The Christie School of Oncology: Christie Research Publications Repository
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Perspectives on prehabilitation for older adults with cancer: A report from the International Society of Geriatric Oncology (SIOG) rehabilitation group
No full textKEYMAKER-U03 Substudy 03B: Pembrolizumab (pembro) and targeted therapy combinations for advanced clear cell renal cell carcinoma (ccRCC)
No full textClinical workflow for reirradiation: national consensus recommendations on imaging, treatment planning, dose accumulation, and treatment delivery
No full textBACKGROUND AND PURPOSE: Reirradiation is becoming more frequent in clinical practice. However, workflows and practices vary widely between clinics, as general guidelines are scarce or lacking in practical detail. This paper presents comprehensive national Danish consensus recommendations covering all steps of the reirradiation workflow. The aim is to standardise and improve reirradiation treatment quality and provide guidance for much-needed large-scale clinical trials. METHODS: An expert panel was formed comprising physicians, clinical physicists, and clinical researchers from all Danish radiotherapy centres. An in-person 2-day workshop was followed by multiple online meetings. Recommendations were based on expert consensus, supported by review of existing literature, and were reviewed by all Danish Multidisciplinary Cancer Groups before publication. RESULTS: Reirradiation cases should be designated clearly as such at each workflow step. Review of patient cases at multidisciplinary reirradiation conferences is encouraged. Immobilisation, positioning, and motion management should resemble that of previous treatment(s) as closely as possible. Information on previous dose should be used in planning and evaluation. The degree of complexity (e.g. summation of dose maxima, rigid/deformable image registration, 3D dose accumulation) should reflect the clinical situation as well as the extent/quality of available information. Dose should always be converted to an equieffective dose before summation. Daily image-guidance and regular evaluation of delivered dose are recommended. We provide guidance on quality assurance of dose mapping and guidelines for clinical reirradiation trials. INTERPRETATION: We present national consensus guidelines for site-independent reirradiation treatment workflows. The guidelines have been approved by the site-specific Danish Multidisciplinary Cancer Groups
AI-Assisted Detection of Sentinel Lymph Node Metastasis in Penile Squamous Cell Carcinoma: Reducing Immunostaining Dependence
No full textThe impact of intermittent energy restriction on women's health
No full textIntermittent energy-restricted diets are used amongst women with overweight and obesity and a healthy weight. For those with overweight and obesity weight control is typically achieved through daily energy restriction (DER) which has reduced adherence and attenuated metabolic benefits over time. Several intermittent energy restriction (IER) regimens have been developed aiming to promote maintained weight loss and additional weight independent metabolic benefits including the 5:2 diet, alternate day fasting (ADF) and time-restricted eating (TRE). This review summarises the potential benefits or harms of these regimens for managing women’s health. 5:2 and ADF diets have equivalent long term (≥ 6-month) adherence, weight loss and metabolic benefits to DER. Current limited evidence suggests IER is a safe weight loss intervention for women which does not affect reproductive or bone health, increase eating disorders or disturb sleep. Adherence and weight loss with both IER and DER are lower amongst younger women compared to older women and men. Weight loss with ADF and TRE has, respectively, improved symptoms of polycystic ovarian syndrome and premenstrual syndrome, but there is no evidence of weight-independent effects of IER on these conditions. There is little evidence of the benefits and/or harms of IER amongst healthy weight women in whom there is a greater potential for adverse effects on reproductive and bone health, fat free mass, eating disorders and sleep. Further research benefits of IER for weight control and metabolic health as well as harms are required
Transdermal oestradiol (tE2) patches as androgen deprivation therapy (ADT): efficacy and safety of combining with androgen receptor pathway inhibitors (ARPIs) in metastatic (M1) prostate cancer-randomised comparison from the STAMPEDE trial platform
No full textInteraction of genetic drivers and dose surface mapping for rectal toxicity following prostate cancer radiotherapy
No full textIndividualised dose mapping uncertainty estimation in the reirradiation setting
No full textBackground and purpose: Deformable image registration (DIR) allows assessing radiation doses of previous treatment courses in reirradiation planning scans. However, DIR can introduce uncertainties in dose mapping. Estimating these uncertainties for individual patients remains a key challenge. We developed an individualised approach to estimate uncertainties in dose mapping using a commercially available treatment planning system. Materials and methods: For 54 patients who underwent reirradiation (27 head and neck, H&N, and 27 lung cases), we performed 16 DIRs per patient. We assessed each DIR geometrically using the mean distance to agreement (mDTA) between mapped contours and the corresponding structures of 30 to 34 organs at risk (OARs). We then estimated dose mapping uncertainties for structures where DIR resulted in plausible registrations, defined as mDTA <= 0.3 cm. We calculated the uncertainty of dose-volume-histogram estimates (mean and D0.1 cm3) and voxel-wise uncertainties using standard deviation (SD). We also tested the impact of using fewer registrations. Results: DIR resulted in plausible mappings for both patient cohorts' OARs, ranging between 78.6 % and 88.2 %, varying between patients and OARs. Mean dose uncertainties ranged between 0 Gy and 0.43 Gy, while larger differences were observed for D0.1 cm3, between 0 Gy and 0.78 Gy. As expected, large voxel-wise uncertainties were in regions of steep dose gradients. Performance between registration sets was similar. Conclusion: We developed a method to estimate dose mapping uncertainties with integrated quality control for reirradiation. Differences between patients were observed, justifying the need for individualised DIR assessment. Few registrations were a pragmatic approach
LAsting Symptoms after Oesophageal Resectional Surgery (LASORS): multicentre validation cohort study
No full textBACKGROUND: Long-term symptom burden and health-related quality-of-life outcomes after curative oesophageal cancer treatment are poorly understood. Existing tools are cumbersome and do not address the post-treatment population specifically. The aim of this study was to validate the six-symptom LASORS tool for identifying patients after curative oesophageal cancer treatment with poor health-related quality of life and to assess its clinical utility. METHODS: Between 2015 and 2019, patients from 15 UK centres who underwent curative-intent oesophageal cancer treatment, and were disease-free at least 1 year after surgery, were invited to participate in the study and complete LASORS and European Organisation for Research and Treatment of Cancer QLQ-C30 and QLQ-OG25 questionnaires. Receiver operating characteristic curve analysis was used to examine the accuracy of the LASORS tool for identifying patients with poor health-related quality of life. RESULTS: A total of 263 patients completed the questionnaire. Four of the six LASORS symptoms were associated with poor health-related quality of life: reduced energy (OR 2.13 (95% c.i. 1.45 to 3.13)); low mood (OR 1.86 (95% c.i. 1.20 to 2.88)); diarrhoea more than three times a day unrelated to eating (OR 1.48 (95% c.i. 1.06 to 2.07)); and bloating or cramping after eating (OR 1.35 (95% c.i. 1.03 to 1.77)). The LASORS tool showed good diagnostic accuracy with an area under the receiver operating characteristic curve of 0.858 for identifying patients with poor health-related quality of life. CONCLUSION: The six-symptom LASORS tool generated a reliable model for identification of patients with poor health-related quality of life after curative treatment for oesophageal cancer. This is the first tool of its kind to be prospectively validated in the post-esophagectomy population. Clinical utility lies in identification of patients at risk of poor health-related quality of life, ease of use of the tool, and in planning survivorship services
