The Christie School of Oncology: Christie Research Publications Repository
Not a member yet
16373 research outputs found
Sort by
Patient experience sub-study of a randomised UK multicentre Phase 2 trial of ASTX727 versus hydroxycarbamide/best supportive care in myelodysplastic (MDS)/myeloproliferative (MPN) overlap syndromes (AMMO)
No full text
Refining Risk Stratification of High-risk and Locoregional Prostate Cancer: A Pooled Analysis of Randomized Trials
No full textBackground and objective: Radiotherapy (RT) and long-term androgen deprivation therapy (ltADT; 18-36 mo) is a standard of care in the treatment of high-risk localized/locoregional prostate cancer (HRLPC). We evaluated the outcomes in patients treated with RT + ltADT to identify which patients have poorer prognosis with standard therapy. Methods: Individual patient data from patients with HRLPC (as defined by any of the following three risk factors [RFs] in the context of cN0 disease-Gleason score >= 8, cT3-4, and prostate-specific antigen [PSA] >20 ng/ml, or cN1 disease) treated with RT and ltADT in randomized controlled trials collated by the Intermediate Clinical Endpoints in Cancer of the Prostate group. The outcome measures of interest were metastasis- free survival (MFS), overall survival (OS), time to metastasis, and prostate cancer- specific mortality. Multivariable Cox and Fine-Gray regression estimated hazard ratios (HRs) for the three RFs and cN1 disease. Key findings and limitations: A total of 3604 patients from ten trials were evaluated, with a median PSA value of 24 ng/ml. Gleason score >= 8 (MFS HR = 1.45; OS HR = 1.42), cN1 disease (MFS HR = 1.86; OS HR = 1.77), cT3-4 disease (MFS HR = 1.28; OS HR = 1.22), and PSA >20 ng/ml (MFS HR = 1.30; OS HR = 1.21) were associated with poorer outcomes. Adjusted 5-yr MFS rates were 83% and 78%, and 10-yr MFS rates were 63% and 53% for patients with one and two to three RFs, respectively; corresponding 10-yr adjusted OS rates were 67% and 60%, respectively. In cN1 patients, adjusted 5- and 10-yr MFS rates were 67% and 36%, respectively, and 10-yr OS was 47%. Conclusions and clinical implications: HRLPC patients with two to three RFs (and cN0) or cN1 disease had the poorest outcomes on RT and ltADT. This will help in counseling patients treated in routine practice and in guiding adjuvant trials in HRLPC. Patient summary: Radiotherapy and long-term hormone therapy are standard treatments for high-risk and locoregional prostate cancer. In this report, we defined prognostic groups within high-risk/locoregional prostate cancer and showed that outcomes to standard therapy are poorest in those with two or more 'high-risk'factors or evidence of lymph node involvement. Such patients may therefore be the best candidates for intensification of treatment. (c) 2024 European Association of Urology. Published by Elsevier B.V. All rights are reserved, including those for text and data mining, AI training, and similar technologies
Incidental findings in volunteer imaging used to develop radiotherapy MRI workflows
No full textINTRODUCTION/BACKGROUND: Healthy volunteer imaging is integral to optimising sequences for use in a treatment planning pathway to ensure they are fit for purpose. Although initial imaging may not be optimal quality, it may still be possible to identify abnormalities. METHODS: All healthy volunteer participants recruited to approved studies aimed at optimising MRI sequences for use in radiotherapy at our institution were included. Participants were imaged on either an MR Sim (Philips Ingenia, Best, Netherlands) or MR Linac system (Unity, Elekta, Sweden), or both and each imaging time point was analysed separately. RESULTS: 145 participants underwent 258 imaging sessions. Incidental findings were identified in 31 (21.3 %) participants. 96 participants were female and median age 29 years (range 22-59). Imaging was reviewed by one of four radiologists and findings categorised in terms of clinical significance. In eleven cases, onward referral was recommended: Three defined as potentially serious. Seven had a documented consultation informing participants of report findings, and actions taken. Positive predictive value was 45 % and negative predictive value 100 %. There was no difference in number of findings between imaging system (p = 0.15). DISCUSSION: Rate of incidental findings compares favourably with the literature. This rate cannot be ignored, and radiotherapy services should be aware of the need to develop, and audit, procedures that appropriately manage findings. CONCLUSION: MRI scanners are not routinely managed by radiotherapy services. Potentially significant findings are seen in around 4 % of healthy volunteers and the procedures around managing findings may be new to radiotherapy services
Barriers to cervical screening and the potential for self-sampling methods in people from ethnically diverse backgrounds living in the UK
No full textA case report of continuous glucose monitoring for a radiographer working in a 1.5T MR Linac
No full textINTRODUCTION: This case report details the first in-vivo use of continuous glucose monitoring (CGM) technology by a therapeutic radiographer working in magnetic resonance image (MRI) guided radiotherapy with type 1 diabetes (T1D) at our institution. As adoption rates of this device increase, understanding how they perform in MR environments is important for staff working in MR specific roles. CASE AND OUTCOMES: For a single member of an MRI guided radiotherapy team with type I diabetes, daily CGM readings in mmol/L were recorded for 4 months when working in all areas of an Elekta Unity MR Linac (Elekta AB, Sweden). These measurements were compared to the mean daily self-monitoring blood glucose (SMBG) readings taken at 2-hour intervals whilst in work over a 4-month testing period. A cloud-based diabetes management system demonstrated successful data transmission as 96% of BG readings had been received from the CGM across all areas of working. A Pearson correlation coefficient of CGM and SMBG readings showed a positive correlation (r = 0.70) and a paired T-Test indicated no significant differences (p = 0.63), indicating CGM reliability in this MR Linac environments across 122 days of testing. CONCLUSION: This case highlights the feasibility and safety of using the Freestyle Libre 2 CGM (FreeStyle Libre 2, Abbott Diabetes Care) for an individual with T1D working in an MR Linac. The data presented here is specific to this scenario and serves as informative guidance for healthcare professionals. Further research and standardisation efforts are needed to enhance the compatibility of non-invasive CGMs in MRI environments
Risk stratified treatment for childhood acute lymphoblastic leukaemia: a multicentre observational study from India
No full textBACKGROUND: Overall survival rates of children with acute lymphoblastic leukaemia (ALL) in high-income countries approach 90%. Treated on the same protocols, outcomes in India, were ∼65%. METHODS: The Indian Childhood Collaborative Leukaemia (ICiCLe) group used genetics and measurable residual disease (MRD) to categorise B-cell precursor (BCP) ALL as standard (SR), intermediate (IR) and high-risk (HR) to receive increasing intensity of therapy. T-ALL were treated uniformly. Data on risk stratification, deaths and relapses were collected annually. FINDINGS: 2695 patients aged 1-18 years were enrolled between January 2013 and May 2018. Induction deaths were significantly lower in SR patients (p = 0·002) compared to others. At a median 61 (59-62) months, the 4-year event free and overall survival was 76% (72-79%) and 88% (85-90%) in SR; 70% (66-74%) and 80% (77-83%) in IR; 61% (51-64%) and 73% (70-76%) in HR; and 69% (62-75%) and 77% (70-83%) in T-ALL patients (p < 0·0001). For BCP-ALL, regression analyses showed age, white cell count, bulky disease, high risk genetics and treating centre as independent prognostic variables. The cumulative incidence of treatment deaths (TRD) and relapses at centres varied from 2% (1-5) to 13% (10-17) (p ≤ 0·0001); and 21% (17-26) to 45% (39-51) (p ≤ 0·0001) respectively with significant differences in proportion of BCP-ALL patients with MRD ≥ 0·01% (p = 0·0007) and time to relapse (p = 0·0001). INTERPRETATION: Risk stratified directed reduced intensity treatment and collaboration decreases treatment deaths and relapses. Standardisation of genetic and MRD tests across centres and access to high quality drugs will lead to further improvements in survival. FUNDING: DBT-Wellcome; UKIERI, TCS Foundation
The role of CNNM4 in the progression of cholangiocarcinoma: implications for ferroptosis and therapeutic potential
No full textArtificial intelligence in breast cancer radiotherapy: Insights from the Toolbox Consortium Delphi study
No full textArtificial intelligence (AI) is being incorporated in several breast cancer care domains, including for radiation therapy (RT). Herein we provide a review about AI for the management and planning of RT for breast cancer, which is part of the Toolbox-3 project's multidisciplinary Delphi study, including a literature review of studies related to the topic raised by the Delphi questionnaire. Our review shows that available evidence mainly consists of small single institutional studies, often at least partly supported by commercial companies. Current studies suffer from a lack of transparency regarding how these systems were developed, the information they are based on, the algorithms used, and potential proprietary issues. This review provides a critical inter- and multidisciplinary assessment of existing systems to help us in guiding development and utilisation of AI-based tools in the field of radiation oncology. As medical professional users, we must remain vigilant and continue to improve our personal experience and knowledge that serves as the 'ground truth'. Employing AI required a critical mindset, particularly in medical applications which may influence the lives of our patients
