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Sandler CX, Goldstein D, Horsfield S, Bennett BK, Friedlander M, Bastick PA, Lewis CR, Segelov E, Boyle FM, Chin MTM, Webber K, Barry BK, Lloyd AR. Randomized Evaluation of Cognitive-Behavioral Therapy and Graded Exercise Therapy for Post-Cancer Fatigue. J Pain Symptom Manage 2017; 54:74-84. [PMID: 28502786 DOI: 10.1016/j.jpainsymman.2017.03.015] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/24/2017] [Accepted: 03/22/2017] [Indexed: 12/13/2022]
Abstract
CONTEXT Cancer-related fatigue is prevalent and disabling. When persistent and unexplained, it is termed post-cancer fatigue (PCF). Cognitive behavioral therapy (CBT) and graded exercise therapy (GET) may improve symptoms and functional outcomes. OBJECTIVES To evaluate the outcomes of a randomized controlled trial, which assigned patients with post-cancer fatigue to education, or 12 weeks of integrated cognitive-behavioral therapy (CBT) and graded exercise therapy (GET). METHODS Three months after treatment for breast or colon cancer, eligible patients had clinically significant fatigue, no comorbid medical or psychiatric conditions that explained the fatigue, and no evidence of recurrence. The CBT/GET arm included individually tailored consultations at approximately two weekly intervals. The education arm included a single visit with clinicians describing the principles of CBT/GET and a booklet. The primary outcome was clinically significant improvement in self-reported fatigue (Somatic and Psychological HEalth REport 0-12), designated a priori as greater than one SD of improvement in fatigue score. The secondary outcome was associated improvement in function (role limitation due to physical health problems-36-Item Short Form Health Survey 0-100) comparing baseline, end treatment (12 weeks), and follow-up (24 weeks). RESULTS There were 46 patients enrolled, including 43 women (94%), with a mean age of 51 years. Fatigue severity improved in all subjects from a mean of 5.2 (±3.1) at baseline to 3.9 (±2.8) at 12 weeks, suggesting a natural history of improvement. Clinically significant improvement was observed in 7 of 22 subjects in the intervention group compared with 2 of 24 in the education group (P < 0.05, χ2). These subjects also had improvement in functional status compared with nonresponders (P < 0.01, t-test). CONCLUSION Combined CBT/GET improves fatigue and functional outcomes for a subset of patients with post-cancer fatigue. Further studies to improve the response rate and the magnitude of the benefit are warranted.
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Loke LPY, Chen TYT, Lewis CR, Ward RL, Rushton SA, Shapiro JD. Quality and impact of eviQ Cancer Treatments Online (www.eviq.org.au): the medical oncologist's perspective. Asia Pac J Clin Oncol 2017; 14:e203-e210. [PMID: 28547805 DOI: 10.1111/ajco.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 03/12/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION eviQ Cancer Treatments Online is a free, web-based resource providing access to over 600 evidence-based treatment protocols in medical oncology, radiation oncology, hematology and cancer genetics. With over 60 000 registrants from 148 countries, eviQ is widely used by cancer clinicians globally. The aim of this study was to examine the perceived quality of eviQ by Australian medical oncologists, the impact it had on their knowledge and practice, and the effect it had on their patients. METHODS A web-based survey was administered to members of the Medical Oncology Group of Australia by email. Two reminders emails were sent to encourage participation. RESULTS Of the 97 respondents (15%), all but one, were practicing in Australia, with varying years of oncology experience (<2 years: 25%, 2-10 years: 36%, >10 years: 39%). eviQ was most frequently used as a source for providing patient information sheets on chemotherapy side effects, with 57% of respondents using eviQ for this purpose. Other uses included accessing side effect information (27%), checking drug doses (26%) and guiding dose adjustments (22%). The majority of respondents rated eviQ as current, accurate and relevant with over 90% agreeing that eviQ was of a high quality. Most of the respondents reported that they provided better care with enhanced patient experiences as a result of using eviQ. CONCLUSIONS eviQ was highly regarded by Australian medical oncologists who responded to our survey. The results suggested that usage of eviQ had a positive impact on individual knowledge, practice and promoted better patient-centered care.
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Grimison PS, Stockler MR, Martin AJ, Buizen L, Lawrence NJ, Thomson DB, Gebski V, Friedlander M, Yeung A, Gurney H, Rosenthal M, Singhal N, Kichenadasse G, Wong SS, Lewis CR, Vasey PA, Toner GC. Long-term outcomes of accelerated BEP (bleomycin, etoposide, cisplatin) for advanced germ cell tumors: updated analysis of an Australian multicenter phase II trial. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e16056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Loke LPY, Chen TYT, Lewis CR, Ward RL, Rushton SA, Shapiro JD. Quality and impact of eviQ Cancer Treatments Online: The medical oncologist's perspective. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e18214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Davidson A, Veillard AS, Tognela A, Chan MMK, Hughes BGM, Boyer M, Briscoe K, Begbie S, Abdi E, Crombie C, Long J, Boyce A, Lewis CR, Varma S, Broad A, Muljadi N, Chinchen S, Espinoza D, Coskinas X, Pavlakis N, Millward M, Stockler MR. A phase III randomized trial of adding topical nitroglycerin to first-line chemotherapy for advanced nonsmall-cell lung cancer: the Australasian lung cancer trials group NITRO trial. Ann Oncol 2015; 26:2280-6. [PMID: 26347110 DOI: 10.1093/annonc/mdv373] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Accepted: 08/29/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We sought to determine whether the substantial benefits of topical nitroglycerin with first-line, platinum-based, doublet chemotherapy in advanced nonsmall-cell lung cancer (NSCLC) seen in a phase II trial could be corroborated in a rigorous, multicenter, phase III trial. PATIENTS AND METHODS Patients starting one of five, prespecified, platinum-based doublets as first-line chemotherapy for advanced NSCLC were randomly allocated treatment with or without nitroglycerin 25 mg patches for 2 days before, the day of, and 2 days after, each chemotherapy infusion. Progression-free survival (PFS) was the primary end point. RESULTS Accrual was stopped after the first interim analysis of 270 events. Chemotherapy was predominantly with carboplatin and gemcitabine (79%) or carboplatin and paclitaxel (18%). The final analysis included 345 events in 372 participants with a median follow-up of 33 months. Topical nitroglycerin had no demonstrable effect on PFS [median 5.0 versus 4.8 months, hazard ratio (HR) = 1.07, 95% confidence interval (CI) 0.86-1.32, P = 0.55], overall survival (median 11.0 versus 10.3 months, HR = 0.99, 95% CI 0.79-1.24, P = 0.94), or objective tumor response (31% versus 30%, relative risk = 1.03, 95% CI 0.82-1.29, P = 0.81). Headache, hypotension, syncope, diarrhea, dizziness, and anorexia were more frequent in those allocated nitroglycerin. CONCLUSION The addition of topical nitroglycerin to carboplatin-based, doublet chemotherapy in NSCLC had no demonstrable benefit and should not be used or pursued further. CLINICAL TRIALS NUMBER Australian New Zealand Clinical Trials Registry Number ACTRN12608000588392.
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Sandler C, Goldstein D, Horsfield S, Bennett BK, Friedlander M, Bastick PA, Lewis CR, Segelov E, Boyle FM, Chin MT, Barry BK, Webber K, Lloyd AR. TOPS: A randomised controlled trial of a multidisciplinary intervention for post-cancer fatigue. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Vardy JL, Bell M, van der Ploeg H, Turner J, Kabourakis M, Spencer L, Lewis CR, Hui R, Blinman PL, Clarke SJ, Boyer MJ, Dhillon HM. The impact of physical activity on fatigue and quality of life in lung cancer patients: A randomised controlled trial (RCT). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.9507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Park SB, Kwok JB, Loy CT, Friedlander ML, Lin CSY, Krishnan AV, Lewis CR, Kiernan MC. Paclitaxel-induced neuropathy: potential association of MAPT and GSK3B genotypes. BMC Cancer 2014; 14:993. [PMID: 25535399 PMCID: PMC4364586 DOI: 10.1186/1471-2407-14-993] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 12/16/2014] [Indexed: 02/07/2023] Open
Abstract
Background Paclitaxel treatment produces dose-limiting peripheral neurotoxicity, which adversely affects treatment and long-term outcomes. In the present study, the contribution of genetic polymorphisms to paclitaxel-induced neurotoxicity were assessed in 21 patients, focusing on polymorphisms involved in the tau-microtubule pathway, an important target of paclitaxel involved in neurotoxicity development. Methods Polymorphisms in the microtubule-associated protein tau (MAPT) gene (haplotype 1 and rs242557 polymorphism) and the glycogen synthase kinase-3β (GSK3β) gene (rs6438552 polymorphism) were investigated. Neurotoxicity was assessed using neuropathy grading scales, neurophysiological studies and patient questionnaires. Results A significant relationship between the GSK-3B rs6438552 polymorphism and paclitaxel-induced neurotoxicity was evident. Conclusions Polymorphisms in tau-associated genes may contribute to the development of paclitaxel-induced neurotoxicity, although larger series will be necessary to confirm these findings.
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Grimison PS, Stockler MR, Chatfield M, Thomson DB, Gebski V, Friedlander M, Boland AL, Houghton B, Gurney H, Rosenthal M, Singhal N, Kichenadasse G, Wong SS, Lewis CR, Vasey PA, Toner GC. Accelerated BEP for metastatic germ cell tumours: a multicenter phase II trial by the Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP). Ann Oncol 2014; 25:143-8. [PMID: 24356625 DOI: 10.1093/annonc/mdt369] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This Australian single-arm, multicenter, phase II trial evaluated feasibility, tolerability and activity of accelerated bleomycin, etoposide and cisplatin (BEP) as first-line chemotherapy for metastatic germ cell tumours. PATIENTS AND METHODS Patients were planned to receive cisplatin 20 mg/m(2) and etoposide 100 mg/m(2) days 1-5, and pegfilgrastim 6 mg day 6, all repeated every 2 weeks for four cycles (three cycles for good prognosis). Bleomycin was given at 30 000 IU weekly to a total of 12 doses (9 doses for good prognosis). Primary end point was feasibility, defined as the proportion of patients able to complete the etoposide and cisplatin components of BEP and be eligible to receive a fourth cycle of BEP by day 50. RESULTS Twelve poor, 16 intermediate and 15 good prognosis (n = 43) eligible patients were enrolled. Two patients aged >40 years were ineligible and excluded from analyses. The regimen was feasible in 86%, not feasible in 7% and not assessable in 7% of patients. Most common grade 3/4 adverse events were non-neutropenic infection (16%) and febrile neutropenia (12%). Complete response (CR) to chemotherapy and surgery was achieved in 33% poor-prognosis, 81% intermediate-prognosis and 100% good-prognosis patients. At median follow-up of 27 months (range 6-42), the 2-year progression-free survival was 50% for poor-prognosis, 94% for intermediate-prognosis and 92% for good-prognosis patients. CONCLUSION Accelerated BEP is feasible and tolerable. Efficacy data appear to be promising. This trial and a similar UK study provide the rationale for a randomised trial comparing accelerated versus standard BEP. Australian New Zealand Clinical Trials Registry Registration number. ACTRN 12607000294459.
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Aidukaitis, CNA L, Allensworth JL, Andallu B, Aqil F, Arora V, Aziz, MD K, Baba Y, Bae YJ, Baveja A, Bisoffi M, Burky R, Bynum D, Calaf GM, Canuto, MD RA, Catalano, MD MG, Chakraborty K, Chen YC, Chen RJ, Chi CW, Chopra K, Coccia R, Cohen J, Cruz A, Das S, Datta P, Del Bo’ C, Devi GR, Evans, MD MK, Fadda M, Fajardo AM, Farias-Eisner R, Finocchiaro C, Foppoli C, Georgakilas AG, Gilaberte Y, Gonzalez S, Goya L, Gupta RC, Hamilton C, Hatzi VI, Hayashi S, Hummel C, Jeyabalan J, Joshi T, Joshua Loke WS, Juarranz A, Kang D, Khuda-Bukhsh AR, Krishnan K, Kuhad A, Lee SA, Lewis CR, Lim MY, Liu P, Maggiora M, Martin OA, Martín MA, Mehrotra S, Munagala R, Muzio G, Naito S, Nakajo M, Nishizawa T, Nowsheen S, O’Neill K, Olas B, Parrado C, Perluigi M, Philips N, Pramanik KC, Rajeshwari C, Ramos S, Ramsauer VP, Riso P, Robison R, Sachdeva AK, Saha SK, Sauer SJ, Schena M, Shiota M, Shobha R, Singh IP, Singh P, Siomyk H, Siva S, Sonoda S, Srivastava SK, Stone W, Sung MK, Sung MT, Suzuki H, Thomas PS, Tosuji N, Vendrame S, Wang YJ, White M, Yokomizo A. List of Contributors. Cancer 2014. [DOI: 10.1016/b978-0-12-405205-5.01002-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Young MA, Herlihy A, Mitchell G, Thomas DM, Ballinger M, Tucker K, Lewis CR, Neuhaus S, Halliday J. The attitudes of people with sarcoma and their family towards genomics and incidental information arising from genetic research. Clin Sarcoma Res 2013; 3:11. [PMID: 23898988 PMCID: PMC3751730 DOI: 10.1186/2045-3329-3-11] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/16/2013] [Indexed: 01/24/2023] Open
Abstract
Purpose The study aimed to examine attitudes of individuals diagnosed with sarcoma and their family members towards genetics, genomic research and incidental information arising as a result of participating in genetic research. Methods A questionnaire was administered to 1200 individuals from the International Sarcoma Kindred Study (ISKS). Respondents were divided into three groups: individuals affected with sarcoma (probands), their spouses and family members. Results Approximately half of all research participants felt positively towards new discoveries in human genetics. Overall, more were positive in their attitudes towards genetic testing for inherited conditions (60%) but family members were less so. Older participants reported more highly positive attitudes more often than younger participants. Males were less likely to feel positive about new genetic discoveries and more likely to believe they could modify genetic risk by altering lifestyle factors. Almost all ISKS participants believed participants would like to be given ancillary information arising as a result of participating in genetic research. Conclusions The only difference between the study groups was the decreased likelihood of family members being highly positive about genetic testing. This may be important if predictive testing for sarcoma becomes available. Generally ISKS research participants supported the notion of returning incidental genetic information to research participants.
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Lewis CR, Smith R, Matthews A, Choo E, Lee C. Abstract PD04-03: Is breast conservation therapy an option for young women with operable breast cancer? Local recurrence rates in young women following surgery: a single centre experience. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-pd04-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer (BC) is less common in young women (defined here as ≤ 40 years age), but is associated with more aggressive biological features, higher risk of local recurrence (LR) and poorer overall survival. This study examines and compares the incidence of LR following breast conservation therapy (BCT) versus mastectomy in women with operable BC treated at our centre.
Methods: The POWCC breast cancer database was retrospectively reviewed for the period January 1995 to December 2008. 2250 eligible women with BC undergoing primary breast surgery were identified. LR rate was compared between young women and older women (age > 40 years), and according to type of surgery. Data were analysed using a competing risk Cox model to account for distant recurrence and death as competing events for local recurrence.
Results: Median follow-up was 70 months. Of 2250 women, 246 (11%) were young women, and the mastectomy rate was 49.2%. In older women (89%), mastectomy rate was 41.7%. LR occurred in 17 (6.9%) and 57 (2.8%) in young and older women respectively (p = 0.001). Amongst the young women, 12 (9.6%) and 5 (4.1%) patients recurred locally in BCT and mastectomy respectively (p = 0.09). Amongst the older women, 43 (3.7%) and 14 (1.7%) patients recurred locally in BCT and mastectomy respectively (p = 0.008). In univariate Cox analysis, significant risk factors for LR were BCT (p = 0.003), positive surgical margins (p = 0.03), age ≤ 40 years (p = 0.001), premenopausal status (p = 0.003) and no adjuvant systemic therapy (0.02). Age remains a significant predictor of LR in multivariate Cox analysis (Table). There was no significant interaction between age and type of surgery on LR (p = 0.72).
Discussion: Our results demonstrate that young women who undergo BCT have the highest risk of early LR. Adjuvant systemic therapy is protective of early LR. This study is hypothesis-generating and a definitive prospective clinical trial is required to better determine the optimal type of breast surgery in young women.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PD04-03.
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Chan E, Sivagnanam T, Zhang Q, Lewis CR, Thomas PS. Tumour Necrosis Factor Alpha and Oxidative Stress in the Breath Condensate of Those with Non-Small Cell Lung Cancer. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jct.2012.324059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cheng Z, Lewis CR, Thomas PS, Raftery MJ. Comparative Proteomics Analysis of Exhaled Breath Condensate in Lung Cancer Patients. ACTA ACUST UNITED AC 2011. [DOI: 10.4236/jct.2011.21001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Park SB, Lin CSY, Krishnan AV, Friedlander ML, Lewis CR, Kiernan MC. Early, progressive, and sustained dysfunction of sensory axons underlies paclitaxel-induced neuropathy. Muscle Nerve 2010; 43:367-74. [PMID: 21321953 DOI: 10.1002/mus.21874] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2010] [Indexed: 11/09/2022]
Abstract
Paclitaxel is used in the adjuvant treatment of breast cancer. It induces disabling and potentially long-lasting sensory neuropathy. This study systematically and prospectively investigated sensory function, using clinical grading scales, quantitative sensory testing, and neurophysiological and nerve excitability studies in 28 patients with early-stage breast cancer. After administration of 529 ± 41 mg/m(2) paclitaxel, 71% of patients developed neuropathic symptoms by 6 weeks of treatment. Early and progressive increases in stimulus threshold (P < 0.05) and reduction in sensory amplitudes from 47.0 ± 3.3 μV to 42.4 ± 3.4 μV (P < 0.05) occurred by 4 weeks, with a further reduction by final treatment (33.7 ± 3.0 μV, P < 0.001). The majority of patients (63%) did not experience recovery of neuropathic symptoms at follow-up. Axonal disruption did not relate to membrane conductance dysfunction. We found that paclitaxel produces early sensory dysfunction and leads to persistent neuropathy. Importantly, significant axonal dysfunction within the first month of treatment predated symptom onset, suggesting a window for neuroprotective therapies.
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Grimison PS, Stockler MR, Thomson DB, Olver IN, Harvey VJ, Gebski VJ, Lewis CR, Levi JA, Boyer MJ, Gurney H, Craft P, Boland AL, Simes RJ, Toner GC. Comparison of Two Standard Chemotherapy Regimens for Good-Prognosis Germ Cell Tumors: Updated Analysis of a Randomized Trial. ACTA ACUST UNITED AC 2010; 102:1253-62. [DOI: 10.1093/jnci/djq245] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Toohey JM, Ismail K, Lonergan D, Lewis CR. Amyloidosis of the breast mimicking recurrence in a previously treated early breast cancer. ACTA ACUST UNITED AC 2008; 51:594-6. [PMID: 17958699 DOI: 10.1111/j.1440-1673.2007.01700.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Amyloid involvement of the breast is infrequently reported and may have clinical and radiological features suspicious for a primary breast malignancy. We describe a case of amyloid of the breast in which asymptomatic mammographic findings were suspicious for locally recurrent disease in a patient with previously treated breast cancer.
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Mai GT, Choo E, Yang JL, Cooke B, Dumitru D, Lonergan D, Lewis CR. Regional radiotherapy may improve outcomes in patients with early stage breast cancer undergoing breast conservation therapy. Anticancer Res 2007; 27:647-52. [PMID: 17348455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Breast conservation therapy (BCT) is recommended as standard management of early breast cancer. The aim of this study was to retrospectively evaluate the results of BCT to identify prognostic factors predictive of treatment outcomes. PATIENTS AND METHODS Four hundred and ninety-eight eligible women with unilateral stage I-II breast cancer who had undergone BCT were analyzed. RESULTS The cumulative incidence of local recurrence (LR) was 1.9% and 3.7% at 3- and 5-years respectively. The 5-year disease-free, cancer-specific, and overall survival (DFS, CSS, OS) were 80.0%, 87.3% and 85.4% respectively. Significant independent predictors for LR included young age and absence of chemotherapy. Regional nodal radiotherapy was significantly associated with improved DFS and OS. CONCLUSION Our results confirmed the efficacy of BCT in the treatment of early breast cancer and indicated that inclusion of regional nodal areas within the radiotherapy field might be beneficial in the BCT setting, particularly for patients with adverse risk features.
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Grulich AE, Wan X, Law MG, Milliken ST, Lewis CR, Garsia RJ, Gold J, Finlayson RJ, Cooper DA, Kaldor JM. B-cell stimulation and prolonged immune deficiency are risk factors for non-Hodgkin's lymphoma in people with AIDS. AIDS 2000; 14:133-40. [PMID: 10708283 DOI: 10.1097/00002030-200001280-00008] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To identify risk factors for non-Hodgkin's lymphoma (NHL) in people with HIV infection. DESIGN AND SETTING Case-control study in Sydney, Australia. PARTICIPANTS AND METHODS Two hundred and nineteen patients with AIDS-related NHL were compared with 219 HIV-infected controls without NHL, matched for CD4 positive cell count and date of specimen collection. Data on demographic, infectious, treatment-related and immunological factors were abstracted by medical record review. The association between demographic factors, sexually transmissible diseases, HIV-related opportunistic infections, anti-viral therapy, duration of immune deficiency and indices of immune stimulation and risk of NHL were derived for these groups. RESULTS In a multivariate model, there were two independent groups of predictors of NHL risk. The first was duration of immunodeficiency, as measured by longer time since seroconversion (P for trend 0.008), and lower CD4 positive cell count 1 year prior to the time of NHL diagnosis (P for trend 0.009). The second predictor was B-cell stimulation, as indicated by higher serum globulin (a surrogate marker for serum immunoglobulin, P for trend 0.044) and HIV p24 antigenaemia [odds ratio (OR) for p24 positivity, 1.82; 95% confidence interval (CI), 1.15-2.88]. Indices of B-cell stimulation preceded the diagnosis of NHL by several years. Factors not related to NHL risk included clinical indices of Epstein-Barr virus infection and receipt of individual nucleoside analogue antiretroviral agents. Combination therapy with these agents was associated with a non-significant reduction in NHL risk (OR, 0.68; 95% CI, 0.39-1.18). CONCLUSIONS Markers of long-standing immune deficiency and B-cell stimulation were associated with an increased risk of developing NHL. Unless the strongest risk factor for NHL, immune deficiency, can be reversed, NHL is likely to become proportionately more important as a cause of morbidity and mortality in people with HIV infection.
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Lewis CR, Wheatley SE. The beginnings of middle class suburbanization in a small town: a case study of Aberystwyth, c. 1870-1930. CYLCHGRAWN LLYFRGELL GENEDLAETHOL CYMRU. THE NATIONAL LIBRARY OF WALES JOURNAL. NATIONAL LIBRARY OF WALES 1999; 31:45-64. [PMID: 22103012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Lewis CR, Russell RR. Chromosomal deletions in Streptococcus mutans. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 1997; 418:677-9. [PMID: 9331742 DOI: 10.1007/978-1-4899-1825-3_158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Kaye SB, Paul J, Cassidy J, Lewis CR, Duncan ID, Gordon HK, Kitchener HC, Cruickshank DJ, Atkinson RJ, Soukop M, Rankin EM, Davis JA, Reed NS, Crawford SM, MacLean A, Parkin D, Sarkar TK, Kennedy J, Symonds RP. Mature results of a randomized trial of two doses of cisplatin for the treatment of ovarian cancer. Scottish Gynecology Cancer Trials Group. J Clin Oncol 1996; 14:2113-9. [PMID: 8683244 DOI: 10.1200/jco.1996.14.7.2113] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE In 1992, we reported the first results of a randomized study in ovarian cancer, comprising two doses of cisplatin and indicated a significant difference (P = .0008) in median survival. Four years later, we now describe the results of this trial. PATIENTS AND METHODS After a median follow-up of 4 years and 9 months, 115 of 159 cases of advanced ovarian cancer, originally randomized to receive six cycles of cyclophosphamide 750 mg/m2 and either a high dose (HD) of 100 mg/m2 cisplatin or a low dose (LD) of 50 mg/m2 (LD) cisplatin, have now died. RESULTS The overall survival for HD and LD patients is 32.4% and 26.6%, respectively, and the overall relative death rate is 0.68 (P = .043). This represents a reduction in overall benefit with longer follow-up compared with the first 2 years (relative death rate of 0.52). Toxicity, particularly neurotoxicity, is still evident in the fourth year (10/31 on HD compared with 1/24 on LD). CONCLUSION Our recommended dose of cisplatin in combination schedule is therefore 75 mg/m2, representing the optimal balance between efficacy and toxicity.
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Lewis CR, Somerville C, Agar JW. Omeprazole induced acute interstitial nephritis. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1994; 24:578. [PMID: 7848166 DOI: 10.1111/j.1445-5994.1994.tb01765.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Lewis CR, Segelov E, Goldstein D, Friedlander ML. Chemotherapy made easier. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1993; 23:387-92. [PMID: 8240152 DOI: 10.1111/j.1445-5994.1993.tb01440.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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