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Lunj S, Song Y, Hudson A, Patel K, Nightingale H, Smith T, Hoskin P, Bristow R, West C, Choudhury A. PO-1933 Can baseline or Ra-223-induced changes in the plasma predict progressive disease mCRPC patients? Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08384-5] [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]
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Clough A, Hales R, Parker J, McMahon J, Whiteside L, McHugh L, Davies L, Sanders J, Benson R, Nelder C, Choudhury A, Eccles C. PD-0938 impact of an atlas on radiographer inter-observer contour variation in prostate radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07217-0] [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]
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McDaid L, Clough A, Benson R, Nelder C, McMahon J, Aznar M, Choudhury A, Jackson S, Eccles C. PO-1952 Quantification of MRI distortion in patients with metallic hip prosthesis: a feasibility study. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08403-6] [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]
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Connors K, Vickers A, Conroy R, Coyle C, Hudson A, Logue J, Serra M, Tran A, Mistry H, Wylie J, Choudhury A, Song Y. PO-1338 Does frailty influence treatment intent in men with non-metastatic prostate cancer? Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07789-6] [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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Zhong J, Slevin F, Scarsbrook A, Serra M, Choudhury A, Hoskin P, Brown S, Henry A. PO-1346 Systematic Review of Salvage Reirradiation Options for Locally Recurrent Prostate Cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07797-5] [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]
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56
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Elumalai T, Song Y, Mistry H, Dubec M, Jackson S, Herk M, Hoskin P, Choudhury A, McWilliam A. PO-1798 Impact of inter-observer variability on MRI radiomic features in bladder cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08249-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Teunissen F, Willigenburg T, Tree A, Hall W, Choi S, Choudhury A, Christodouleas J, De Boer J, De Groot-Van Breugel E, Kerkmeijer L, Pos F, Vesprini D, Verkooijen H, Van Der Voort Van Zyp J. Magnetic Resonance guided adaptive Radiotherapy (MRgRT) for localised prostate cancer: The first result from a prospective international registry for the evidence-based Introduction of MRgRT. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01424-x] [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]
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Thongprayoon C, Lapumnuaypol K, Kaewput W, Petnak T, Qureshi F, Mao MA, Boonpheng B, Bathini T, Choudhury A, Vallabhajosyula S, Cheungpasitporn W. Gastrointestinal bleeding among hospitalizations for salicylate poisoning in the United States. QJM 2021; 114:190-195. [PMID: 33599273 DOI: 10.1093/qjmed/hcab034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/01/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND This study aimed to determine the incidence, as well as evaluate risk factors, and impact of gastrointestinal bleeding on outcomes and resource use in patients admitted for salicylate poisoning. METHODS We used the National Inpatient Sample to construct a cohort of patients hospitalized primarily for salicylate poisoning from 2003 to 2014. We compared clinical characteristics, in-hospital treatments, outcomes and resource use between salicylate poisoning patients with and without gastrointestinal bleeding. RESULTS Of 13 805 hospital admissions for salicylate poisoning, gastrointestinal bleeding occurred in 482 (3.5%) admissions. The risk factors for gastrointestinal bleeding included older age, history of atrial fibrillation and cirrhosis. After adjusting for difference in baseline characteristics, patients with gastrointestinal bleeding required more gastric lavage, gastrointestinal endoscopy, invasive mechanical ventilation and red blood cell transfusion. Gastrointestinal bleeding was significantly associated with increased risk of anemia, circulatory, liver and hematological failure but was not significantly associated with increased in-hospital mortality. The length of hospital stay and hospitalization cost was significantly higher in patients with gastrointestinal bleeding. CONCLUSION Gastrointestinal bleeding occurred in about 4% of patients admitted for salicylate poisoning. Gastrointestinal bleeding was associated with higher morbidity and resource use but not mortality.
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Choudhury A. The Dawn of Another New Era. Clin Oncol (R Coll Radiol) 2021; 33:415-416. [PMID: 33947624 DOI: 10.1016/j.clon.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/27/2022]
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Smith TO, Choudhury A, Fletcher J, Choudhury Z, Mansfield M, Tennent D, Hing CB. Changes in pain catastrophization and neuropathic pain following operative stabilisation for patellofemoral instability: a prospective study with twelve month follow-up. INTERNATIONAL ORTHOPAEDICS 2021; 45:1745-1750. [PMID: 33877405 DOI: 10.1007/s00264-021-05046-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 04/12/2021] [Indexed: 01/26/2023]
Abstract
PURPOSE To determine the prevalence and change in neuropathic pain or pain catastrophizing before and 12 months following patellar stabilisation surgery for patellofemoral instability. METHODS We conducted a prospective clinical audit within a UK NHS orthopaedic surgical centre. Data from 84 patients with patellofemoral instability requiring stabilisation were analysed. Fifty percent (42/84) underwent MPFL reconstruction alone, and 16% (13/84) had both trochleoplasty and MPFL reconstruction. Neuropathic pain was assessed using painDETECT score. Pain catastrophizing was assessed using the Pain Catastrophizing Score. The Norwich Patellar Instability (NPI) Score and Kujala Patellofemoral Disorder Score were also routinely collected pre-operatively and one year post-operatively. RESULTS At 12 months post-operatively there was a statistically significant reduction in mean Pain Catastrophizing Scores (18.9-15.7; p < 0.02), but no change in mean painDETECT scores (7.3-7.8; p = 0.72). There was a statistically significant improvement in NPI scores (90.2-61.9; p < 0.01) and Kujala Patellofemoral Disorder Scores (48.7-58.1; p = 0.01). The prevalence of pain catastrophizing decreased from 31% pre-operatively to 24% post-operatively, whereas the prevalence of neuropathic pain remained consisted (10-11%). CONCLUSIONS Neuropathic pain and catastrophizing symptoms are not commonly reported and did not significantly change following patellofemoral stabilisation surgery. Whilst low, for those affected, there remains a need to intervene to improve outcomes following PFI surgery.
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Mee T, Vickers AJ, Jena R, Kirkby KJ, Choudhury A, Kirkby NF. Variations in Demand across England for the Magnetic Resonance-Linac Technology, Simulated Utilising Local-level Demographic and Cancer Data in the Malthus Project. Clin Oncol (R Coll Radiol) 2021; 33:e285-e294. [PMID: 33775495 PMCID: PMC8217906 DOI: 10.1016/j.clon.2021.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/14/2021] [Accepted: 03/05/2021] [Indexed: 11/26/2022]
Abstract
AIMS Cancer incidence varies across England, which affects the local-level demand for treatments. The magnetic resonance-linac (MR-linac) is a new radiotherapy technology that combines imaging and treatment. Here we model the demand and demand variations for the MR-linac across England. MATERIALS AND METHODS Initial clinical indications were provided by the MR-linac consortium and introduced into the Malthus radiotherapy clinical decision trees. The Malthus model contains Clinical Commissioning Group (CCG) population, cancer incidence and stage presentation data (for lung and prostate) and simulated the demand for the MR-linac for all CCGs and Radiotherapy Operational Delivery Networks (RODN) across England. RESULTS Based on the initial target clinical indications, the MR-linac could service 16% of England's fraction burden. The simulated fractions/million population demand/annum varies between 3000 and 10 600 fractions/million at the CCG level. Focussing only on the cancer population, the simulated fractions/1000 cancer cases demand/annum ranges from 1028 to 1195 fractions/1000 cases. If a national average for fractions/million demand was then used, at the RODN level, the variation from actual annual demand ranges from an overestimation of 8400 fractions to an underestimation of 5800 fractions. When using the national average fractions/1000 cases, the RODN demand varies from an overestimation of 3200 fractions to an underestimation of 3000 fractions. CONCLUSIONS Planning cancer services is complex due to regional variations in cancer burden. The variations in simulated demand of the MR-linac highlight the requirement to use local-level data when planning to introduce a new technology.
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Lodhi T, Song YP, West C, Hoskin P, Choudhury A. Hypoxia and its Modification in Bladder Cancer: Current and Future Perspectives. Clin Oncol (R Coll Radiol) 2021; 33:376-390. [PMID: 33762140 DOI: 10.1016/j.clon.2021.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
Radiotherapy plays an essential role in the curative treatment of muscle-invasive bladder cancer (MIBC). Hypoxia affects the response to MIBC radiotherapy, limiting radiocurability. Likewise, hypoxia influences MIBC genetic instability and malignant progression being associated with metastatic disease and a worse prognosis. Hypoxia identification in MIBC enables treatment stratification and the promise of improved survival. The most promising methods are histopathological markers such as necrosis; biomarkers of protein expression such as HIF-1α, GLUT-1 and CAIX; microRNAs; and novel mRNA signatures. Although hypoxia modification can take different forms, the gold standard remains carbogen and nicotinamide, which improve local control rates in bladder preservation and absolute overall survival with no significant increase in late toxicity. This is an exciting time for evolving therapies such as bioreductive agents, novel oxygen delivery techniques, immunotherapy and poly (ADP-ribose) polymerase 1 (PARP) inhibitors, all in development and representing upcoming trends in MIBC hypoxia modification. Whatever the future holds for hypoxia-modified radiotherapy, there is no doubt of its importance in MIBC. mRNA signatures provide an ideal platform for the selection of those with hypoxic tumours but are yet to qualified and integrated into the clinic. Future interventional trials will require biomarker stratification to ensure optimal treatment response to improve outcomes for patients with MIBC.
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Choudhury A. SP-0248: Bladder preservation strategies. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00272-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thiruthaneeswaran N, Bibby B, Pereira R, Bristow R, Choudhury A, West C. The Largest Transcriptomic Resource for Radiotherapy-treated High-risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2115] [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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Gao C, Kogame N, Smits P, Tonino P, Moreno R, Choudhury A, Hofma S, Petrov I, Cequier A, Colombo A, Onuma Y, Kaul U, Zaman A, De Winter R, Serruys P. A prospective multicentre randomized all-comers trial to assess the safety and effectiveness of the ultra-thin-strut sirolimus-eluting coronary stent Supraflex: 2-year results of the TALENT trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Supraflex is a sirolimus-eluting stent with a biodegradable polymeric coating and 60um ultra-thin struts. In the TALENT study, we found the Supraflex stent was non-inferior to the Xience stent for a device-oriented composite endpoint (DOCE, defined as cardiac death, target-vessel myocardial infarction, or clinically indicated target lesion revascularisation) at 12 months in an all-comer population. Additionally, per-protocol analysis showed a significantly lower clinically indicated target lesion revascularisation (CI-TLR) in the Supraflex group than in the Xience group. We now present the 2-year follow-up results.
Methods
The TALENT study was a prospective, randomised, single-blind, multicentre study across 23 centres in Europe. Eligible participants underwent percutaneous coronary intervention in an all-comers fashion in vessels of 2.25–4.5 mm. Patients were randomized (1:1) to implantation of either Supraflex or Xience (NCT02870140).
Results
Between October 21, 2016 and July 3, 2017, 720 patients with 1046 lesions were randomly assigned to Supraflex, and 715 patients with 1030 lesions to Xience. At 24 months, DOCE had occurred in 49 patients (6.9%) in the Supraflex group and in 56 patients (7.9%) in the Xience group (absolute difference −1.0% [95% CI: −3.7 to 1.7], Plog-rank=0.491). Per-protocol analysis at 24 months showed CI-TLR occurred in 21 and 30 patients in the Supraflex and Xience, respectively (3.3% versus 4.5%, absolute difference −1.2%, [95% CI: −3.3 to 0.9], Plog-rank=0.267).
Conclusion
In an all-comer population, at 2-year follow-up, the use of Supraflex stent was at least as safe and efficacious as Xience stent. However, the significantly lower rate of CI-TLR shown in patients treated with Supraflex at 1-year was no longer retained in the 2-year results. Whether theoretical advantage of ultra-thin strut drug eluting stents Supraflex can translate into clinical benefit or not will be further elucidated through a total of 3 years of follow-up.
Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): SMT
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Zhang C, Choudhury A, Shi Z, Zhu C, Bermejo I, Dekker A, Wee L. Feasibility of Privacy-Preserving Federated Deep Learning on Medical Images. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.234] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vasudevan H, Magill S, Seo K, Villanueva-Meyer J, Choudhury A, Liu S, Pekmezci M, Findakly S, Hilz S, LaStella S, Braunstein S, Oberheim N, Aghi M, Theodosopoulos P, Sneed P, Berger M, McDermott M, Lim D, Ulian E, Costello J, Raleigh D. Multiplatform Genomic Profiling and Magnetic Resonance Imaging Identify Molecular and Radiologic Determinants of Intratumor Heterogeneity Underlying Aggressive Behavior in Meningioma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2146] [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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Thiruthaneeswaran N, Bibby B, Pereira R, More E, Bristow R, Choudhury A, West C. OC-0319: Validation of a companion diagnostic biomarker for prospective use in prostate radiotherapy trials. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00343-1] [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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69
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Hales R, Rodgers J, Whiteside L, Budgell G, Berresford J, Choudhury A, Eccles C. OC-0683: RTTs at the helm: moving towards RTT-led MR-guided radiotherapy. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00705-2] [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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Corden M, Chin S, Cree A, Hoskin P, McWilliam A, Satiti A, Song Y, Green A, Choudhury A. PO-1216: Can sarcopenia predict outcomes in bladder cancer patients treated with chemoradiotherapy? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01234-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Anjanappa M, Roberts D, Reeves K, Song Y, Akturk N, Choudhury A. PO-1206: Immune response gene expression analysis and response to radical chemoradiation in bladder cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01224-x] [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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Fuertes L, Dubec M, Anjanappa M, Rodgers J, Hales R, Clough A, Aznar M, Choudhury A. PO-1020: Does MR imaging give us advantage in contouring thoracic structures for Cardiac SABR? Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01037-9] [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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Forker L, Bibby B, Yang L, Irlam J, Valentine H, Shenjere P, Wylie J, Leahy M, Gaunt P, Billingham L, Robinson M, Choudhury A, West C. OC-0086: A sarcoma hypoxia signature (nanoString® assay) validates in the phase III VorteX radiotherapy trial. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Elumalai T, Aversa C, Buijtenhuijs B, Conroy R, Croxford W, Das A, Doss G, Enting D, Kitetere E, Sanderson B, Vasudev N, Mistry H, Choudhury A. 765P Predicting survival in urothelial cancer patients after immunotherapy using real-world data. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Patel K, Choudhury A, Hoskin P, Varughese M, James N, Huddart R, Birtle A. Clinical Guidance for the Management of Patients with Urothelial Cancers During the COVID-19 Pandemic - Rapid Review. Clin Oncol (R Coll Radiol) 2020; 32:347-353. [PMID: 32389318 PMCID: PMC7180390 DOI: 10.1016/j.clon.2020.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
The current COVID-19 pandemic presents a substantial obstacle to cancer patient care. Data from China as well as risk models suppose that cancer patients, particularly those on active, immunosuppressive therapies are at higher risks of severe infection from the illness. In addition, staff illness and restructuring of services to deal with the crisis will inevitably place treatment capacities under significant strain. These guidelines aim to expand on those provided by NHS England regarding cancer care during the coronavirus pandemic by examining the known literature and provide guidance in managing patients with urothelial and rarer urinary tract cancers. In particular, they address the estimated risk and benefits of standard treatments and consider the alternatives in the current situation. As a result, it is recommended that this guidance will help form a framework for shared decision making with patients. Moreover, they do not advise a one-size-fits-all approach but recommend continual assessment of the situation with discussion within and between centres.
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