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Hussain S, Ansari J, Huddart R, Power D, Lyons J, Wylie J, Vilarino-Varela M, Elander N, McMenemin R, Pickering L, Faust G, Chauhan S, Jakson R. VICTOR: Vinflunine in advanced metastatic transitional cell carcinoma of the urothelium (TCCU): a retrospective analysis of the use of vinflunine in multi-centre real life setting as second line chemotherapy through free of charge programme (FOCP) for patients in the UK and Ireland. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw373.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Thompson A, Adamson A, Bahl A, Borwell J, Dodds D, Heath C, Huddart R, Mcmenemin R, Patel P, Peters J, Payne H. Guidelines for the diagnosis, prevention and management of chemical- and radiation-induced cystitis. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415813512647] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective Haemorrhagic cystitis (HC) is a relatively common complication of chemotherapy and radiotherapy to the pelvic area, but can be a challenging condition to treat, particularly since there is currently a lack of UK-led guidelines available on how it should optimally be defined and managed. Materials and methods A comprehensive literature search was undertaken to evaluate the evidence for the diagnosis, prevention and management of cancer treatment-induced HC. Results Recommendations and a proposed management algorithm for the diagnosis, prevention and treatment of HC, as well as the management of intractable haematuria, have been developed based on the expert opinion of the multidisciplinary consensus panel following a comprehensive review of the available clinical data. Conclusion These guidelines are relevant and applicable to current clinical practice and will help clinicians optimally define and manage this potentially serious condition.
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Hafeez S, Horwich A, Omar O, Mohammed K, Thompson A, Kumar P, Khoo V, Van As N, Eeles R, Dearnaley D, Huddart R. Selective organ preservation with neo-adjuvant chemotherapy for the treatment of muscle invasive transitional cell carcinoma of the bladder. Br J Cancer 2016; 114:e24. [PMID: 27228294 PMCID: PMC4984461 DOI: 10.1038/bjc.2016.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Hussain S, Jackson R, Chauhan S, Ansari J, Huddart R, Harrold E, Power D, Lyons J, Wylie J, Vilarino-Varela M, Wilkinson D, McMenemin R, Pickering L, Faust G. 2632 VICTOR: Vinflunine in advanced metastatic transitional cell carcinoma of the urothelium (TCCU): A retrospective analysis of the use of Vinflunine in a multi-centre real life setting as second line chemotherapy through the free of charge programme (FOCP) for patients in the UK. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31449-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carducci M, Armstrong A, Pili R, Ng S, Huddart R, Agarwal N, Khvorostenko D, Lyulko O, Brize A, Vogelzang N, Delva R, Harza M, Thanos A, James N, Werbrouck P, Bögemann M, Hutson T, Milecki P, Nederman T, Sternberg C. 4BA A phase 3, randomized, double-blind, placebo-controlled study of tasquinimod (TASQ) in men with metastatic castrate resistant prostate cancer (mCRPC). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Huddart R, Porta N, Lewis R, Hendron C, Hussein S, James N, Hall E. 2507 Prognostic factors in muscle invasive bladder cancer patients receiving radiotherapy with or without chemotherapy in the BC2001 trial (CRUK/01/004). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31328-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Fischer S, Tandstad T, Weather M, Fléchon A, Aparicio J, Klingbiel D, Skrbinc B, Shamash J, Lorch A, Basso U, Dieckmann K, Huddart R, Cohn-Cedermark G, Ståhl O, Chau C, Arriola E, Laguerre B, Maroto P, Beyer J, Gillessen S. 2601 Outcome of relapses after adjuvant carboplatin in clinical stage I seminoma. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31419-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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58
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Hafeez S, Horwich A, Omar O, Mohammed K, Thompson A, Kumar P, Khoo V, Van As N, Eeles R, Dearnaley D, Huddart R. Selective organ preservation with neo-adjuvant chemotherapy for the treatment of muscle invasive transitional cell carcinoma of the bladder. Br J Cancer 2015; 112:1626-35. [PMID: 25897675 PMCID: PMC4430712 DOI: 10.1038/bjc.2015.109] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/12/2015] [Accepted: 02/23/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Radiotherapy for muscle invasive bladder cancer (MIBC) aims to offer organ preservation without oncological compromise. Neo-adjuvant chemotherapy provides survival advantage; response may guide patient selection for bladder preservation and identify those most likely to have favourable result with radiotherapy. METHODS Ninety-four successive patients with T2-T4aN0M0 bladder cancer treated between January 2000 and June 2011 were analysed at the Royal Marsden Hospital. Patients received platinum-based chemotherapy following transurethral resection of bladder tumour; repeat cystoscopy (± biopsy) was performed to guide subsequent management. Responders were treated with radiotherapy. Poor responders were recommended radical cystectomy. Progression-free survival (PFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan-Meier method; univariate and multivariate analyses were performed using the Cox proportional hazard regression model. RESULTS Response assessment was performed in 89 patients. Seventy-eight (88%) demonstrated response; 53 (60%) achieved complete response (CR); 74 responders had radiotherapy; 4 opted for cystectomy. Eleven (12%) demonstrated poor response, 10 received cystectomy. Median survival for CR was 90 months (95% CI 64.7, 115.9) compared with 16 months (95% CI 5.4, 27.4; P < 0.001) poor responders. On multivariate analysis, only response was associated with significantly improved PFS, OS and DSS. After a median follow-up of 39 months (range 4-127 months), 14 patients (16%) required salvage cystectomy (8 for non-muscle invasive disease, 5 for invasive recurrence, 1 for radiotherapy related toxicity). In all, 82% had an intact bladder at last follow-up after radiotherapy; 67% had an intact bladder at last follow-up or death. Our study is limited by its retrospective nature. CONCLUSIONS Response to neo-adjuvant chemotherapy is a favourable prognostic indicator and can be used to select patients for radiotherapy allowing bladder preservation in >80% of the selected patients.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Carcinoma, Transitional Cell/drug therapy
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/radiotherapy
- Carcinoma, Transitional Cell/surgery
- Chemotherapy, Adjuvant
- Cisplatin/administration & dosage
- Cystectomy/methods
- Disease-Free Survival
- Female
- Humans
- Male
- Middle Aged
- Neoadjuvant Therapy
- Neoplasm Invasiveness
- Neoplasm Recurrence, Local/drug therapy
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Organ Preservation/methods
- Retrospective Studies
- Salvage Therapy/methods
- Treatment Outcome
- Urinary Bladder/drug effects
- Urinary Bladder/pathology
- Urinary Bladder/radiation effects
- Urinary Bladder/surgery
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Hafeez S, McDonald F, Lalondrelle S, McNair H, Warren-Oseni K, Jones K, Harris V, Taylor H, Khoo V, Thomas K, Hansen V, Dearnaley D, Horwich A, Huddart R. EP-1240: Clinical outcomes of image guided adaptive radiotherapy (IGART) for hypofractionated treatment of bladder cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41232-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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McNair HA, Hafeez S, Taylor H, Lalondrelle S, McDonald F, Hansen VN, Huddart R. Radiographer-led plan selection for bladder cancer radiotherapy: initiating a training programme and maintaining competency. Br J Radiol 2015; 88:20140690. [PMID: 25564753 DOI: 10.1259/bjr.20140690] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The implementation of plan of the day selection for patients receiving radiotherapy (RT) for bladder cancer requires efficient and confident decision-making. This article describes the development of a training programme and maintenance of competency. METHODS Cone beam CT (CBCT) images acquired on patients receiving RT for bladder cancer were assessed to establish baseline competency and training needs. A training programme was implemented, and observers were asked to select planning target volumes (PTVs) on two groups of 20 patients' images. After clinical implementation, the PTVs chosen were reviewed offline, and an audit performed after 3 years. RESULTS A mean of 73% (range, 53-93%) concordance rate was achieved prior to training. Subsequent to training, the mean score decreased to 66% (Round 1), then increased to 76% (Round 2). Six radiographers and two clinicians successfully completed the training programme. An independent observer reviewed the images offline after clinical implementation, and a 91% (126/139) concordance rate was achieved. During the audit, 125 CBCT images from 13 patients were reviewed by a single observer and concordance was 92%. CONCLUSION Radiographer-led selection of plan of the day was implemented successfully with the use of a training programme and continual assessment. Quality has been maintained over a period of 3 years. ADVANCES IN KNOWLEDGE The training programme was successful in achieving and maintaining competency for a plan of the day technique.
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Callender J, Parsons E, McNair H, Reilly A, Huddart R, Hafeez S, Hansen V, Tsang Y, Hall E, Baker A. OC-0564: Implementing a remote access database for clinical trials' IGRT quality assurance in the United Kingdom. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40559-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vestergaard A, Hafeez S, Muren L, Nill S, Høyer M, Hansen V, Grønborg C, Pedersen E, Petersen J, Huddart R, Olfke U. OC-0403: The potential of MRI-guided online adaptive radiotherapy of urinary bladder cancer. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40399-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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63
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Maund IF, Benson RJ, Fairfoul J, Cook J, Huddart R, Poynter A. Image-guided radiotherapy of the prostate using daily CBCT: the feasibility and likely benefit of implementing a margin reduction. Br J Radiol 2014; 87:20140459. [PMID: 25354015 DOI: 10.1259/bjr.20140459] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate whether planning target volume (PTV) margins may be safely reduced in radiotherapy of localized prostate cancer incorporating daily online tube potential-cone beam CT (CBCT) image guidance and the anticipated benefit in predicted rectal toxicity. METHODS The prostate-only clinical target volume (CTV2) and rectum were delineated on 1 pre-treatment CBCT each week in 18 randomly selected patients. By transposing these contours onto the original plan, dose-volume histograms (DVHs) for CTV2 and the rectum were each calculated and combined, for each patient, to produce a single mean DVH representative of the dose delivered over the treatment course. Plans were reoptimized using reduced CTV2 to PTV2 margins and the consequent radiobiological impact modelled by the tumour control probability (TCP) and normal tissue complication probability (NTCP) of the rectum. RESULTS All CBCT images were deemed of sufficient quality to identify the CTV and rectum. No loss of TCP was observed when plans using the standard 5-mm CTV2 to PTV2 margin of the centre were reoptimized with a 4- or 3-mm margin. Margin reduction was associated with a significant decrease in rectal NTCP (5-4 mm; p < 0.05 and 5-3 mm; p < 0.01). CONCLUSION Using daily online image guidance with CBCT, a reduction in CTV2 to PTV2 margins to 3 mm is achievable without compromising tumour control. The consequent sparing of surrounding normal tissues is associated with reduced anticipated rectal toxicity. ADVANCES IN KNOWLEDGE Margin reduction is feasible and potentially beneficial. Centres with image-guided radiotherapy capability should consider assessing whether margin reduction is possible within their institutes.
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Parker C, Venkitaraman R, Lorente D, Murthy V, Thomas K, Ahiabor R, Dearnaley D, Huddart R, de Bono J. A Randomised Phase Ii Trial of Dexamethasone Versus Prednisolone in Castration Resistant Prostate Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu336.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hafeez S, Huddart R. Audit of Patient Pathway for those Receiving Radical Radiotherapy for Bladder Cancer. Clin Oncol (R Coll Radiol) 2014. [DOI: 10.1016/j.clon.2014.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Horwich A, Fossa SD, Huddart R, Dearnaley DP, Stenning S, Aresu M, Bliss JM, Hall E. Second cancer risk and mortality in men treated with radiotherapy for stage I seminoma. Br J Cancer 2014; 110:256-63. [PMID: 24263066 PMCID: PMC3887279 DOI: 10.1038/bjc.2013.551] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/02/2013] [Accepted: 08/14/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with stage I testicular seminoma are typically diagnosed at a young age and treatment is associated with low relapse and mortality rates. The long-term risks of adjuvant radiotherapy in this patient group are therefore particularly relevant. METHODS We identified patients and obtained treatment details from 12 cancer centres (11 United Kingdom, 1 Norway) and ascertained second cancers and mortality through national registries. Data from 2629 seminoma patients treated with radiotherapy between 1960 and 1992 were available, contributing 51,151 person-years of follow-up. RESULTS Four hundred and sixty-eight second cancers (excluding non-melanoma skin cancers) were identified. The standardised incidence ratio (SIR) was 1.61 (95% confidence interval (CI): 1.47-1.76, P<0.0001). The SIR was 1.53 (95% CI: 1.39-1.68, P<0.0001) when the 32 second testicular cancers were also excluded. This increase was largely due to an excess risk to organs in the radiation field; for pelvic-abdominal sites the SIR was 1.62 (95% CI: 1.43-1.83), with no significant elevated risk of cancers in organs elsewhere. There was no overall increase in mortality with a standardised mortality ratio (SMR) of 1.06 (95% CI: 0.98-1.14), despite an increase in the cancer-specific mortality (excluding testicular cancer deaths) SMR of 1.46 (95% CI: 1.30-1.65, P<0.0001). CONCLUSION The prognosis of stage I seminoma is excellent and it is important to avoid conferring long-term increased risk of iatrogenic disease such as radiation-associated second cancers.
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Hafeez S, Koh M, Sohaib A, Huddart R. PO-0734: Assessing response to radiotherapy with diffusion weighted MRI (DW-MRI) in muscle invasive bladder cancer (MIBC). Radiother Oncol 2014. [DOI: 10.1016/s0167-8140(15)30852-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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68
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Singhera M, Huddart R. Comment on 'Prevalence of the metabolic syndrome and cardiovascular disease risk in chemotherapy-treated testicular germ cell tumour survivors'. Br J Cancer 2013; 109:2502-3. [PMID: 24045657 PMCID: PMC3817322 DOI: 10.1038/bjc.2013.566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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69
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McDonald F, Lalondrelle S, Taylor H, Warren-Oseni K, Khoo V, McNair H, Harris V, Hafeez S, Hansen V, Thomas K, Jones K, Dearnaley D, Horwich A, Huddart R. Clinical Implementation of Adaptive Hypofractionated Bladder Radiotherapy for Improvement in Normal Tissue Irradiation. Clin Oncol (R Coll Radiol) 2013; 25:549-56. [DOI: 10.1016/j.clon.2013.06.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 04/15/2013] [Accepted: 04/16/2013] [Indexed: 11/25/2022]
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70
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Huddart R, McDonald F, Lewis R, Hall E. HYBRID - evaluating new radiation technology in patients with unmet needs. Clin Oncol (R Coll Radiol) 2013; 25:546-8. [PMID: 23796918 DOI: 10.1016/j.clon.2013.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 03/27/2013] [Accepted: 04/02/2013] [Indexed: 11/23/2022]
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71
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Creak A, Hall E, Horwich A, Eeles R, Khoo V, Huddart R, Parker C, Griffin C, Bidmead M, Warrington J, Dearnaley D. Randomised pilot study of dose escalation using conformal radiotherapy in prostate cancer: long-term follow-up. Br J Cancer 2013; 109:651-7. [PMID: 23880826 PMCID: PMC3738135 DOI: 10.1038/bjc.2013.394] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/10/2013] [Accepted: 06/22/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Radical three-dimensional conformal radiotherapy (CFRT) with initial androgen suppression (AS) is a standard management for localised prostate cancer (PC). This pilot study evaluated the role of dose escalation and appropriate target volume margin. Here, we report long-term follow-up. METHODS Eligible patients had T1b-T3b N0 M0 PC. After neoadjuvant AS, they were randomised to CFRT, giving (a) 64 Gy with either a 1.0- or 1.5-cm margin and (b) ±10 Gy boost to the prostate alone. RESULTS One hundred and twenty-six men were randomised and treated. Median follow-up was 13.7 years. The median age was 66.6 years at randomisation. Median presenting prostate-specific antigen (PSA) was 14 ng ml(-1). Sixty-four out of 126 patients developed PSA failure. Forty-nine out of 126 patients restarted AS, 34 out of 126 developed metastases and 28 out of 126 developed castrate-resistant prostate cancer (CRPC). Fifty-one out of 126 patients died; 19 out of 51 died of PC. Median overall survival (OS) was 14.4 years. Although escalated dose results were favourable, no statistically significant differences were seen between the randomised groups; PSA control (hazard ratio (HR): 0.77 (95% confidence interval (CI): 0.47-1.26)), development of CRPC (HR: 0.81 (95% CI: 0.40-1.65)), PC-specific survival (HR: 0.59 (95% CI:0.23-1.49)) and OS (HR: 0.81 (95% CI: 0.47-1.40)). There was no evidence of a difference in PSA control according to margin size (HR: 1.01 (95% CI: 0.61-1.66)). INTERPRETATION Long-term follow-up of this small pilot study is compatible with a benefit from dose escalation, but confirmation from larger trials is required. There was no obvious detriment using the smaller radiotherapy margin.
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McNair H, Hansen V, Hafeez S, Thomas K, Harris V, Omar O, South C, Huddart R, Dearnaley D. PD-0272: Can CBCT image quality be improved to reduce inter observer error in patients receiving radiotherapy to the prostate? Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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73
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Huddart R, Birtle A, Lewis R, Bahl A, Falconer A, Maynard L, Hall E. Results of the SPARE Feasibility Study – Selective Bladder Preservation Against Radical Excision in Muscle Invasive T2/T3 Transitional Cell Carcinoma of the Bladder (CRUK/07/011). Int J Radiat Oncol Biol Phys 2012. [DOI: 10.1016/j.ijrobp.2012.07.211] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Payne H, Clarke N, Huddart R, Parker C, Troup J, Graham J. Nasty or Nice? Findings from a UK Survey to evaluate the impact of the National Institute for Health and Clinical Excellence (NICE) clinical guidelines on the management of prostate cancer. Clin Oncol (R Coll Radiol) 2012; 25:178-89. [PMID: 23079099 DOI: 10.1016/j.clon.2012.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Revised: 06/26/2012] [Accepted: 06/28/2012] [Indexed: 11/30/2022]
Abstract
AIMS Although the National Institute for Health and Clinical Excellence clinical guideline 58 (CG58) for prostate cancer management was expected to have a positive effect, several recommendations raised concern among UK physicians. We conducted a survey of UK oncologists in 2008 and a second, similar survey in 2010 to assess views on these recommendations and to evaluate the change in opinion over time. MATERIALS AND METHODS Two semi-structured questionnaires were issued by the British Uro-oncology Group to society members in September 2008 and October 2010. RESULTS In 2008, 61 UK oncologists completed the survey; 60% agreed that CG58 would make a positive contribution towards improving patient care. There was strong opposition towards active surveillance as the first-line treatment for men with low-risk localised prostate cancer (49% disagreement); implementing 5 yearly flexible sigmoidoscopy post-prostate radiotherapy (51% disagreement); offering follow-up outside of the hospital (e.g. by general practitioners in primary care) for men with a stable prostate-specific antigen for ≥2 years (44% disagreement); and recommendations against docetaxel retreatment (47% disagreement) or bisphosphonate use (58% disagreement). In 2010, 77 UK oncologists completed the survey. The results were largely consistent with 2008, although several recommendations, particularly for localised disease, seem to have promoted a change in clinical practice, suggesting that they are facilitating a standardised approach. Compared with 2008, the 2010 results indicate a shift in favour of active surveillance (80% agreement) and primary care follow-up (59% agreement), but increasing opposition for docetaxel retreatment (57% disagreement). Opinions remained divided for flexible sigmoidoscopy and bisphosphonates. CONCLUSIONS Despite initial concerns, the CG58 seems to have had a positive impact on prostate cancer management in the UK, with adherence likely facilitating a standardised approach. However, with new data emerging, these findings underscore the need to regularly update guidelines. A revision of the CG58 is anticipated by 2014.
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Singhera M, Selvadurai E, Smythe G, Creak A, Horwich A, Huddart R, Dearnaley D. PO-0680 DOSIMETRIC COMPARISON OF FORWARD PLANNED IMRT (F-IMRT), INVERSE PLANNED IMRT (I-IMRT) AND VMAT FOR PROSTATE CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71013-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Harris V, Warren-Oseni K, Huddart R. EP-1536 RADIOTHERAPY PLANNING STUDY COMPARING VMAT, IMRT AND 3D-CRT IN THE TREATMENT OF BLADDER AND PELVIC LYMPH NODES. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71869-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Lalondrelle S, Sohaib SA, Castellano IA, Mears D, Huddart R, Khoo V. Investigating the relationship between virtual cystoscopy image quality and CT slice thickness. Br J Radiol 2012; 85:1112-7. [PMID: 22215882 DOI: 10.1259/bjr/99567374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To investigate the effect of reconstruction slice thickness on image quality at CT virtual cystoscopy (VC). METHODS Pelvic CT examinations in bladder cancer patients were reconstructed at different slice thicknesses (0.6-5 mm) and intervals, and resulting VC images assessed. Quality indicators were ridging, holes, floaters and dimpling artefacts, tumour definition, and an overall score, ranked 1 (best) to 7 (worst). CT number and standard deviation (SD) for bladder contents and bladder wall were recorded. The mean SD was used as a measure of noise, and the contrast-to-noise ratio (CNR) was calculated as the CT number difference between them divided by the average image noise. The mean CNR across the three levels was used for analysis. Each qualitative image quality measure was compared with CT number, noise and CNR measurements. RESULTS Dimpling artefacts increased with thinner slice reconstruction and correlated with increased noise, often resulting in poor tumour definition. The best overall image quality score was seen for VC images reconstructed at 1.2 mm slice thickness, probably because of the competing effects of spatial resolution and CNR. CONCLUSION A slice thickness reconstruction <1.2 mm does not provide for better image quality at VC owing to the presence of increased noise.
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Warde P, Huddart R, Bolton D, Heidenreich A, Gilligan T, Fossa S. Management of Localized Seminoma, Stage I-II: SIU/ICUD Consensus Meeting on Germ Cell Tumors (GCT), Shanghai 2009. Urology 2011; 78:S435-43. [PMID: 21986223 DOI: 10.1016/j.urology.2011.02.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 01/04/2011] [Accepted: 02/14/2011] [Indexed: 10/16/2022]
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Maroto P, Huddart R, Garcia del Muro X, Horwich A, Paz Ares L, Aparicio J, Germa-Lluch JR. Brief report: phase II multicenter study of temozolomide in patients with cisplatin-resistant germ cell tumors. Oncology 2011; 80:219-22. [PMID: 21734411 DOI: 10.1159/000329041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 04/11/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the activity and toxicity of temozolomide in a phase II multicenter trial in patients diagnosed with relapsed or cisplatin-refractory germ cell tumors. PATIENTS AND METHODS During a recruitment period of 30 months, 20 patients received temozolomide 150 mg/m(2)/day p.o. for 5 days every 4 weeks, escalating to 200 mg/m(2)/day if grade II toxicity was not observed in the first cycle. Eligibility criteria were tumor progression or relapse after previous cisplatin and ifosfamide-containing chemotherapy, creatinine clearance of >40 ml/min, and a performance status of 0-2. RESULTS The median age was 38 years (range 27-56). Seventeen patients had nonseminomatous tumors, and 3 had seminomatous tumors. Six of the patients had extragonadal primary tumors (3 retroperitoneal and 3 mediastinal). The median number of prior cisplatin-containing cycles was 11 (range 7-20). Eight patients received prior high-dose chemotherapy and 14 were refractory or absolutely refractory to cisplatin. A total of 45 cycles were administered. Two partial responses lasting 9 and 3.5 months (overall response rate 10%, 95% CI 1.2-31.7) were observed. One of these responses was seen in a patient with a cisplatin-refractory tumor that had previously been treated with high-dose chemotherapy. The median time to progression and the median overall survival were 1.5 and 3.1 months, respectively. Grade III hematological toxicity consisted of thrombocytopenia in 2 patients and anemia in 1 patient. No grade IV toxicity was observed. CONCLUSIONS Temozolomide had some activity in heavily pretreated patients resistant to cisplatin-based chemotherapy.
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Creak A, Hall E, Horwich A, Eeles R, Huddart R, Dearnaley D. 497 oral PHASE III PILOT STUDY OF DOSE ESCALATION USING CON-FORMAL RADIOTHERAPY IN PROSTATE CANCER: LONG TERM FOLLOW UP. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70619-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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81
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Schmoll HJ, Jordan K, Huddart R, Pes MPL, Horwich A, Fizazi K, Kataja V. Testicular seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v140-6. [PMID: 20555065 DOI: 10.1093/annonc/mdq176] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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82
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Schmoll HJ, Jordan K, Huddart R, Laguna Pes M, Horwich A, Fizazi K, Kataja V. Testicular non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010; 21 Suppl 5:v147-54. [DOI: 10.1093/annonc/mdq177] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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83
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McVey G, Van AS N, Thomas K, Margaret B, South C, Chris P, Khoo V, Huddart R, Horwich A, Dearnaley D. Intensity Modulated Radiotherapy (IMRT) Can Safely Deliver 60 Gy to the Pelvic Lymph Node Regions in Patients with Prostate Cancer: Report of a Phase I Dose Escalation Study. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McVey G, Morgan S, Vergis R, Cooper C, Huddart R, Corbishley C, Horwich A, Dearnaley D, Parker C. 2018 Benefit of radiotherapy dose escalation in localized prostate cancer with respect to expression of intrinsic markers of hypoxia. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70534-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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85
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McDonald F, Hall E, James N, Huddart R. 2043 Defining bowel dose constraints for bladder radiotherapy: using data from patients entered into phase III randomised trial. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70559-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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86
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Huddart R, James N, Adab F, Syndikus I, Jenkins P, Rawlings C, Rogers S, Lewis R, Hendron C, Hussain S, Hall E. 7102 Updated results of the BC2001 phase III randomized trial of standard vs reduced high dose volume radiotherapy for muscle invasive bladder cancer (ISCRTN:68324339): tumour control, toxicity and quality of life. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)71435-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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87
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Moynihan C, Hall E, Lewis R, Birtle A, Mead GM, Huddart R. SPARE: A qualitative study investigating randomization barriers in a Selective Bladder Preservation trial (SBP) (ISCRCTN: 61126465). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5077 Background: Recruitment to randomised trials is challenging, especially when treatment strategies are complex. While studies have demonstrated barriers to recruitment, few have investigated why patients accept or refuse randomisation. The SPARE feasibility study included such an investigation to highlight difficulties that might be dealt with as the study progressed and to inform procedures for a subsequent phase III trial. Methods: Patients had newly diagnosed invasive bladder cancer and were receiving neoadjuvant chemotherapy prior to invitation to a randomised trial (SPARE) that offered the possibility of radical cystectomy or SBP. Patients allocated SBP received cystectomy or radiotherapy dependent on chemotherapy response. 15 acceptors and 10 decliners to randomisation participated in the qualitative substudy. Methods included recorded transcribed interviews and a ‘framework analysis.’ Results: Both groups experienced initial confusion, ‘muddled’ communication, information overload, and lack of time leading to misunderstandings about the trial. Perceived side effects did not necessarily inform decisions. Decision to participate was seldom made unilaterally. Individual specialist input by, and continuity between, professionals and their patients, appeared to make decision making easier. Acceptors were inclined to altruism and trust in the medical profession, often agreeing to participate with minimum understanding regarding randomisation and/or equipoise and a ‘nothing to lose’ attitude as long as withdrawal from the trial was possible. Decliners tended to opt for radiotherapy, perceived as a rational choice in the context of this trial; many abhorred the thought of surgery that was perceived as undermining and a ‘treatment in reserve.’ Conclusions: Health professionals need to consider streamlining procedures and recognise patient preferences in terms of treatments offered and information received. Recognition of the complexity of communicating equipoise and randomisation may increase ‘informed consent’ levels and recruitment rates. A further qualitative substudy investigating doctor/patient consultations in real time with confidential feedback is proposed to optimise recruitment rates. No significant financial relationships to disclose.
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McVey GP, Morgan SC, Vergis R, Corbishley C, Thomas K, Cooper C, Horwich A, Huddart R, Dearnaley DP, Parker CC. Benefit of radiotherapy dose escalation in localized prostate cancer with respect to expression of intrinsic markers of hypoxia. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16068 Background: Dose escalation improves the efficacy of prostate cancer radiotherapy (RT) at the cost of increased toxicity. Tumor hypoxia causes radioresistance, so the benefit of RT dose escalation may be greater in more hypoxic cancers. Methods: Cases had localized prostate cancer treated with neo-adjuvant androgen deprivation and radical RT at the Royal Marsden in two randomized trials of dose escalation (64 vs 74Gy). Tumour expression of three markers (vascular endothelial growth factor (VEGF), hypoxia inducible factor-1α(HIF-1α), and osteopontin) was assessed immunohistochemically using a semi-quantitative scale by a uro-pathologist, and analyzed with respect to freedom from biochemical failure (FFBF) using the Phoenix definition. Expression of each marker was dichotomised about the median for analysis of the impact of dose-escalation on outcome. Results: 201 cases with a median follow-up of 7 years were evaluable. Seven-year FFBF was 67% vs 40% (HR: 0.42, 95% CI 0.26–0.7, p=0.001) for 74 Gy versus 64Gy, respectively, among cases with high osteopontin expression, and 70% vs 82% (HR: 1.41, 95% CI 0.53–3.76, p=0.49) for 74Gy vs 64Gy among cases with low osteopontin expression. The benefit of RT dose escalation was similar regardless of VEGF or HIF- 1α expression. Conclusions: These data generate the hypothesis that osteopontin expression could inform RT dose individualisation. If validated, patients with low tumor expression of osteopontin could elect to receive less toxic, standard dose RT. No significant financial relationships to disclose.
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Harland SJ, Welch R, Huddart R, Stenning S, Pollock P, Gabe R. On the necessity for postchemotherapy surgery for residual abdominal masses in metastatic nonseminomatous germ cell tumors (NSGCT) of testis. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5088 Background: Residual abdominal masses after chemotherapy for metastatic NSGCT of testis may contain viable tumor-derived tissue which can be a nidus for relapse of disease, particularly when the tissue is frankly malignant. This justifies routine retroperitoneal lymph node dissection (RPLND) for large masses where malignant tissue is found at an appreciable rate. Yet RPLND is often carried out for smaller, or even absent, residual masses and differentiated teratoma (TD) is commonly found. There is little data on the consequence of leaving these smaller masses in situ, which is the practice in some units in the UK. Methods: 51 patients were identified from the MRC patients entered into the TE20 trial of 3 vs 4 cycles of BEP for good prognosis metastatic NSGCT who fell into the following category: metastatic NSGCT, residual abdominal mass only, unresected post-chemotherapy, response evaluation: CR or PR marker -ve. Collaborators were asked to report on mass size, relapse status, whether an operation was ever performed and the latest CT appearance. Results: 51/51 responses were received. Follow-up from the end of chemotherapy was >3years in all but two cases and the median was 5 years. When later surgery was carried out, for persistence or enlargement of the masses, the specimens contained TD with or without necrosis. One patient suffered a relapse one year after the surgery which took place 4.5 years after chemotherapy. Of the 41 patients who did not undergo surgery, 37 were considered on subsequent CTs to have normal appearances without further treatment. Conclusions: For patients with small residual masses in good prognosis metastatic disease no short or medium term benefit from routine surgery would have been seen. Its role in this situation is therefore questionable. For larger (>14mm) masses the need for routine surgery merits further study. [Table: see text] No significant financial relationships to disclose.
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Wheater MJ, Huddart R, White J, Rustin G, Abab J, Mead GM. Salvage chemotherapy with gemcitabine, paclitaxel, ifosphamide, and cisplatin (Gem-TIP) for relapsed germ cell tumours (GCT). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e16031 Background: Patients with relapsed metastatic GCT following treatment with cisplatin based combination chemotherapy, may be cured with further intensive chemotherapy. A Medical Research Council trial of TIP achieved 1 year progression free survival (PFS) of 38% with 65% survival (Br J Cancer. 2005;93:178). A more dose intense schedule of TIP with growth factors achieved 2-year PFS of 91% (Proc Am Soc Clin Oncol. 22:2003 [abstr 1537]). Gemcitabine has activity in the treatment of multiply relapsed disease. This study aims to investigate the feasibility of adding gem to TIP with the addition of growth factor support, while maintaining TIP dose intensity, with a view to improving the outcome from TIP alone. Methods: A phase I dose escalation study of Gem-TIP was carried out in patients at first relapse from metastatic GCT following cisplatin chemotherapy. All patients received TIP without dose reduction (paclitaxel 175 mg/m2 d1, cisplatin 20 mg/m2 d1–5, ifosphamide 1 g/m2 d2–6) with GCSF days 7–18 of a 21 day cycle for maximum 4 cycles. 3 dose levels of gem were investigated, 600 mg/m2 d1, 900 mg/m2 d1 and 1,200 mg/m2 d1. Dose limiting toxicity (DLT) was non-haematological grade 3 or 4, except nausea, vomiting and alopecia. Results: 13 patients treated, 12 male, 1 female, age 21–48 years. Baseline histology seminoma 8, non-seminoma 5. Cohort 1: 4 patients treated, 1 withdrew after 1 cycle. No DLT observed. Cohort 2: 3 patients completed treatment with no DLT. Cohort 3: 1 patient treated suffered allergic pneumonitis at cycle 1 complicated by a malignant pleural effusion. A further 5 patients were treated at this dose level. The minimum course duration was 63 days. The mean duration for each cohort was 69 days for cohort 1 and 2, 64 days for cohort 3. Grade 3/4 haematological toxicity was; neutropaenia 9 patients, thrombocytopaenia 10 patients, with 2 episodes of febrile neutropaenia but no bleeding. 10 platelet transfusions were required. 10 patients were assessable for response, 5 CR, 3 PR, 2 PD. At median follow up 18 months the median PFS is 10 months. Conclusions: Gem-TIP can be delivered with 1200mg/m2 gem with manageable toxicity in the context of growth factor support. This dose will be taken forward to a phase II study. No significant financial relationships to disclose.
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Schmoll HJ, Jordan K, Huddart R, Laguna M, Horwich A, Fizazi K, Kataja V. Testicular non-seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20 Suppl 4:89-96. [DOI: 10.1093/annonc/mdp139] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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92
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Schmoll HJ, Jordan K, Huddart R, Laguna M, Horwich A, Fizazi K, Kataja V. Testicular seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol 2009; 20 Suppl 4:83-8. [DOI: 10.1093/annonc/mdp138] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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93
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Lalondrelle S, Huddart R. Improving radiotherapy for bladder cancer: an opportunity to integrate new technologies. Clin Oncol (R Coll Radiol) 2009; 21:380-4. [PMID: 19394804 DOI: 10.1016/j.clon.2009.03.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Accepted: 03/31/2009] [Indexed: 10/20/2022]
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Sohaib S, Koh D, Barbachano Y, Parikh J, Husband J, Dearnaley D, Horwich A, Huddart R. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours. Clin Radiol 2009; 64:362-7. [DOI: 10.1016/j.crad.2008.10.011] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2008] [Revised: 10/06/2008] [Accepted: 10/26/2008] [Indexed: 12/23/2022]
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Jhavar S, Bartlett J, Kovacs G, Corbishley C, Dearnaley D, Eeles R, Khoo V, Huddart R, Horwich A, Thompson A, Norman A, Brewer D, Cooper CS, Parker C. Biopsy tissue microarray study of Ki-67 expression in untreated, localized prostate cancer managed by active surveillance. Prostate Cancer Prostatic Dis 2008; 12:143-7. [DOI: 10.1038/pcan.2008.47] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Lalondrelle S, Hansen V, McNair H, Huddart R, Horwich A, Dearnaley D, Khoo V. One Size Doesn't Fit All: The Value of Adaptive Radiotherapy (ART) Planning Methods using Daily Image Guidance in Bladder Radiotherapy (RT). Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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James N, Hussain S, Tremlett J, Crundwell M, Jenkins P, Rawlings C, Hall E, Rogers S, Huddart R. First Toxicity Report of the BC2001 Trial: A Multicentre Phase III Randomised Trial of Radiotherapy with and without Synchronous Chemotherapy in Muscle Invasive Bladder Cancer ISCRTN No. 68324339, EUDRACT No. 2004-000164-26. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Huddart R, Kataja V. Testicular seminoma: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol 2008; 19 Suppl 2:ii49-51. [DOI: 10.1093/annonc/mdn086] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Huddart R, Kataja V. Mixed or non-seminomatous germ-cell tumors: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol 2008; 19 Suppl 2:ii52-4. [DOI: 10.1093/annonc/mdn087] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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100
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Huddart R, Dearnaley D, Horwich A, Shepherd R, Birtle A. 4511 POSTER Selective organ preservation in muscle-invasive transitional cell carcinoma of the bladder: Pilot study for a randomised phase III trial. EJC Suppl 2007. [DOI: 10.1016/s1359-6349(07)71142-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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