoms (e.g., sweating, nausea, dizziness) than patients, whereas patients undergoing head and neck and bone oligometastases scans were more reluctant to repeat the procedure. Most patients perceived MR Linac imaging as easier or comparable to diagnostic MRI, though 20 % of brain cancer patients found it more difficult. CONCLUSION: MR Linac imaging is generally well tolerated, though specific subgroups, particularly those requiring immobilisation, report greater anxiety and discomfort. These findings highlight the need for tailored strategies to improve patient experience, supporting wider implementation of MRIgRT
The proton therapy research beamline at The Christie NHS Foundation Trust
No full textProton therapy is a relatively new modality for cancer treatment and has several open research questions, particularly in the biological realm. Due to large infrastructure costs the modality is reserved for specialist treatment, limiting the patient outcome dataset. This requires supplementation with fundamental research throughin vitroandin vivosystems. Similarly, the safety and potential benefits of new treatments, such as FLASH, should be demonstrated in lab environments prior to clinical translation. Greater access to clinically relevant research platforms is required. This work presents the capabilities of the Manchester proton therapy research facility for experimentalists' assessment to meet their research goals. Details of the research beamline geometry are presented, along with workflows forin vitrosample irradiation within an automated sample handling environmental chamber. Absolute dose and dose depth of the proton research beamline was measured. The dose calibration across a range of energies and dose rates is presented and fits are mathematically described. Methods to convert measured, or planned, dose to sample dose are presented including for biological studies investigating end of proton range effects. Elements of the beam optics, impacting on spot size and therefore field homogeneity, were measured for sample irradiation and beam model development. A Monte Carlo beam model was established to predict physically difficult measurements and is compared to measurements throughout. Achievable dose rates for FLASH are presented alongside absolute dosimetric accuracy. There was a focus on radiobiological research in establishing the beamline. Special care was taken to develop high-throughput repeatablein vitroirradiation workflows, with an adjacent radiobiological lab for immediate processing. This will lead to a reduction in experimental uncertainties seen in the literature with demonstrated accurate dosimetry, tight environmental control, and a high degree of versatility. The infrastructure presented in this work is a unique facility in the UK
Preanalytical variables and analytes in liquid biopsy approach for brain tumors: a comprehensive review and recommendations from the RANO group and the brain liquid biopsy consortium
No full textThis review explores the pivotal role of preanalytical variables in bringing liquid biopsy approaches into the clinic for brain tumors. Preanalytical variables encompass a range of critical issues, from blood sample collection and handling to the impact of tumor heterogeneity and patient-specific factors. These variables introduce challenges such as false positives, false negatives, and variability in the analysis of tumor signals, which can hinder the diagnostic and prognostic utility of liquid biopsies. Understanding the nuances of preanalytical variables is essential for the successful implementation of liquid biopsy in clinical settings. This paper delves into strategies aimed at mitigating the influence of preanalytical variables by emphasizing the importance of standardized sample collection protocols, optimized sample processing and storage, quality control measures, and the integration of multiple liquid biopsy modalities
Radiological predictors of cognitive impairment in paediatric brain tumours using multiparametric magnetic resonance imaging: a review of current practice, challenges and future directions
No full textPaediatric brain tumours and their treatments are associated with long-term cognitive impairment. While the aetiology of cognitive impairment is complex and multifactorial, multiparametric Magnetic Resonance Imaging (MRI) can identify many risk factors including tumour location, damage to eloquent structures and tumour phenotype. Hydrocephalus and raised intracranial pressure can be observed, along with risk factors for post-operative paediatric cerebellar mutism syndrome or epilepsy. MRI can also identify complications of surgery or radiotherapy and monitor treatment response. Advanced imaging sequences provide valuable information about tumour and brain physiology, but clinical use is limited by extended scanning times and difficulties in processing and analysis. Brain eloquence classifications exist, but focus on adults with neurological deficits and are outdated. For the analysis of childhood tumours, limited numbers within tumour subgroups and the investigation of long-term outcomes necessitate using historical scans and/or multi-site collaboration. Variable imaging quality and differing acquisition parameters limit the use of segmentation algorithms and radiomic analysis. Harmonisation can standardise imaging in collaborative research, but can be challenging, while data-sharing produces further logistical challenges. Consequently, most research consists of small single-centre studies limited to regional analyses of tumour location. Technological advances reducing scanning times increase the feasibility of clinical acquisition of high-resolution standardised imaging including advanced physiological sequences. The RAPNO and SIOPE paediatric brain tumour imaging guidelines have improved image standardisation, which will benefit future collaborative imaging research. Modern machine learning techniques provide more nuanced approaches for integration and analysis of the complex and multifactorial data involved in cognitive outcome prediction
