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Growcott S, Renninson E, Rayner L, McKeon J, Ayre G, Comins C, Challapalli A, Owadally W, Beasley M, Hawley L, Hilman S, Strawson-Smith T, Bahl A. Commentary on the New National Institute for Health and Care Excellence Guideline for Metastatic Spinal Cord Compression. Clin Oncol (R Coll Radiol) 2024; 36:200-201. [PMID: 38216346 DOI: 10.1016/j.clon.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 01/05/2024] [Indexed: 01/14/2024]
Affiliation(s)
- S Growcott
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - E Renninson
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - L Rayner
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - J McKeon
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - G Ayre
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - C Comins
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - A Challapalli
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - W Owadally
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - M Beasley
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - L Hawley
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - S Hilman
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - T Strawson-Smith
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
| | - A Bahl
- Department of Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Haematology and Oncology Centre, Bristol, UK
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Gan R, Stokes S, Bahl A, Jose J. Modified transseptal approach in endoscopic transsphenoidal pituitary surgery. J Laryngol Otol 2023; 137:1409-1412. [PMID: 36799014 DOI: 10.1017/s0022215123000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE Transsphenoidal pituitary surgery is commonly performed via a direct transostial approach with a posterior septectomy. However, a technique via an endoscopic transseptal route has been described that avoids a posterior septectomy, but it comes with its own disadvantages. METHODS This paper describes a modification, and discusses its pros and cons. RESULTS The initial incision in the mucosa is placed level with the anterior middle turbinate. The mucoperichondrial flap is raised ipsilaterally until the sphenoid sinus ostium. An incision is made at the osseocartilaginous junction, and the contralateral mucoperichondrial flap is raised. The bony septum and posterior aspect of this flap is excised. The size and position of this window can be adapted. At the end of the operation, the lateralised intact mucoperichondrial flap is moved back to the midline. CONCLUSION Excision or deflection of the cartilaginous septum is not required. It maintains an intact septal mucosa on one side and avoids a septal perforation.
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Affiliation(s)
- R Gan
- Ear, Nose & Throat Department, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | - S Stokes
- Neurosurgery Department, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, UK
| | - A Bahl
- Neurosurgery Department, Hull Royal Infirmary, Hull University Teaching Hospitals NHS Trust, UK
| | - J Jose
- Ear, Nose & Throat Department, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
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Biernacka KM, Barker R, Sewell A, Bahl A, Perks CM. A role for androgen receptor variant 7 in sensitivity to therapy: Involvement of IGFBP-2 and FOXA1. Transl Oncol 2023; 34:101698. [PMID: 37307644 PMCID: PMC10276180 DOI: 10.1016/j.tranon.2023.101698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/10/2023] [Accepted: 05/21/2023] [Indexed: 06/14/2023] Open
Abstract
Prostate cancer (PCa) is one of the leading causes of cancer-related deaths in men. Localised PCa can be treated effectively, but most patients relapse/progress to more aggressive disease. One possible mechanism underlying this progression is alternative splicing of the androgen receptor, with AR variant 7(ARV7) considered to play a major role. Using viability assays, we confirmed that ARV7-positive PCa cells were less sensitive to treatment with cabazitaxel and an anti-androgen-enzalutamide. Also, using live-holographic imaging, we showed that PCa cells with ARV7 exhibited an increased rate of cell division, proliferation, and motility, which could potentially contribute to a more aggressive phenotype. Furthermore, protein analysis demonstrated that ARV7 knock-down was associated with a decrease in insulin-like growth factor-2 (IGFBP-2) and forkhead box protein A1(FOXA1). This correlation was confirmed in-vivo using PCa tissue samples. Spearman rank correlation analysis showed significant positive associations between ARV7 and IGFBP-2 or FOXA1 in tissue from patients with PCa. This association was not present with the AR. These data suggest an interplay of FOXA1 and IGFBP-2 with ARV7-mediated acquisition of an aggressive prostate cancer phenotype.
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Affiliation(s)
- K M Biernacka
- Cancer Endocrinology Group, Translational Health Sciences, University of Bristol Southmead Hospital, BS10 5NB, Bristol, UK
| | - R Barker
- Cancer Endocrinology Group, Translational Health Sciences, University of Bristol Southmead Hospital, BS10 5NB, Bristol, UK
| | - A Sewell
- Department of Cellular Pathology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - A Bahl
- Bristol Haematology and Oncology Centre, Department of Clinical Oncology, University Hospitals Bristol, Bristol BS2 8ED, UK
| | - C M Perks
- Cancer Endocrinology Group, Translational Health Sciences, University of Bristol Southmead Hospital, BS10 5NB, Bristol, UK.
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Bahl A, Qureshi B, Bravo C, Mahr C, Li S. Race and Incidence of Right Heart Failure after Left Ventricular Assist Device Implantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Bahl A, Panda N, Bakshi J, Verma R, Oinam A, Mohindra S, Ghoshal S, Gupta R. 23P Treatment outcomes in nasal cavity and paranasal sinus tumors treated with postoperative volumetric modulated arc therapy. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Renninson E, Sonker P, Challapalli A, Hudson Z, Hilman S, Bahl A. Audit of Avelumab Maintenance Therapy for Advanced or Metastatic Urothelial Carcinoma Treated in the Early Access Scheme. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Renninson E, Channell K, Ball J, Masson S, Challapalli A, Bahl A. Patient Experience and Impact of Rectal Spacers on Dosimetry and Acute Toxicity in Patients Undergoing Radical Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2023. [DOI: 10.1016/j.clon.2022.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Johnson S, Pai E, Voroba A, Chen NW, Bahl A. 222 ED-ACT, Examining D-dimer and Empiric Anti-coagulation in COVID-19 Related Thrombosis. Ann Emerg Med 2022. [PMCID: PMC9519214 DOI: 10.1016/j.annemergmed.2022.08.246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Challapalli A, Ratnayake G, McGrane J, Frazer R, Gupta S, Parslow D, Kingdon S, Lydon A, Sharma A, Tuthill M, McCusker C, Ford V, Ferrera A, Malik J, Boh Z, Jones E, T.R. Geldart, Nelmes S, Brown J, Bahl A. 1463P Patterns of care and outcomes of metastatic renal cell carcinoma (mRCC) patients (pts) with bone metastases (BM): A UK multicenter review. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Ratnayake G, Challapalli A, McGrane J, Frazer R, Gupta S, Parslow D, Kingdon S, Lydon A, Sharma A, Tuthill M, McCartney T, Jabbar R, Charnley N, Malik J, Abhi D, Chau C, Geldart T, Halstead A, Anuforom U, Bahl A. 1457P A UK multicentre retrospective review of metastatic renal cell carcinoma (mRCC) patients (pts) outcomes with brain metastases (BM) in the modern era. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Krebs M, Lord S, Kenny L, Baird R, MacPherson I, Bahl A, Clack G, Ainscow E, Barrett A, Dickinson P, Fuchter M, Lehnert M, Ali S, Mcintosh S, Coombes R. 230MO First in human, modular study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in patients with advanced solid malignancies. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Howell S, Krebs M, Lord S, Kenny L, Bahl A, Clack G, Ainscow E, Arkenau HT, Mansi J, Palmieri C, Richards P, Jeselsohn R, Mitri Z, Gradishar W, Sardesai S, O'Shaughnessy J, Lehnert M, Ali S, McIntosh S, Coombes R. 265P Study of samuraciclib (CT7001), a first-in-class, oral, selective inhibitor of CDK7, in combination with fulvestrant in patients with advanced hormone receptor positive HER2 negative breast cancer (HR+BC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bahl A, Rajamanickam T, Isaacs R, Oberoi A. POS-560 HEMODIALYSIS CATHETER ASSOCIATED BLOODSTREAM INFECTIONS (CABSI) AT A TERTIARY CARE HOSPITAL IN NORTH INDIA: INCIDENCE,OUTCOME AND ANTIBIOGRAM OF THE ISOLATED ORGANISMS. Kidney Int Rep 2021. [DOI: 10.1016/j.ekir.2021.03.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Biswas I, Bahl A, Kumar B, Singh H, Thingnam S, Puri G. COVID-19 Infection in a 13-year-old Heart Transplant Recipient in Immediate Post Transplant Period - A Case Report. J Heart Lung Transplant 2021. [PMCID: PMC7979411 DOI: 10.1016/j.healun.2021.01.1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Experience regarding course and outcome of Covid-19 infection in heart transplant recipients is limited. Case fatality rate of 25% of covid-19 infection in adult recipients of heart transplant and mild and self-limited disease in young heart transplant patients have been reported in small case series. We describe a case where a 13 year old patient contracted covid-19 infection on 7th post-operative day after undergoing heart transplant and was subsequently discharged from hospital uneventfully. Case Report A 13 year old boy, with dilated cardiomyopathy underwent orthotopic heart transplant surgery. In the immediate pre-operative period, the real-time polymerase chain reaction (RTPCR) of nasopharyngeal swabs of both the recipient and the brain-dead organ donor were negative for severe acute respiratory syndrome coronavirus type 2 (SARS CoV 2). The intraoperative and immediate postoperative periods were uneventful. The recipient got weaned off from mechanical ventilation on the 1st postoperative day and O2 support was weaned off on 4th postoperative day. He was put on immunosuppressive regimen consisting of mycophenolate mofetil, tacrolimus and prednisone. On 7th postoperative day, he complained of fever, sore throat and dry cough. Nasopharyngeal swab for RTPCR was sent. It reported positive for SARS CoV 2. He was shifted to isolation facility. He maintained more than 94% saturation on pulse oximetry in room air. Immunosuppressive regimen was continued. He was administered 5-day course of remdesivir. Inotropic support was weaned off on 10th postoperative day. On serial bedside echocardiography, the allograft function was found to be normal throughout. He was kept on prophylactic antimicrobial, antifungal and anti-cytomegaloviral therapy and on prophylactic dose of low molecular weight heparin. There was initial rise in neutrophil lymphocyte ratio (17), C reactive protein (58 mg/l), ferritin (871 ng/ml), D-dimer (1904 ng/ml), Troponin T (227 pg/ml) levels, which gradually came down to within normal limits. He was discharged on 38th postoperative day to a home isolation facility as his RTPCR for SARS CoV 2 was still positive, although he remained completely asymptomatic for the last 21 days. Summary The course of Covid-19 infection in the immediate post-transplant period of this young heart transplant recipient was largely uneventful.
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Ballari N, Rai B, Bahl A, Mittal BR, Ghoshal S. Prospective observational study evaluating acute and delayed treatment related toxicities of prophylactic extended field volumetric modulated arc therapy with concurrent cisplatin in cervical cancer patients with pelvic lymph node metastasis. Tech Innov Patient Support Radiat Oncol 2021; 17:48-56. [PMID: 33748442 PMCID: PMC7970137 DOI: 10.1016/j.tipsro.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To evaluate the treatment related acute and delayed toxicities of extended field Volumetric modulated arc therapy (VMAT) with concurrent chemotherapy in patients of locally advanced cervical cancer with pelvic lymph nodes. MATERIAL AND METHODS From 2014 to 2016, 15 patients of locally advanced cervical cancer with Fluoro-deoxyglucose positron emission tomography (FDG-PET) positive pelvic lymph nodes were treated with extended field Simultaneous integrated boost (SIB)-VMAT 45 Gy/55 Gy/25#/5weeks and concurrent cisplatin. Acute toxicities were documented according to common terminology criteria for adverse events version 4 (CTCAE v.4). Dose volume parameters and patient characteristics were analyzed for association with toxicities. RESULTS Median age of patients at diagnosis was 48 years. 40% (6 patients) were stage IIB & 60% (9 patients) were stage IIIB. Median number of involved pelvic lymph nodes was 2 (range, 1-4), commonest location was external iliac lymph node region (86%). Median number of concurrent chemotherapy cycles received was five. Treatment was well tolerated and there were no grade ≥ 3 acute toxicities. Commonest acute toxicities observed were vomiting (≥grade2 -13.3%) followed by & nausea (grade ≥ 2 in 6%) and were associated with volume of bowel bag receiving 45 Gy. Constitutional symptoms (≥grade 2) were observed in 6% patients and had no dosimetric associations. At a median follow up of 43 months, delayed ≥ grade1, 2, 3 toxicity were observed in 80%, 0%, and 0% respectively with diarrhea being the commonest. CONCLUSION Prophylactic para aortic extended field VMAT with concurrent chemotherapy for locally advanced cervical cancer is well tolerated with acceptable acute toxicity profile. Significant grade 3 acute/delayed toxicities were not observed in this cohort of patients.
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Affiliation(s)
- N Ballari
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - B Rai
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - A Bahl
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - B R Mittal
- Nuclear Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - S Ghoshal
- Departments of Radiotherapy, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Gullick G, Mohan V, Gibbs L, Comins C, Braybrooke J, Jenkins J, Bahl A, Caws C. Leptomeningeal Disease in Breast Cancer, Bristol Experience. Clin Oncol (R Coll Radiol) 2020. [DOI: 10.1016/j.clon.2020.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Immerzeel WW, Lutz AF, Andrade M, Bahl A, Biemans H, Bolch T, Hyde S, Brumby S, Davies BJ, Elmore AC, Emmer A, Feng M, Fernández A, Haritashya U, Kargel JS, Koppes M, Kraaijenbrink PDA, Kulkarni AV, Mayewski PA, Nepal S, Pacheco P, Painter TH, Pellicciotti F, Rajaram H, Rupper S, Sinisalo A, Shrestha AB, Viviroli D, Wada Y, Xiao C, Yao T, Baillie JEM. Importance and vulnerability of the world’s water towers. Nature 2019; 577:364-369. [DOI: 10.1038/s41586-019-1822-y] [Citation(s) in RCA: 477] [Impact Index Per Article: 95.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/11/2019] [Indexed: 11/09/2022]
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18
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Price J, Hijazi M, Clavette-Lachapelle L, Bahl A. 346 Ultra Long Versus Standard Long Peripheral Intravenous Catheters: A Randomized Controlled Trial of Ultrasound-Guided Catheter Survival. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bahl A, Elangovan A, Oinam A, Kumar R, Mittal B, Verma R, Panda N, Ghoshal S. PO-080 Radiotherapy versus concurrent chemo radiotherapy in cancers of unknown primary of Head and Neck. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30246-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Randhawa M, Jones R, Stratton I, Bahl A, Bottomley D, Carruthers H. The National Radium-223 Dichloride Audit Group: Data from Patients in 17 UK Oncology Centres with Metastatic Castrate-resistant Prostate Cancer Treated with Radium-223 Dichloride. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2018.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bahl A, Choudhary P, Bhatia K, Singhla S, Shrivastava G, Bal J, Anand A, Chaturvedi H. Palliative chemotherapy (CT) with or without cetuximab (CTX) in recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN): An Indian retrospective analysis. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy438.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Elangovan A, Bahl A, Patel F, Dracham C, Rai B, Trivedi G. Is bone marrow sparing intensity modulated radiotherapy better than 3-dimensional conformal radiotherapy in reducing haematological toxicities during pelvic irradiation in locally advanced carcinoma cervix?: A prospective study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy436.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sharma A, Bahl A, Kirk H, White P, Law R, Challapalli A. Efficacy and Toxicity of Hypofractionated Palliative Radiation Therapy for Muscle Invasive Bladder Cancer in the Elderly: A Single Institution Experience. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kirk H, Challapalli A, Braybrooke J, Bahl A. Stage 1 Testicular Seminomas Treated with Single Cycle Carboplatin: Outcomes and Management of Relapse: A Single-Centre Experience. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Velikova G, Williams LJ, Willis S, Dixon JM, Loncaster J, Hatton M, Clarke J, Kunkler IH, Russell NS, Alhasso A, Adamson D, Algurafi H, Allerton R, Anandadas C, Bahl A, Barraclough L, Barrett-Lee P, Barthakur U, Bedi C, Beresford M, Bishop J, Blackman G, Bliss P, Bloomfield D, Blunt M, Branson T, Brazil L, Brunt A, Chakrabarti A, Chittalie A, Churn M, Clarke J, Cleator S, Crellin P, Danwata F, De-Silva-Minor S, Dhadda A, Eicholz A, Fernando I, Forrest J, Fraser J, Geropantas K, Goodman A, Grieve R, Griffin M, Hadaki M, Hall A, Hatton M, Hicks J, Hignett S, Hogg M, Jyothirmayi R, Khan M, Kumar S, Lawton P, Lee D, Lewinski C, Lim C, Locke I, Loncaster J, Lumsden G, Lupton S, Magee B, Marshall J, Masinghe S, McGregor C, McLennan M, Memtsa P, Milanovic D, Misra V, Mithal N, Mukesh MB, Neal A, Needleman S, Persic M, Quigley M, Raj S, Riddle P, Ritchie D, Roberts F, Robson P, Roe H, Rolles M, Shah N, Sharma R, Sherwin E, Simmonds P, Skailles G, Skaria S, Soe W, Sripadam R, Stevens A, Stockdale A, Storey N, Storey N, Syndikus I, Thorp N, Thorp N, Upadhyay S, Varughese M, Walji N, Welch R, Wells T, Wolstenholme V, Wolstenholme V, Woodings P, Yuille F. Quality of life after postmastectomy radiotherapy in patients with intermediate-risk breast cancer (SUPREMO): 2-year follow-up results of a randomised controlled trial. Lancet Oncol 2018; 19:1516-1529. [DOI: 10.1016/s1470-2045(18)30515-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 11/12/2022]
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Shotkin P, Hang B, Brackney A, Joseph S, Karabon P, Nnanabu I, Mohammad A, Bahl A. 173 A Comparison of Ultrasound-Guided Vascular Access Catheter Survival between Standard Long Intravenous Lines and Extended Dwell Catheters. Ann Emerg Med 2018. [DOI: 10.1016/j.annemergmed.2018.08.178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wahlstrand JK, Zahedpour S, Bahl A, Kolesik M, Milchberg HM. Bound-Electron Nonlinearity Beyond the Ionization Threshold. Phys Rev Lett 2018; 120:183901. [PMID: 29775376 PMCID: PMC6074032 DOI: 10.1103/physrevlett.120.183901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Indexed: 05/25/2023]
Abstract
We present absolute space- and time-resolved measurements of the ultrafast laser-driven nonlinear polarizability in argon, krypton, xenon, nitrogen, and oxygen up to ionization fractions of a few percent. These measurements enable determination of the strongly nonperturbative bound-electron nonlinear polarizability well beyond the ionization threshold, where it is found to remain approximately quadratic in the laser field, a result normally expected at much lower intensities where perturbation theory applies.
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Affiliation(s)
- J. K. Wahlstrand
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, MD 20742
- Engineering Physics Division, National Institute of Standards and Technology, Gaithersburg, MD 20899
| | - S. Zahedpour
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, MD 20742
| | - A. Bahl
- College of Optical Sciences, University of Arizona, Tucson, AZ 85712
| | - M. Kolesik
- College of Optical Sciences, University of Arizona, Tucson, AZ 85712
| | - H. M. Milchberg
- Institute for Research in Electronics and Applied Physics, University of Maryland, College Park, MD 20742
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Zielinska HA, Holly JMP, Bahl A, Perks CM. Inhibition of FASN and ERα signalling during hyperglycaemia-induced matrix-specific EMT promotes breast cancer cell invasion via a caveolin-1-dependent mechanism. Cancer Lett 2018; 419:187-202. [PMID: 29331414 PMCID: PMC5832758 DOI: 10.1016/j.canlet.2018.01.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/25/2017] [Accepted: 01/08/2018] [Indexed: 12/11/2022]
Abstract
Since disturbed metabolic conditions such as obesity and diabetes can be critical determinants of breast cancer progression and therapeutic failure, we aimed to determine the mechanism responsible for their pro-oncogenic effects. Using non-invasive, epithelial-like ERα-positive MCF-7 and T47D human breast cancer cells we found that hyperglycaemia induced epithelial to mesenchymal transition (EMT), a key programme responsible for the development of metastatic disease. This was demonstrated by loss of the epithelial marker E-cadherin together with increases in mesenchymal markers such as vimentin, fibronectin and the transcription factor SLUG, together with an enhancement of cell growth and invasion. These phenotypic changes were only observed with cells grown on fibronectin and not with those plated on collagen. Analyzing metabolic parameters, we found that hyperglycaemia-induced, matrix-specific EMT promoted the Warburg effect by upregulating glucose uptake, lactate release and specific glycolytic enzymes and transporters. We showed that silencing of fatty acid synthase (FASN) and the downstream ERα, which we showed previously to mediate hyperglycaemia-induced chemoresistance in these cells, resulted in suppression of cell growth: however, this also resulted in a dramatic enhancement of cell invasion and SLUG mRNA levels via a novel caveolin-1-dependent mechanism.
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Affiliation(s)
- H A Zielinska
- IGFs & Metabolic Endocrinology Group, School of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 5NB, UK.
| | - J M P Holly
- IGFs & Metabolic Endocrinology Group, School of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 5NB, UK
| | - A Bahl
- Department of Clinical Oncology, Bristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - C M Perks
- IGFs & Metabolic Endocrinology Group, School of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 5NB, UK
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Bahl A, Singh R, Wadhwa J, Gupta S, Ahmed M, Uppal PN, Parikh PM, Aggarwal S. Practical consensus recommendations regarding the management of HER2 neu positive early breast cancer. South Asian J Cancer 2018; 7:102-105. [PMID: 29721473 PMCID: PMC5909284 DOI: 10.4103/sajc.sajc_111_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Over-expression of HER2 is generally considered to be a negative prognostic feature because it accompanies an increase in breast cancer mortality. However, the development of agents that specifically target HER2 has improved the management of patients with these tumours. This expert group used data from published literature, practical experience and opinion of a large group of academic oncologists to arrive at these practical consensus recommendations with regards to the use of these agents and the management of HER2 neu early breast cancer for the benefit of community oncologists.
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Affiliation(s)
- A. Bahl
- Deparment of Medical Oncology, Max Hospital, New Delhi, India
| | - R. Singh
- Department of Medical Oncology, Artemis Hospital, Gurugram, India
| | - J. Wadhwa
- Department of Medical Oncology, Medanta Hospital, Gurugram, India
| | - S. Gupta
- Department of Medical Oncology, Sarvodaya Hospital, New Delhi, India
| | - M. Ahmed
- Department of Radiation Oncology, Jolly Grant Himalayan Institute, Dehradoon, India
| | - P. N. Uppal
- Department of Surgical Oncology, Jaipur Golden Hospital, New Delhi, India
| | - Purvish M. Parikh
- Department of Oncology, Shalby Cancer and Research Institute, Mumbai, Maharashtra, India
| | - S. Aggarwal
- Department of Medical Oncology, Sir Ganga Ram Hospital, New Delhi, India
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Shams A, Hung J, Bahl A. Ability of computed tomography to predict right heart strain on an echocardiogram in patients with acute pulmonary embolus. J BIOL REG HOMEOS AG 2018; 32:365-370. [PMID: 29685020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Patients with submassive pulmonary embolism (PE) resulting in right heart strain (RHS) have an increased risk of mortality compared to those with a preserved right ventricular function. This study aimed to investigate the predictive value of computed tomography pulmonary angiogram (CTPA) findings of right heart strain in patients with computed tomography (CT)-proven PE for the diagnosis of right heart strain by echocardiogram (ECHO). The institutional review board (IRB) approved retrospective chart review of the adult emergency department patients diagnosed with an acute PE between 2012 and 2016. A total of 128 patients diagnosed with RHS by CT who had received an ECHO during their hospitalization were included in the study. Descriptive statistics were run for the variables of interest. The majority of patients (101 patients) with reported findings of RHS on CT had similar findings on ECHO. In our cohort, a finding of enlarged right atrium (RA) on CT was 100% predictive of RHS diagnosis on ECHO, whereas having interventricular septal bowing alone on CT was the least predictive of RHS on subsequent ECHO (61%). The 2 remaining subgroups: right ventricle (RV) enlargement alone and RV enlargement with either interventricular septal bowing/hepatic vein blood reflux or both lies somewhere in between, with 80% of these patients showing strain on ECHO. We found that signs of RHS on CT are predictive of strain on an ECHO (78%) and RA enlargement in any combination was the most predictive finding of RHS on ECHO (100%). Future prospective randomized investigations are needed to confirm such findings.
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Affiliation(s)
- A Shams
- Department of Emergency Medicine, Beaumont Health System, Royal Oak, Michigan, United States of America
| | - J Hung
- Department of Biomedical Sciences, Oakland University William Beaumont School of Medicine, Rochester, Michigan, United States of America
| | - A Bahl
- Department of Emergency Medicine, Beaumont Health System, Royal Oak, Michigan, United States of America
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Zielinska HA, Bahl A, Holly JMP, Perks CM. Abstract P6-02-09: Hyperglycaemia and fibronectin: The criminal partnership during breast cancer progression. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-02-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- HA Zielinska
- University of Bristol, Bristol, United Kingdom; Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - A Bahl
- University of Bristol, Bristol, United Kingdom; Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - JMP Holly
- University of Bristol, Bristol, United Kingdom; Bristol Haematology and Oncology Centre, Bristol, United Kingdom
| | - CM Perks
- University of Bristol, Bristol, United Kingdom; Bristol Haematology and Oncology Centre, Bristol, United Kingdom
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Biernacka KM, Persad RA, Bahl A, Gillatt D, Holly JMP, Perks CM. Hyperglycaemia-induced resistance to Docetaxel is negated by metformin: a role for IGFBP-2. Endocr Relat Cancer 2017; 24:17-30. [PMID: 27754854 PMCID: PMC5118949 DOI: 10.1530/erc-16-0095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/17/2016] [Indexed: 12/13/2022]
Abstract
The incidence of many common cancers varies between different populations and appears to be affected by a Western lifestyle. Highly proliferative malignant cells require sufficient levels of nutrients for their anabolic activity. Therefore, targeting genes and pathways involved in metabolic pathways could yield future therapeutics. A common pathway implicated in energetic and nutritional requirements of a cell is the LKB1/AMPK pathway. Metformin is a widely studied anti-diabetic drug, which improves glycaemia in patients with type 2 diabetes by targeting this pathway. We investigated the effect of metformin on prostate cancer cell lines and evaluated its mechanism of action using DU145, LNCaP, PC3 and VCaP prostate cancer cell lines. Trypan blue dye-exclusion assay was used to assess levels of cell death. Western immunoblotting was used to determine the abundance of proteins. Insulin-like growth factor-binding protein-2 (IGFBP-2) and AMPK genes were silenced using siRNA. Effects on cell morphology were visualised using microscopy. IGFBP-2 gene expression was assessed using real-time RT-PCR. With DU145 and LNCaP cells metformin alone induced cell death, but this was reduced in hyperglycaemic conditions. Hyperglycaemia also reduced the sensitivity to Docetaxel, but this was countered by co-treatment with metformin. LKB1 was required for the activation of AMPK but was not essential to mediate the induction of cell death. An alternative pathway by which metformin exerted its action was through downregulation of IGFBP-2 in DU145 and LNCaP cells, independently of AMPK. This finding could have important implications in relation to therapeutic strategies in prostate cancer patients presenting with diabetes.
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Affiliation(s)
- K M Biernacka
- IGFs & Metabolic Endocrinology GroupSchool of Clinical Sciences, Learning & Research Building, Southmead Hospital, Bristol, UK
| | - R A Persad
- Department of UrologySouthmead Hospital, Bristol, UK
| | - A Bahl
- Department of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - D Gillatt
- Department of UrologySouthmead Hospital, Bristol, UK
| | - J M P Holly
- IGFs & Metabolic Endocrinology GroupSchool of Clinical Sciences, Learning & Research Building, Southmead Hospital, Bristol, UK
| | - C M Perks
- IGFs & Metabolic Endocrinology GroupSchool of Clinical Sciences, Learning & Research Building, Southmead Hospital, Bristol, UK
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Nair V, Madan H, Sofat S, Ganguli P, Jacob MJ, Datta R, Bharadwaj P, Sarkar RS, Pandit AJ, Nityanand S, Goel PK, Garg N, Gambhir S, George PV, Chandy S, Mathews V, George OK, Talwar KK, Bahl A, Marwah N, Bhatacharya A, Bhargava B, Airan B, Mohanty S, Patel CD, Sharma A, Bhatnagar S, Mondal A, Jose J, Srivastava A. Authors' response. Indian J Med Res 2016; 143:833. [PMID: 27748312 PMCID: PMC5094127 DOI: 10.4103/0971-5916.192081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- V Nair
- Army Hospital (Research & Referral), New Delhi, India
| | - H Madan
- Army Hospital (Research & Referral), New Delhi, India
| | - S Sofat
- Army Hospital (Research & Referral), New Delhi, India
| | - P Ganguli
- Army Hospital (Research & Referral), New Delhi, India
| | - M J Jacob
- Army Hospital (Research & Referral), New Delhi, India
| | - R Datta
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - P Bharadwaj
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - R S Sarkar
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - A J Pandit
- Military Hospital, Cardio Thoracic Centre, Pune, India
| | - S Nityanand
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - P K Goel
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - N Garg
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - S Gambhir
- Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - P V George
- Christian Medical College, Vellore, India
| | - S Chandy
- Christian Medical College, Vellore, India
| | - V Mathews
- Christian Medical College, Vellore, India
| | - O K George
- Christian Medical College, Vellore, India
| | - K K Talwar
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - A Bahl
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - N Marwah
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - A Bhatacharya
- Postgraduate Institute of Medical Education & Research, Chandhigarh, India
| | - B Bhargava
- All India Institute of Medical Sciences, New Delhi, India
| | - B Airan
- All India Institute of Medical Sciences, New Delhi, India
| | - S Mohanty
- All India Institute of Medical Sciences, New Delhi, India
| | - C D Patel
- All India Institute of Medical Sciences, New Delhi, India
| | - A Sharma
- Department of Biotechnology, Government of India, New Delhi, India
| | - S Bhatnagar
- All India Institute of Medical Sciences, New Delhi, India
| | - A Mondal
- Institute of Nuclear Medicine & Allied Sciences, Delhi, India
| | - J Jose
- Christian Medical College, Vellore, India
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Hilman S, Smith R, Masson S, Coomber H, Bahl A, Challapalli A, Jacobs P. Implementation of a Daily Transperineal Ultrasound System as Image-guided Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2016; 29:e49. [PMID: 27448432 DOI: 10.1016/j.clon.2016.07.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 07/10/2016] [Indexed: 11/17/2022]
Affiliation(s)
- S Hilman
- Bristol Cancer Institute, Bristol, UK
| | - R Smith
- Bristol Cancer Institute, Bristol, UK
| | - S Masson
- Bristol Cancer Institute, Bristol, UK
| | - H Coomber
- Bristol Cancer Institute, Bristol, UK
| | - A Bahl
- Bristol Cancer Institute, Bristol, UK
| | | | - P Jacobs
- Bristol Cancer Institute, Bristol, UK
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- A Thompson
- Urology Department, Wrightington, Wigan and Leigh NHS Foundation Trust, UK
| | - A Adamson
- Department of Urology, Royal Hampshire County Hospital, UK
| | - A Bahl
- Bristol Oncology and Haematology Centre, UK
| | - J Borwell
- Department of Urology, Frimley Park Hospital, UK
| | - D Dodds
- Beatson West of Scotland Cancer Care, UK
| | - C Heath
- Southampton Oncology Centre, Southampton General Hospital, UK
| | | | | | - P Patel
- Queen Elizabeth Hospital, UK
| | - J Peters
- Whipps Cross Hospital, Barts Health NHS Trust, UK
| | - H Payne
- University College Hospital, UK
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Eylert MF, Hounsome LS, Persad RA, Bahl A, Jefferies ER, Verne J, Mostafid H. Falling bladder cancer incidence from 1990 to 2009 is not producing universal mortality improvements. Journal of Clinical Urology 2016. [DOI: 10.1177/2051415813492724] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The objective of this article is to obtain up-to-date epidemiological statistics of bladder cancer in England. Methods We collected incidence from the National Cancer Data Repository (NCDR), survival from the national Cancer Information System (CIS), ethnicity information from the Hospital Episode Statistics (HES), mortality and smoking rates from the Office for National Statistics (ONS). Results Incidence of bladder cancer has fallen continuously. Mortality has reduced less, leading to worsening survival. Bladder cancer mainly affects men, the most deprived, and the elderly. The gender gap is decreasing, and the deprivation gap is unchanged. Mortality is unchanged in the youngest, oldest and least deprived females. Mortality has recently increased in the oldest males. The highest incidence and mortality is found in industrial areas. This study is limited by i) its retrospective design using existing databases, allowing identification of associations and statistical differences, but not causation; and ii) very restricted ethnicity data. onclusion Reductions in bladder cancer incidence and mortality in England coincide with a decrease in high-risk occupations and public health measures to reduce smoking. Some risk factors in modern living may as yet be unidentified. It remains paramount to ensure equity of access and treatment regardless of gender, age, region and social deprivation to further improve mortality.
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Affiliation(s)
- MF Eylert
- Department of Urology, Morriston Hospital, UK
| | | | - RA Persad
- Department of Urology, Bristol Royal Infirmary, UK
| | - A Bahl
- Bristol Haematology and Oncology Centre, UK
| | - ER Jefferies
- Department of Urology, Royal United Hospital, UK
| | - J Verne
- South West Public Health Observatory, UK
| | - H Mostafid
- Department of Urology, The Royal Berkshire Hospital, UK
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Duran I, Fink M, Bahl A, Hoefeler H, Mahmood A, Lüftner D, Ghazal H, Wei R, Chung K, Hechmati G, Green J, Atchison C. Health resource utilisation associated with skeletal-related events in patients with bone metastases secondary to solid tumours: regional comparisons in an observational study. Eur J Cancer Care (Engl) 2016; 26. [DOI: 10.1111/ecc.12452] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2015] [Indexed: 12/25/2022]
Affiliation(s)
- I. Duran
- Medical Oncology Department; Centro Integral Oncologico Clara Campal; Madrid Spain
| | - M.G. Fink
- Orange Coast Memorial Medical Center; Fountain Valley CA USA
| | - A. Bahl
- Bristol Haematology and Oncology Centre; University Hospitals Bristol; Bristol UK
| | - H. Hoefeler
- Forschungszentrum Ruhr; KliFoCenter GmbH; Witten Germany
| | - A. Mahmood
- Cancer Specialists of South Texas; Corpus Christi Cancer Center; Corpus Christi TX USA
| | - D. Lüftner
- Universitätsmedizin Berlin; Charité Campus Benjamin Franklin; Berlin Germany
| | | | - R. Wei
- Biostatistics; Amgen, Inc.; Thousand Oaks CA
| | - K.C. Chung
- Global Health Economics; Amgen Inc.; Thousand Oaks CA USA
| | - G. Hechmati
- Global Health Economics; Amgen Inc.; Zug Switzerland
| | - J. Green
- Global Study Management; Amgen Inc.; Thousand Oaks CA
| | - C. Atchison
- Global Health Economics; Amgen Inc.; Thousand Oaks CA USA
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Zeng L, Zielinska HA, Arshad A, Shield JP, Bahl A, Holly JMP, Perks CM. Hyperglycaemia-induced chemoresistance in breast cancer cells: role of the estrogen receptor. Endocr Relat Cancer 2016; 23:125-34. [PMID: 26647383 DOI: 10.1530/erc-15-0507] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/08/2022]
Abstract
Breast cancer patients with diabetes respond less well to chemotherapy; in keeping with this we determined previously that hyperglycaemia-induced chemoresistance in estrogen receptor (ERα) positive breast cancer cells and showed that this was mediated by fatty acid synthase (FASN). More recent evidence suggests that the effect of metabolic syndrome and diabetes is not the same for all subtypes of breast cancer with inferior disease-free survival and worse overall survival only found in women with ERα positive breast cancer and not for other subtypes. Here we examined the impact of hyperglycaemia on ERα negative breast cancer cells and further investigated the mechanism underlying chemoresistance in ERα with a view to identifying strategies to alleviate hyperglycaemia-induced chemoresistance. We found that hyperglycaemia-induced chemoresistance was only observed in ERα breast cancer cells and was dependent upon the expression of ERα as chemoresistance was negated when the ERα was silenced. Hyperglycaemia-induced an increase in activation and nuclear localisation of the ERα that was downstream of FASN and dependent on the activation of MAPK. We found that fulvestrant successfully negated the hyperglycaemia-induced chemoresistance, whereas tamoxifen had no effect. In summary our data suggests that the ERα may be a predictive marker of poor response to chemotherapy in breast cancer patients with diabetes. It further indicates that anti-estrogens could be an effective adjuvant to chemotherapy in such patients and indicates the importance for the personalised management of breast cancer patients with diabetes highlighting the need for clinical trials of tailored chemotherapy for diabetic patients diagnosed with ERα positive breast cancers.
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Affiliation(s)
- L Zeng
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - H A Zielinska
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - A Arshad
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - J P Shield
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - A Bahl
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - J M P Holly
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
| | - C M Perks
- IGFs and Metabolic Endocrinology GroupSchool of Clinical Sciences, University of Bristol, Learning and Research Building, Southmead Hospital, Bristol BS10 1TD, UKDepartment of Clinical OncologyBristol Haematology and Oncology Centre, University Hospitals Bristol, Bristol, UK
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Kannan S, Bahl A, Khosla PP. Knowledge and perception of off-label drug use amongst prescribing physicians in a tertiary care hospital. Int J Risk Saf Med 2016; 27:219-23. [PMID: 26756895 DOI: 10.3233/jrs-150664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Off-label drug use is commonly reported in various disciplines of medicine. Considering the lacunae of studies from prescribers in the Indian subcontinent, the present study was conducted to explore their awareness and views of off-label drug use. METHODS A validated questionnaire was administered to interns, junior residents and faculty members who were recruited in the present study of various medical and surgical departments of Subharti Medical College, Meerut, India, a tertiary care teaching hospital. Descriptive statistics was used for analyzing the data. RESULTS A total of 59/85 (69%) stated that they have used a drug in an off-label manner mainly [31/85 (36.5%)] related to indications. Nearly half of the study participants (41/85, 48.2%) considered prescribing an off-label drug illegal and only 25/85 (29.3%) participants felt that they had adequate knowledge regarding the use of drugs in off-label manner. Out of the total 70 participants who answered the question related to informing parents/relatives while prescribing an off label drug, only 39/70 (55.7%) answered affirmative. Out of the remaining 31/70 (44.3%) of participants who did not inform about prescribing an off label drug, 9/31 (29%) felt that it was illegal and more than two-third (24/31, 77%) felt their knowledge on off-label drug use was insufficient. Surprisingly, 74/82 (90.2%) participants felt that a drug approved to be used in adults cannot be used in children for the same indication despite not having any alternative in pediatric age group. CONCLUSION We found an inadequate knowledge regarding the off-label drug use amongst the prescribers in a tertiary care medical college hospital. Many of the physicians felt such use as illegal and do not inform the patient's relatives about such acts. Considering the legal issues, clearly there exists a need to patch up this lacuna in developing countries like India.
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Affiliation(s)
- S Kannan
- Department of Health Sciences, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - A Bahl
- Department of Phamacology, Subharti Medical College and Hospital, Meerut, Uttar Pradesh, India
| | - P P Khosla
- Department of Phamacology, Subharti Medical College and Hospital, Meerut, Uttar Pradesh, India
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Hallam S, Govindarajulu S, Huckett R, Bahl A. Breast-conserving Therapy and the Risk of Second Primaries in BRCA1/2 Mutation Carriers. Clin Oncol (R Coll Radiol) 2015; 28:225. [PMID: 26712587 DOI: 10.1016/j.clon.2015.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/19/2015] [Indexed: 11/17/2022]
Affiliation(s)
- S Hallam
- University Hospitals Bristol, Bristol, UK
| | | | - R Huckett
- University Hospitals Bristol, Bristol, UK
| | - A Bahl
- University Hospitals Bristol, Bristol, UK
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Christodouleas J, Baumann B, Bosch W, Bahl A, Birtle A, Breau R, Challapalli A, Chang A, Choudhury A, Daneshmand S, Feldman A, Guzzo T, Hilman S, Jani A, Malkowicz B, Master V, Mitra A, Porten S, Efstathiou J, Eapen L. Development and Validation of Contouring Guidelines for Postcystectomy Adjuvant Radiation of Bladder Cancer. Int J Radiat Oncol Biol Phys 2015. [DOI: 10.1016/j.ijrobp.2015.07.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Bahl A, Brown JM, Wright EM, Kolesik M. Assessment of the metastable electronic state approach as a microscopically self-consistent description for the nonlinear response of atoms. Opt Lett 2015; 40:4987-4990. [PMID: 26512500 DOI: 10.1364/ol.40.004987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This Letter presents the first quantitative assessment of the recently proposed metastable electronic state approach (MESA) for calculation of the nonlinear optical response of noble gas atoms. Based on the single active electron potentials for several atomic species, Stark resonant states are used to extract the nonlinear polarization and ionization rates free of any additional fitting parameters. It is shown that even the simplest version of the method provides a viable, first-principle-based, and self-consistent alternative to the standard model commonly used for simulations in the field of extreme nonlinear optics.
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Hallam S, Govindarajulu S, Bahl A. BRCA1/2 mutation associated breast cancer, wide local excision and radiotherapy or unilateral mastectomy: A systematic review. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wagstaff J, Jones R, Hawkins R, Porfiri E, Pickering L, Bahl A, Brown J, Buchan S. Treatment patterns and clinical outcomes in patients with renal cell carcinoma in the UK: insights from the RECCORD registry. Ann Oncol 2015; 27:159-65. [PMID: 26489444 PMCID: PMC4684158 DOI: 10.1093/annonc/mdv504] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 10/11/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of the RECCORD registry was to gather real-world UK data on the use of targeted therapies in renal cell carcinoma (RCC) and assess clinical outcomes. Here, demographic and outcome data are presented with the treatment patterns and demographic profile of patients on the registry. PATIENTS AND METHODS Patients were retrospectively identified at seven UK hospitals with large cancer centres in England (5), Scotland (1) and Wales (1). Anonymised data were collected through an online registry covering demographics, treatments and outcomes. Five hundred and fourteen UK adult patients with metastatic RCC were included in the study for analysis. Patients were included if they were treated for metastatic RCC at one of the seven centres, and started systemic anti-cancer treatment from March 2009 to November 2012 inclusive. In addition to demographic factors, the principal outcome measures were overall survival (OS), time to disease progression and toxicity. RESULTS The majority of first-line treatment was with sunitinib; first-line use of pazopanib increased as the study progressed. 15.8% of patients received second-line treatment, half of whom were prescribed everolimus. Median OS (from initiation of first-line treatment) was 23.9 months (95% confidence interval [CI] 18.6-29.1 months), similar to that reported for clinical trials of targeted RCC therapies [Ljungberg B, Campbell SC, Choi HY et al. The epidemiology of renal cell carcinoma. Eur Urol 2011; 60: 615-621; Abe H, Kamai T. Recent advances in the treatment of metastatic renal cell carcinoma. Int J Urol 2013; 20: 944-955; Motzer RJ, Hutson TE, Tomczak P et al. Overall survival and updated results for sunitinib compared with interferon alfa in patients with metastatic renal cell carcinoma. J Clin Oncol 2009; 27: 3584-3590]. OS was significantly longer for those who received second-line treatment after disease progression (33.0 months; 95% CI 30.8-35.2 months) than those who did not (20.9 months; 95% CI 16.4-25.3 months; P = 0.008). CONCLUSIONS RECCORD is a large 'real-world' database assessing metastatic RCC treatment patterns and outcomes. Treatment patterns changed over time as targeted therapies were approved and became widely available; survival data in RECCORD are consistent with those reported for systemic treatments in clinical trials. Kaplan-Meier analysis of results demonstrated that receiving second-line therapy was a major prognostic factor for longer OS.
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Affiliation(s)
- J Wagstaff
- South West Wales Cancer Institute and Swansea University College of Medicine, Swansea
| | - R Jones
- Beatson West of Scotland Cancer Centre, Glasgow
| | - R Hawkins
- The Christie Hospital NHS Trust, Manchester
| | - E Porfiri
- Department of Oncology, Queen Elizabeth Hospital, Birmingham
| | - L Pickering
- Department of Urology, Royal Marsden Hospital, London
| | - A Bahl
- Bristol Haematology and Oncology Centre, Bristol
| | - J Brown
- St James' University Hospital, Leeds
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Jamali A, Ramesh G, Sharafi M, Ditkoff J, Bahl A. 22 Impact of Early Urine Specimen Collection on Emergency Department Time to Disposition. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Bagan M, Bahl A. 379 Comparison of Nurse-Performed Ultrasound-Guided versus Standard of Care Intravenous Access in Emergency Department Patients With Difficult Access. Ann Emerg Med 2015. [DOI: 10.1016/j.annemergmed.2015.07.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Pan S, Bahl A, Gee A, Butt M, Malik Z, Dew R, Birtle A. 2552 Real Life treatment sequences and survival of men with metastatic castrate-resistant prostate cancer (mCRPC) receiving cabazitaxel in UK clinical practice. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31371-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eylert MF, Bahl A, Hounsome L, Verne J, Jefferies ER, Persad RA. The impact of socio-economic deprivation on incidence, treatment and mortality from prostate cancer in England, 1990–2010. Journal of Clinical Urology 2015. [DOI: 10.1177/2051415815594976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To explore any association between socio-economic deprivation and prostate cancer diagnosis and/or treatment. Patients and methods: Data was extracted as follows: We gained the incident cases and staging from the National Cancer Data Repository, survival from the Cancer Information System, mortality from the Office for National Statistics, treatment data from Hospital Episode Statistics and National Clinical Analysis and Specialised Applications Team. Our analysis regarding socio-economic deprivation was controlled for age distribution. Results: We recorded 518,453 diagnoses of prostate cancer; 174,579 prostate cancer deaths; 33,889 prostatectomies and 21,351 radiotherapy treatments. Incidence is increasing in all groups, but the highest is amongst the least deprived. Mortality is decreasing, with survival consistently better in the least deprived. Prostatectomies are more frequent in the least deprived; however, this gap is narrowing. Conclusions: Prostate cancer incidence, survival and treatment are associated with socio-economic deprivation. Prostatectomy rates show a decrease in the gap of inequality. Multiple potential confounding factors, such as rates of prostate specific antigen (PSA) testing and access to health care are associated with socio-economic deprivation. The unifying influences of Improving Outcomes Guidance and the National Treatment Guidelines are intended to counteract the above inequalities. Particularly in prostate cancer, where long-term gain depends on multiple factors, individualised treatment decisions are paramount.
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Affiliation(s)
- MF Eylert
- Department of Urology, University Hospital of Wales, Cardiff, Wales, UK
| | - A Bahl
- Department of Oncology, Bristol Haematology and Oncology Centre, Bristol, UK
| | - L Hounsome
- Knowledge and Intelligence Team, Public Health England, Bristol, UK
| | - J Verne
- Knowledge and Intelligence Team, Public Health England, Bristol, UK
| | - ER Jefferies
- Department of Urology, Southmead Hospital, Bristol, UK
| | - RA Persad
- Department of Urology, Southmead Hospital, Bristol, UK
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Hallam S, Govindarajulu S, Huckett B, Bahl A. BRCA1/2 Mutation-associated Breast Cancer, Wide Local Excision and Radiotherapy or Unilateral Mastectomy: A Systematic Review. Clin Oncol (R Coll Radiol) 2015; 27:527-35. [PMID: 26113392 DOI: 10.1016/j.clon.2015.06.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 05/21/2015] [Accepted: 06/02/2015] [Indexed: 01/13/2023]
Abstract
AIMS BRCA1/2 mutation carriers show reduced apoptotic response to ionising radiation leading to recent debate about the safety of wide local excision and radiotherapy. The aim of the current study was to determine if BRCA1/2 mutation carriers with breast cancer undergoing wide local excision and radiotherapy show increased ipsilateral and contralateral breast tumour recurrence and reduced survival compared with unilateral mastectomy. MATERIALS AND METHODS Following a detailed literature search, the methodology, populations, biases and outcomes of ipsilateral breast tumour recurrence, contralateral breast tumour recurrence and survival were evaluated for 25 articles. RESULTS No differences in outcomes were found between wide local excision and mastectomy. BRCA1/2 mutation status was predictive of contralateral breast cancer only. Radiotherapy reduces the risk of ipsilateral recurrence and confers no increase in contralateral recurrence. CONCLUSION BRCA1/2 mutation status does not preclude treatment with wide local excision and radiotherapy. Given the retrospective studies with inherent flaws and small patient numbers, further large prospective trials are required.
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Affiliation(s)
- S Hallam
- University Hospitals Bristol, UK.
| | | | | | - A Bahl
- University Hospitals Bristol, UK
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Kapoor R, Khosla D, Gupta R, Bahl A, Shukla AK, Sharma SC. Role of neoadjuvant concurrent chemoradiation in locally advanced unresectable pancreatic cancer: a feasibility study at tertiary care centre. Indian J Cancer 2015; 51:176-9. [PMID: 25104204 DOI: 10.4103/0019-509x.138295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pancreatic cancer has an extremely poor prognosis and prolonged survival is achieved only by resection with macroscopic tumor clearance. There is a strong rationale for a neoadjuvant approach, since a relevant percentage of pancreatic cancer patients present with non-metastatic but locally advanced disease. The objective of the present study was to assess the effect of neoadjuvant chemoradiation therapy (NACRT) on tumor response, down staging and resection, toxicity and any survival advantage. MATERIALS AND METHODS A prospective pilot study was carried out from January 2009 to June 2011 in which 15 patients of locally advanced unresectable pancreatic cancer were included. All patients were treated with NACRT protocol with oral Capecitabine and 3D conformal radiotherapy (3DCRT) of 30 Gy in 10 fractions. The patients were restaged 3 to 4 weeks after the completion of NACRT and explored for resection. RESULTS Out of 15 patients, fourteen were evaluable. Four patients underwent surgery, 5 had partial response but remained unresectable, 2 patients had stable disease and 3 had progressive disease. Most of the toxicities were slight and were in grade 1 to 2. None of the patients developed grade 3 or 4 gastrointestinal or hematological toxicity. The median survival was 15 months for resected patients and 8.6 months for unresected patients, respectively. The 2 year actuarial overall survival was 34.6%. CONCLUSION All patients with locally unresectable pancreatic cancer should be offered chemoradiation therapy, in hopes of down staging the tumor for possible resection and achieving higher survival.
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Affiliation(s)
| | - D Khosla
- Department of Radiotherapy and Oncology, Regional Cancer Centre, Chandigarh, Haryana and Punjab, India
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