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Gupta A, McQuaid D, Dunlop A, Barnes H, Mohajer J, Smith G, Nartey J, Morrison K, Herbert T, Alexander S, McNair H, Newbold K, Nutting C, Bhide S, Harrington KJ, Wong KH. Measurement and Incorporation of Laryngeal Motion Using cine-MRI on an MR-Linear Accelerator to Generate Radiation Therapy Plans for Early-stage Squamous Cell Cancers of the Glottis. Adv Radiat Oncol 2024; 9:101490. [PMID: 38681895 PMCID: PMC11046225 DOI: 10.1016/j.adro.2024.101490] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/26/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Swallow-related motion of the larynx is most significant in the cranio-caudal directions and of` short duration. Conventional target definition for radical radiation therapy includes coverage of the whole larynx. This study longitudinally examined respiration- and swallow-related laryngeal motions using cine-magnetic resonance imaging. We further analyzed the dosimetry to organs at risk by comparing 3D-conformal radiation therapy (3D-CRT), volumetric modulated arc therapy (VMAT), and intensity modulated radiation therapy (IMRT) techniques. Methods Fifteen patients with T1-2 N0 glottic squamous cell carcinomas were prospectively recruited for up to 3 cine-MRI scans on the Elekta Unity MR-Linear accelerator, at the beginning, middle, and end of a course of radical radiation therapy. Swallow frequency and motion of the hyoid bone, cricoid and thyroid cartilages, and vocal cords were recorded during swallow and rest. Adapted treatment volumes consisted of gross tumor volume + 0.5-1 cm to a clinical target volume with an additional internal target volume (ITV) for personalized resting-motion. Swallow-related motion was deemed infrequent and was not accounted for in the ITV. We compared radiation therapy plans for 3D-CRT (whole larynx), VMAT (whole larynx), and VMAT and IMRT (ITV for resting motion). Results Resting- and swallow-related motions were most prominent in the cranio-caudal plane. There were no significant changes in the magnitude of motion over the course of radiation therapy. There was a trend of a progressive reduction in the frequency of swallow. Treatment of partial larynx volumes with intensity modulated methods significantly reduced the dose to carotid arteries, compared with treatment of whole larynx volumes. Robustness analysis demonstrated that when accounting for intrafraction swallow, the total dose delivered to the ITV/planning target volume was maintained at above 95%. Conclusions Swallow-related motions are infrequent and accounting for resting motion in an ITV is sufficient. VMAT/IMRT techniques that treat more conformal targets can significantly spare critical organs at risk such as the carotid arteries and thyroid gland, potentially reducing the risk of carotid artery stenosis-related complications and other long-term complications.
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Affiliation(s)
- Amit Gupta
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Dualta McQuaid
- The Joint Department of Physics, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Alex Dunlop
- The Joint Department of Physics, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Helen Barnes
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Jonathan Mohajer
- The Joint Department of Physics, The Royal Marsden Hospital and The Institute of Cancer Research, Sutton, United Kingdom
| | - Gillian Smith
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Jayde Nartey
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Kian Morrison
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Trina Herbert
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Sophie Alexander
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Helen McNair
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Kate Newbold
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Chris Nutting
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Shreerang Bhide
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Kevin Joseph Harrington
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Head & Neck Unit, London, United Kingdom
| | - Kee Howe Wong
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Naderi E, Aguado-Barrera ME, Schack LMH, Dorling L, Rattay T, Fachal L, Summersgill H, Martínez-Calvo L, Welsh C, Dudding T, Odding Y, Varela-Pazos A, Jena R, Thomson DJ, Steenbakkers RJHM, Dennis J, Lobato-Busto R, Alsner J, Ness A, Nutting C, Gómez-Caamaño A, Eriksen JG, Thomas SJ, Bates AM, Webb AJ, Choudhury A, Rosenstein BS, Taboada-Valladares B, Herskind C, Azria D, Dearnaley DP, de Ruysscher D, Sperk E, Hall E, Stobart H, Chang-Claude J, De Ruyck K, Veldeman L, Altabas M, De Santis MC, Farcy-Jacquet MP, Veldwijk MR, Sydes MR, Parliament M, Usmani N, Burnet NG, Seibold P, Symonds RP, Elliott RM, Bultijnck R, Gutiérrez-Enríquez S, Mollà M, Gulliford SL, Green S, Rancati T, Reyes V, Carballo A, Peleteiro P, Sosa-Fajardo P, Parker C, Fonteyne V, Johnson K, Lambrecht M, Vanneste B, Valdagni R, Giraldo A, Ramos M, Diergaarde B, Liu G, Leal SM, Chua MLK, Pring M, Overgaard J, Cascallar-Caneda LM, Duprez F, Talbot CJ, Barnett GC, Dunning AM, Vega A, Andreassen CN, Langendijk JA, West CML, Alizadeh BZ, Kerns SL. Large-scale meta-genome-wide association study reveals common genetic factors linked to radiation-induced acute toxicities across cancer types. JNCI Cancer Spectr 2023; 7:pkad088. [PMID: 37862240 PMCID: PMC10653584 DOI: 10.1093/jncics/pkad088] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/18/2023] [Accepted: 10/18/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND This study was designed to identify common genetic susceptibility and shared genetic variants associated with acute radiation-induced toxicity across 4 cancer types (prostate, head and neck, breast, and lung). METHODS A genome-wide association study meta-analysis was performed using 19 cohorts totaling 12 042 patients. Acute standardized total average toxicity (STATacute) was modelled using a generalized linear regression model for additive effect of genetic variants, adjusted for demographic and clinical covariates (rSTATacute). Linkage disequilibrium score regression estimated shared single-nucleotide variation (SNV-formerly SNP)-based heritability of rSTATacute in all patients and for each cancer type. RESULTS Shared SNV-based heritability of STATacute among all cancer types was estimated at 10% (SE = 0.02) and was higher for prostate (17%, SE = 0.07), head and neck (27%, SE = 0.09), and breast (16%, SE = 0.09) cancers. We identified 130 suggestive associated SNVs with rSTATacute (5.0 × 10‒8 < P < 1.0 × 10‒5) across 25 genomic regions. rs142667902 showed the strongest association (effect allele A; effect size ‒0.17; P = 1.7 × 10‒7), which is located near DPPA4, encoding a protein involved in pluripotency in stem cells, which are essential for repair of radiation-induced tissue injury. Gene-set enrichment analysis identified 'RNA splicing via endonucleolytic cleavage and ligation' (P = 5.1 × 10‒6, P = .079 corrected) as the top gene set associated with rSTATacute among all patients. In silico gene expression analysis showed that the genes associated with rSTATacute were statistically significantly up-regulated in skin (not sun exposed P = .004 corrected; sun exposed P = .026 corrected). CONCLUSIONS There is shared SNV-based heritability for acute radiation-induced toxicity across and within individual cancer sites. Future meta-genome-wide association studies among large radiation therapy patient cohorts are worthwhile to identify the common causal variants for acute radiotoxicity across cancer types.
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Affiliation(s)
- Elnaz Naderi
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY, USA
| | - Miguel E Aguado-Barrera
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Line M H Schack
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Gødstrup Hospital, Herning, Denmark
- NIDO | Centre for Research and Education, Gødstrup Hospital, Herning, Denmark
| | - Leila Dorling
- Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Tim Rattay
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Laura Fachal
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Holly Summersgill
- Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - Laura Martínez-Calvo
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
| | - Ceilidh Welsh
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Tom Dudding
- Bristol Dental School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Yasmin Odding
- Bristol Cancer Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ana Varela-Pazos
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Rajesh Jena
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - David J Thomson
- Division of Cancer Sciences, University of Manchester, Manchester, UK
- The Christie NHS Foundation Trust, Manchester, UK
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Joe Dennis
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Ramón Lobato-Busto
- Department of Medical Physics, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Jan Alsner
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Andy Ness
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Chris Nutting
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
| | - Antonio Gómez-Caamaño
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Jesper G Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Steve J Thomas
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Amy M Bates
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Adam J Webb
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Ananya Choudhury
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - Barry S Rosenstein
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Begona Taboada-Valladares
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Carsten Herskind
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - David Azria
- Fédération Universitaire d’Oncologie Radiothérapie d’Occitanie Méditérranée, Département d’Oncologie Radiothérapie, ICM Montpellier, INSERM U1194 IRCM, University of Montpellier, Montpellier, France
| | - David P Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - Dirk de Ruysscher
- MAASTRO Clinic, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands
| | - Elena Sperk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Hilary Stobart
- Patient Advocate, Independent Cancer Patients’ Voice, London, UK
| | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kim De Ruyck
- Departments of Basic Medical Sciences and Radiotherapy, Ghent University Hospital, Ghent, Belgium
| | - Liv Veldeman
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Manuel Altabas
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Marie-Pierre Farcy-Jacquet
- Fédération Universitaire d’Oncologie Radiothérapie d’Occitanie Méditérranée, Département d’Oncologie Radiothérapie, CHU Carémeau, Nîmes, France
| | - Marlon R Veldwijk
- Department of Radiation Oncology, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Matthew Parliament
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | - Nawaid Usmani
- Division of Radiation Oncology, Department of Oncology, Cross Cancer Institute, University of Alberta, Edmonton, AB, Canada
| | | | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Paul Symonds
- Cancer Research Centre, University of Leicester, Leicester, UK
| | - Rebecca M Elliott
- Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - Renée Bultijnck
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d’Hebron Institute of Oncology, Vall d’Hebron Hospital Campus, Barcelona, Spain
| | - Meritxell Mollà
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sarah L Gulliford
- Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Sheryl Green
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tiziana Rancati
- Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Victoria Reyes
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ana Carballo
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Paula Peleteiro
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Paloma Sosa-Fajardo
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Chris Parker
- Department of Medical Physics and Biomedical Engineering, University College London, UK
| | - Valérie Fonteyne
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Kerstie Johnson
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | | | - Ben Vanneste
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
- Department of Radiation Oncology (Maastro Clinic), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Riccardo Valdagni
- Radiation Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alexandra Giraldo
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Mónica Ramos
- Radiation Oncology Department, Vall d’Hebron Hospital Universitari, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Brenda Diergaarde
- Department of Human Genetics, School of Public Health, University of Pittsburgh, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Geoffrey Liu
- Princess Margaret Cancer Centre, Temerty Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Suzanne M Leal
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, and the Department of Neurology, Columbia University Medical Center, New York, NY, USA
- Taub Institute for Alzheimer’s Disease and the Aging Brain, Columbia University Medical Center, New York, NY, USA
| | - Melvin L K Chua
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Oncology Academic Clinical Programme, Singapore
| | - Miranda Pring
- Bristol Dental School, University of Bristol, Bristol, UK
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Luis M Cascallar-Caneda
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Fréderic Duprez
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Christopher J Talbot
- Department of Genetics and Genome Biology, University of Leicester, Leicester, UK
| | - Gillian C Barnett
- Department of Oncology, Addenbrooke’s Hospital, University of Cambridge, Cambridge, UK
| | - Alison M Dunning
- Centre for Cancer Genetic Epidemiology, Department of Oncology, University of Cambridge, Cambridge, UK
| | - Ana Vega
- Fundación Pública Galega Medicina Xenómica, Santiago de Compostela, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela, Santiago de Compostela, Spain
- Grupo de Medicina Xenómica, Centro de Investigación Biomédica en Red de Enfermedades Raras, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Christian Nicolaj Andreassen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Johannes A Langendijk
- Department of Radiation Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - Catharine M L West
- Translational Radiobiology Group, Division of Cancer Sciences, University of Manchester, Manchester Academic Health Science Centre, Christie NHS Foundation Trust Hospital, Manchester, UK
| | - Behrooz Z Alizadeh
- Department of Epidemiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah L Kerns
- Department of Radiation Oncology, The Medical College of Wisconsin, Milwaukee, WI, USA
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Li M, Nutting C, Zhang T, Gou Q, Liu T. Nutrition impact symptoms in head and neck cancer during radiotherapy: a longitudinal study. Acta Otolaryngol 2023:1-8. [PMID: 37335205 DOI: 10.1080/00016489.2023.2217844] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/12/2023] [Accepted: 05/15/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Patients with head and neck cancer (HNC) receiving radiotherapy (RT) are at a high risk of weight loss (WL) due to a variety of nutrition impact symptoms (NISs). OBJECTIVE This prospective observational study aimed to investigate the consecutive changes of NIS during RT and analyzed its impact on body weight. MATERIALS AND METHODS The Head and Neck patient Symptom Checklist was adopted to evaluate NIS. NIS, body weight, hemoglobin and lymphocyte of 94 participants were assessed at four time points during RT and the treatment outcomes were assessed at the time of 12 months after the completion of RT. Generalised estimation equations (GEEs) and Kendall's tau-b were used for statistical analysis. RESULTS Our study found that pain, taste changes and dry mouth were the most common NIS, reported by >90% of patients and had higher interference scores (more than 85% >2) at the end of RT. The average WL was 4.22 ± 3.59 kg after treatment, and more than two-thirds of patients (67.02%, 64/94) experienced significant WL of >5%. Lack of energy, vomiting and taste changes impacted WL significantly (p < .05). Taste changes were also associated with hemoglobin and lymphocyte reduction (p = .018, p < .001). WL correlated negatively with tumor response (p = .031). CONCLUSIONS AND SIGNIFICANCE In patients with HNC, taste changes, pain, dry mouth and vomiting were seen. Nutritional intervention applied as early as the first 10 days of RT could help to change the nutrition status and improve the clinical outcomes.
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Affiliation(s)
- Minmin Li
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chris Nutting
- Head and Neck Unit, The Royal Marsden Hospital, London, UK
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Tao Zhang
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qitao Gou
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Liu
- Department of Oncology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Samant P, Ruysscher DD, Hoebers F, Canters R, Hall E, Nutting C, Maughan T, Van den Heuvel F. Machine learning for normal tissue complication probability prediction: Predictive power with versatility and easy implementation. Clin Transl Radiat Oncol 2023; 39:100595. [PMID: 36880063 PMCID: PMC9984444 DOI: 10.1016/j.ctro.2023.100595] [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: 01/31/2023] [Accepted: 02/05/2023] [Indexed: 02/11/2023] Open
Abstract
Background and purpose A popular Normal tissue Complication (NTCP) model deployed to predict radiotherapy (RT) toxicity is the Lyman-Burman Kutcher (LKB) model of tissue complication. Despite the LKB model's popularity, it can suffer from numerical instability and considers only the generalized mean dose (GMD) to an organ. Machine learning (ML) algorithms can potentially offer superior predictive power of the LKB model, and with fewer drawbacks. Here we examine the numerical characteristics and predictive power of the LKB model and compare these with those of ML. Materials and methods Both an LKB model and ML models were used to predict G2 Xerostomia on patients following RT for head and neck cancer, using the dose volume histogram of parotid glands as the input feature. Model speed, convergence characteristics and predictive power was evaluated on an independent training set. Results We found that only global optimization algorithms could guarantee a convergent and predictive LKB model. At the same time our results showed that ML models remained unconditionally convergent and predictive, while staying robust to gradient descent optimization. ML models outperform LKB in Brier score and accuracy but compare to LKB in ROC-AUC. Conclusion We have demonstrated that ML models can quantify NTCP better than or as well as LKB models, even for a toxicity that the LKB model is particularly well suited to predict. ML models can offer this performance while offering fundamental advantages in model convergence, speed, and flexibility, and so could offer an alternative to the LKB model that could potentially be used in clinical RT planning decisions.
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Key Words
- AB, AdaBooost (aka Adaptive Boosting)
- Clinical radiobiology
- DA, Dual Annealing
- DE, Differential Evolution
- DT, Decision Tree
- DVH, Dose Volume Histogram
- GB, Gradient Boost
- GD, Gradient Descent
- GMD, Generalized Mean Dose
- Head and Neck Cancer
- LKB, Lyman Kutcher Burman
- LR, Logistic Regression
- ML, Machine Learning
- Machine Learning
- NTCP, Normal Tissue Complication Probability
- Normal Tissue Complication Probability
- OAR, Organ(s) at Risk
- RT, Radiotherapy
- Radiotherapy
- Treatment Planning
- Xerostomia
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Affiliation(s)
- Pratik Samant
- Oxford University Hospitals NHS Foundation Trust, Radiotherapy Physics, Oxford, United Kingdom
- University of Oxford, Department of Oncology, Oxford, United Kingdom
| | - Dirk de Ruysscher
- Maastricht University Medical Centre, Department of Radiation Oncology (Maastro), Maastricht, The Netherlands
| | - Frank Hoebers
- Maastricht University Medical Centre, Department of Radiation Oncology (Maastro), Maastricht, The Netherlands
| | - Richard Canters
- Maastricht University Medical Centre, Department of Radiation Oncology (Maastro), Maastricht, The Netherlands
| | - Emma Hall
- Institute of Cancer Research, Division of Clinical Studies, Sutton, United Kingdom
| | - Chris Nutting
- Institute of Cancer Research, Division of Radiotherapy and Imaging, Sutton, United Kingdom
| | - Tim Maughan
- University of Oxford, Department of Oncology, Oxford, United Kingdom
| | - Frank Van den Heuvel
- University of Oxford, Department of Oncology, Oxford, United Kingdom
- Zuidwest Radiotherapeutisch Instituut, Physics, Vlissingen (Flushing), The Netherlands
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Rieu R, Crellin A, Thomson D, Nutting C. Developing a National Infrastructure for Proton Beam Therapy Trials. Clin Oncol (R Coll Radiol) 2022; 35:279-282. [PMID: 36564290 DOI: 10.1016/j.clon.2022.11.017] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 11/10/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Affiliation(s)
- R Rieu
- The Institute of Cancer Research, London, UK; Head and Neck Unit, The Royal Marsden, London, UK.
| | - A Crellin
- Leeds Cancer Centre, St James's Institute of Oncology, Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - D Thomson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - C Nutting
- Head and Neck Unit, The Royal Marsden, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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Abraham R, Davis R, Lewandowski R, Liu D, Gordon A, Collins Z, Westcott M, Nutting C, Karnia J, Kim D, Gregoire M, Verma A, Dobrowski D, Bryan J. Abstract No. 310 Novel radiopaque Y-90 glass microspheres (Eye90 microspheres) for canine hepatocellular carcinoma: correlation of microsphere radiopacity with TOF PET radioactivity and mRECIST and pathologic tumor response determination. J Vasc Interv Radiol 2022. [DOI: 10.1016/j.jvir.2022.03.391] [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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Nutting C. SP-0001 Developing a national infrastructure for proton beam therapy trials. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03857-9] [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: 10/18/2022]
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Gupta A, Bano W, Barnes H, Newbold K, Nutting C, Bhide S, Harrington K, Wetscherek A, Wong K. PO-1111 Hypoxia and Perfusion MR-Imaging on the MR-Linear Accelerator for Head and Neck Cancer. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03075-4] [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: 11/15/2022]
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Biau J, Nutting C, Langendijk J, Frédéric-Moreau T, Thariat J, Piram L, Bellini R, Saroul N, Pham Dang N, O'Sullivan B, Giralt J, Blanchard P, Bourhis J, Lapeyre M. Radiographic-anatomy, natural history and extension pathways of parotid and submandibular gland cancers. Radiother Oncol 2022; 170:48-54. [DOI: 10.1016/j.radonc.2022.03.005] [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] [Received: 02/25/2021] [Revised: 01/27/2022] [Accepted: 03/06/2022] [Indexed: 11/16/2022]
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Gupta A, Dunlop A, Mitchell A, McQuaid D, Nill S, Barnes H, Newbold K, Nutting C, Bhide S, Oelfke U, Harrington KJ, Wong KH. Online adaptive radiotherapy for head and neck cancers on the MR linear Accelerator: Introducing a novel modified Adapt-to-Shape approach. Clin Transl Radiat Oncol 2022; 32:48-51. [PMID: 34849412 PMCID: PMC8608651 DOI: 10.1016/j.ctro.2021.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The Elekta Unity MR-Linac (MRL) has enabled adaptive radiotherapy (ART) for patients with head and neck cancers (HNC). Adapt-To-Shape-Lite (ATS-Lite) is a novel Adapt-to-Shape strategy that provides ART without requiring daily clinician presence to perform online target and organ at risk (OAR) delineation. In this study we compared the performance of our clinically-delivered ATS-Lite strategy against three Adapt-To-Position (ATP) variants: Adapt Segments (ATP-AS), Optimise Weights (ATP-OW), and Optimise Shapes (ATP-OS). METHODS Two patients with HNC received radical-dose radiotherapy on the MRL. For each fraction, an ATS-Lite plan was generated online and delivered and additional plans were generated offline for each ATP variant. To assess the clinical acceptability of a plan for every fraction, twenty clinical goals for targets and OARs were assessed for all four plans. RESULTS 53 fractions were analysed. ATS-Lite passed 99.9% of mandatory dose constraints. ATP-AS and ATP-OW each failed 7.6% of mandatory dose constraints. The Planning Target Volumes for 54 Gy (D95% and D98%) were the most frequently failing dose constraint targets for ATP. ATS-Lite median fraction times for Patient 1 and 2 were 40 mins 9 s (range 28 mins 16 s - 47 mins 20 s) and 32 mins 14 s (range 25 mins 33 s - 44 mins 27 s), respectively. CONCLUSIONS Our early data show that the novel ATS-Lite strategy produced plans that fulfilled 99.9% of clinical dose constraints in a time frame that is tolerable for patients and comparable to ATP workflows. Therefore, ATS-Lite, which bridges the gap between ATP and full ATS, will be further utilised and developed within our institute and it is a workflow that should be considered for treating patients with HNC on the MRL.
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Affiliation(s)
- Amit Gupta
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Alex Dunlop
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Adam Mitchell
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Dualta McQuaid
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Simeon Nill
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Helen Barnes
- The Royal Marsden NHS Foundation Trust; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Kate Newbold
- The Royal Marsden NHS Foundation Trust; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Chris Nutting
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Shreerang Bhide
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Uwe Oelfke
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research; Downs Road, Sutton SM2 5PT, United Kingdom
| | - Kevin Joseph Harrington
- The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, Head & Neck Unit, 15 Cotswold Road, Sutton, London SM2 5NG, United Kingdom
| | - Kee Howe Wong
- The Royal Marsden NHS Foundation Trust; Downs Road, Sutton SM2 5PT, United Kingdom
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Vreugdenhil M, Fong C, Iqbal G, Roques T, Evans M, Palaniappan N, Yang H, O'Toole L, Sanghera P, Nutting C, Foran B, Sen M, Al Booz H, Fulton-Lieuw T, Dalby M, Dunn J, Hartley A, Mehanna H. Improvement in Dysphagia Outcomes Following Clinical Target Volume Reduction in the De-ESCALaTE Study. Clin Oncol (R Coll Radiol) 2021; 33:795-803. [PMID: 34340917 DOI: 10.1016/j.clon.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/08/2021] [Revised: 06/02/2021] [Accepted: 07/14/2021] [Indexed: 11/29/2022]
Abstract
AIMS The De-ESCALaTE study showed an overall survival advantage for the administration of synchronous cisplatin chemotherapy with radiotherapy in low-risk oropharyngeal cancer when compared with synchronous cetuximab. During the trial, a radiotherapy quality assurance protocol amendment permitted centres to swap from the original radiotherapy contouring protocol (incorporating the whole oropharynx into the high-dose clinical target volume (CTV); anatomical protocol) to a protocol that incorporated the gross tumour volume with a 10 mm margin into the CTV (volumetric protocol). The purpose of this study was to examine both toxicity and tumour control related to this protocol amendment. MATERIALS AND METHODS Overall survival and recurrence at 2 years were used to compare tumour control in the two contouring cohorts. For toxicity, the cohorts were compared by both the number of severe (grades 3-5) and all grades acute and late toxicities. In addition, quality of life and swallowing were compared using EORTC-C30 and MD Anderson Dysphagia Inventory, respectively. RESULTS Of 327 patients included in this study, 185 were contoured according to the anatomical protocol and 142 by the volumetric protocol. The two cohorts were well balanced, with the exception of significantly more patients in the anatomical cohort undergoing prophylactic feeding tube insertion (P < 0.001). With a minimum of 2 years of follow-up there was no significant difference in overall survival or recurrence between the two contouring protocols. Similarly, there was no significant difference in the rate of reported severe or all grades acute or late toxicity and no sustained significant difference in quality of life. However, there was a significant difference in favour of volumetric contouring in several domains of the MD Anderson Dysphagia Inventory questionnaire at 1 year, which persisted to 2 years in the dysphagia functional (P = 0.002), dysphagia physical (P = 0.009) and dysphagia overall function (P = 0.008) domains. CONCLUSION In the context of the unplanned post-hoc analysis of a randomised trial, measurable improvement in long-term dysphagia has been shown following a reduction in the CTV. Further reductions in the CTV should be subject to similar scrutiny within the confines of a prospective study.
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Affiliation(s)
- M Vreugdenhil
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - C Fong
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | - G Iqbal
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - T Roques
- Norfolk and Norwich University Hospitals, Norwich, UK
| | - M Evans
- Velindre University NHS Trust, Cardiff, UK
| | | | - H Yang
- Addenbrooke's Hospital, Cambridge, UK
| | - L O'Toole
- Castle Hill Hospital, Cottingham, UK
| | - P Sanghera
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK
| | | | - B Foran
- Weston Park Hospital, Sheffield, UK
| | - M Sen
- St James' Institute of Oncology, Leeds, UK
| | - H Al Booz
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - T Fulton-Lieuw
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
| | - M Dalby
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - J Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - A Hartley
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham, UK.
| | - H Mehanna
- Institute of Head and Neck Studies and Education (InHANSE), University of Birmingham, Birmingham, UK
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Gupta A, Wong KH, Newbold K, Bhide S, Nutting C, Harrington KJ. Early-Stage Glottic Squamous Cell Carcinoma in the Era of Image-Guided Radiotherapy. Front Oncol 2021; 11:753908. [PMID: 34616688 PMCID: PMC8488425 DOI: 10.3389/fonc.2021.753908] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/05/2021] [Accepted: 09/06/2021] [Indexed: 11/13/2022] Open
Abstract
Early-stage squamous cell cancer (SCC) of the glottis has a good prognosis. Therefore, patients have long survival outcomes and may potentially suffer from late toxicities of radiotherapy. Radiotherapy with a conventional parallel-opposed-pair or anterior-oblique beam arrangements for stage 1 and 2 glottic SCC have field borders that traditionally cover the entire larynx, exposing organs-at-risk (e.g. carotid arteries, contralateral vocal cord, contralateral arytenoid and inferior pharyngeal constrictor muscles) to high radiation doses. The potential long-term risk of cerebrovascular events has attracted much attention to the dose that carotid arteries receive. Swallow and respiratory motion of laryngeal structures has been an important factor that previously limited reduction of the radiation treatment volume. Motion has been evaluated using multiple imaging modalities and this information has been used to calculate PTV margins for generation of more limited target volumes. This review discusses the current literature surrounding dose-effect relationships for various organs-at-risk and the late toxicities that are associated with them. This article also reviews the currently available data and effects of laryngeal motions on dosimetry to the primary target. We also review the current limitations and benefits of a more targeted approach of radiotherapy for early-stage glottic SCCs and the evolution of CT-based IGRT and MR-guided radiotherapy techniques that may facilitate a shift away from a conventional 3D-conformal radiotherapy approach.
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Affiliation(s)
- Amit Gupta
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Kee Howe Wong
- Head and Neck Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Kate Newbold
- Head and Neck Department, The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Shreerang Bhide
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Chris Nutting
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
| | - Kevin Joseph Harrington
- Radiotherapy and Imaging, The Royal Marsden NHS Foundation Trust and the Institute of Cancer Research, London, United Kingdom
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Tyler J, Bernstein D, Seithel M, Rooney K, Petkar I, Miles E, Clark CH, Hall E, Nutting C. Quality assurance of dysphagia-optimised intensity modulated radiotherapy treatment planning for head and neck cancer. Phys Imaging Radiat Oncol 2021; 20:46-50. [PMID: 34754954 PMCID: PMC8560997 DOI: 10.1016/j.phro.2021.10.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 12/04/2022] Open
Abstract
This study aimed to assess the impact of the margin applied to the clinical target volume, to create the planning target volume, on plan quality of a novel dysphagia-optimised intensity modulated radiotherapy technique developed within a head and neck cancer multicentre randomised controlled trial. Protocol compliant plans were used for a single benchmark planning case. Larger margins were associated with higher doses to adjacent organs at risk, particularly the inferior pharyngeal constrictor muscle, but coincided with some improved low dose target coverage. A 3 mm margin is recommended for this technique if local practices allow.
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Key Words
- CERR, Computational Environment for Radiotherapy Research
- DARS, dysphagia/aspiration related structures
- DICOM, Digital Imaging and Communications in Medicine
- DO-IMRT, dysphagia optimised intensity modulated radiotherapy
- Dysphagia
- Head and neck cancer
- ICR-CTSU, Clinical Trials and Statistics Unit and the Institute of Cancer Research
- IPCM, inferior pharyngeal constrictor muscle
- Intensity modulated radiotherapy (IMRT)
- NIHR, National Institute for Health Research
- PAF, plan assessment form
- Quality assurance
- RTQA, radiotherapy quality assurance
- RTTQA, UK’s National Radiotherapy Trials Quality Assurance Group
- Randomised controlled trial
- S-IMRT, standard intensity modulated radiotherapy
- SMPCM, superior and middle pharyngeal constrictor muscles
- TMG, Trial Management Group
- Volumetric arc therapy (VMAT)
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Affiliation(s)
- Justine Tyler
- National Radiotherapy Trials Quality Assurance Group, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - David Bernstein
- National Radiotherapy Trials Quality Assurance Group, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Matthew Seithel
- National Radiotherapy Trials Quality Assurance Group, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Keith Rooney
- Radiotherapy Department, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Imran Petkar
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
- Radiotherapy Department, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
| | - Elizabeth Miles
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK
| | - Catharine H Clark
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, Northwood, Middlesex HA6 2RN, UK
- Radiotherapy Physics, University College London Hospital NHS Foundation Trust, 5th Floor West, 250 Euston Road, NW1 2PG, UK
- Department of Medical Physics and Biomedical Engineering, University College London, WC1E 6BT, UK
- Metrology for Medical Physics, National Physical Laboratory, Hampton Rd, Teddington, TW11 0PX, UK
| | - Emma Hall
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
| | - Chris Nutting
- The Institute of Cancer Research, 123 Old Brompton Road, London SW7 3RP, UK
- Radiotherapy Department, The Royal Marsden NHS Foundation Trust, 203 Fulham Road, London SW3 6JJ, UK
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Syeed Z, Forster M, Boukovinas I, Nutting C, Carnell D, Guerrero Urbano T, Sibtain A, Kalavrezos N, Patel G, Al Bakir M, Arkenau HT, Levva S, Gonnet P, Morelli C, Guerriero S, Rofei M, Formica V, Patrikidou A. 889P Development of a head and neck immune prognostic index (HN-IPI) classification for patients with recurrent/metastatic head and neck squamous cell carcinoma (R/M HNSCC) who received immune checkpoint inhibitors (ICIs). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.1299] [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] Open
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15
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Nutting C, Rooney K, Foran B, Pettit L, Beasley M, Finneran L, Roe J, Tyler J, Petkar I, Bhide S, Frogley R, Sydenham M, Emson M, Hall E. P-59 Results of DARS: a randomised phase III trial of dysphagia-optimised intensity modulated radiotherapy (DO-IMRT) versus standard IMRT (S-IMRT) in oropharyngeal (OPC) and hypopharyngeal (HPC) cancer. Oral Oncol 2021. [DOI: 10.1016/s1368-8375(21)00346-8] [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: 10/21/2022]
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Vasiliadou I, Breik O, Baker H, Leslie I, Sim VR, Hegarty G, Michaelidou A, Nathan K, Hartley A, Good J, Sanghera P, Fong C, Urbano TG, Lei M, Petkar I, Ferreira MR, Nutting C, Wong KH, Newbold K, Harrington K, Bhide S, Kong A. Safety and Treatment Outcomes of Nivolumab for the Treatment of Recurrent or Metastatic Head and Neck Squamous Cell Carcinoma: Retrospective Multicenter Cohort Study. Cancers (Basel) 2021; 13:cancers13061413. [PMID: 33808781 PMCID: PMC8003537 DOI: 10.3390/cancers13061413] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 02/08/2021] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 01/19/2023] Open
Abstract
Nivolumab is an anti-PD-1 monoclonal antibody currently used as immunotherapy for patients with recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) with evidence of disease progression after platinum-based chemotherapy. This study evaluates real-world safety and treatment outcomes of non-trial nivolumab use. A retrospective multicenter cohort study of patients with recurrent/metastatic HNSCC treated with nivolumab between January 2017 and March 2020 was performed. Overall, 123 patients were included. The median age was 64 years, the majority of patients were male (80.5%) and had a smoking history (69.9%). Primary outcomes included overall response rate (ORR) of 19.3%, median progression-free survival (PFS) of 3.9 months, 1-year PFS rate of 16.8%, a median overall survival (OS) of 6.5 months and 1-year OS rate of 28.6%. These results are comparable to the CHECKMATE-141 study. Of 27 patients who had PD-L1 status tested, positive PD-L1 status did not significantly affect PFS (p = 0.86) or OS (p = 0.84). Nivolumab was well tolerated with only 15.1% experiencing immune-related toxicities (IRT) and only 6.7% of patients stopping due to toxicity. The occurrence of IRT appeared to significantly affect PFS (p = 0.01) but not OS (p = 0.07). Nivolumab in recurrent/metastatic HNSCC is well tolerated and may be more efficacious in patients who develop IRT.
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Affiliation(s)
- Ifigenia Vasiliadou
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Omar Breik
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
- Department of Oral and Maxillofacial Surgery, Royal Brisbane and Women’s Hospital, QLD 4029 Brisbane, Australia
| | - Holly Baker
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Isla Leslie
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Van Ren Sim
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Gemma Hegarty
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent ME16 9QQ, UK; (G.H.); (A.M.); (K.N.)
| | - Andriana Michaelidou
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent ME16 9QQ, UK; (G.H.); (A.M.); (K.N.)
| | - Kannon Nathan
- Kent Oncology Centre, Maidstone and Tunbridge Wells NHS Trust, Kent ME16 9QQ, UK; (G.H.); (A.M.); (K.N.)
| | - Andrew Hartley
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - James Good
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - Paul Sanghera
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - Charles Fong
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
| | - Teresa Guerrero Urbano
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Mary Lei
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Imran Petkar
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Miguel Reis Ferreira
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
| | - Chris Nutting
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Kee Howe Wong
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Kate Newbold
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Kevin Harrington
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London SW7 3RP, UK
| | - Shree Bhide
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London SW3 6JJ, UK; (I.L.); (C.N.); (K.H.W.); (K.N.); (K.H.); (S.B.)
| | - Anthony Kong
- Guys Cancer Centre, Guy’s and St. Thomas NHS Foundation Trust, London SE1 9RT, UK; (I.V.); (V.R.S.); (T.G.U.); (M.L.); (I.P.); (M.R.F.)
- Department of Oncology, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB, UK; (O.B.); (H.B.); (A.H.); (J.G.); (P.S.); (C.F.)
- College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Comprehensive Cancer Centre, King’s College London, Guy’s Campus, London SE1 1UL, UK
- Correspondence:
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Petkar I, McQuaid D, Dunlop A, Tyler J, Hall E, Nutting C. Inter-Observer Variation in Delineating the Pharyngeal Constrictor Muscle as Organ at Risk in Radiotherapy for Head and Neck Cancer. Front Oncol 2021; 11:644767. [PMID: 33768005 PMCID: PMC7985335 DOI: 10.3389/fonc.2021.644767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 01/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE To evaluate the inter-observer variation (IOV) in pharyngeal constrictor muscle (PCM) contouring, and resultant impact on dosimetry and estimated toxicity, as part of the pre-trial radiotherapy trial quality assurance (RTQA) within DARS, a multicenter phase III randomized controlled trial investigating the functional benefits of dysphagia-optimized intensity-modulated radiotherapy (Do-IMRT) in pharyngeal cancers. METHODS AND MATERIALS Outlining accuracy of 15 clinicians' superior and middle PCM (SMPCM) and inferior PCM (IPCM) were retrospectively assessed against gold standards (GS) using volume, location, and conformity indices (CIs) on a pre-trial benchmark case of oropharyngeal cancer. The influence of delineation variability on dose delivered to the constrictor muscles with Do-IMRT and resultant normal tissue complication probability (NTCP) for physician-scored radiation-associated dysphagia at 6 months was evaluated. RESULTS For GS, SMPCM, and IPCM volumes were 13.51 and 1.67 cm3; corresponding clinician mean volumes were 12.18 cm3 (SD 3.0) and 2.40 cm3 (SD 0.9) respectively. High IOV in SMPCM and IPCM delineation was observed by the low DICE similarity coefficient value, along with high geographical miss index and discordance index values. Delineation variability did not significantly affect the mean dose delivered to the constrictors, relative to the GS plan. Mean clinician NTCP was 24.6% (SD 0.6), compared to the GS-NTCP of 24.7%. CONCLUSIONS Results from this benchmark case demonstrate that inaccurate PCM delineation existed, even with protocol guidelines. This did not impact on delivered dose to this structure with Do-IMRT, or on estimated swallowing toxicity, in this single benchmark case.
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Affiliation(s)
- Imran Petkar
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
| | - Dualta McQuaid
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Alex Dunlop
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Justine Tyler
- Department of Physics, Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, United Kingdom
| | - Chris Nutting
- Head and Neck Unit, Royal Marsden NHS Foundation Trust, London, United Kingdom
- Division of Radiotherapy and Imaging, Institute of Cancer Research, London, United Kingdom
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18
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Gunn L, Gilbert J, Nenclares P, Soliman H, Newbold K, Bhide S, Wong KH, Harrington K, Nutting C. Taste dysfunction following radiotherapy to the head and neck: A systematic review. Radiother Oncol 2021; 157:130-140. [PMID: 33545253 DOI: 10.1016/j.radonc.2021.01.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 07/07/2020] [Revised: 01/10/2021] [Accepted: 01/12/2021] [Indexed: 01/04/2023]
Abstract
BACKGROUND An intact sense of taste provides pleasure, supports sustenance and alerts the body to toxins. Head and neck cancer (HNC) patients who receive radiotherapy (RT) are high-risk for developing radiation-induced taste dysfunction. Advances in RT offer opportunities for taste-preserving strategies by reducing dose to the gustatory organs-at-risk. METHODS PubMed, Medline and EMBASE were searched for publications reporting on taste, RT and HNC. Randomised trials, cohort studies and cross-sectional studies were included. RESULTS 31 studies were included in this review. Meta-analysed prevalence of acute taste dysfunction following RT was approximately 96% (95% CI 64 to 100%) by objective measures and 79% (95% CI 65 to 88%) by subjective measures, with the majority of patients showing at least partial recovery. Long-term dysfunction was seen in ~25% of patients. Taste dysfunction was associated with sequalae including weight loss and reduced quality-of-life (QoL). Taste dysfunction was more common when the oral cavity, and specifically the anterior two-thirds of the tongue, was irradiated, suggesting a dose constraint for taste preservation might be feasible. Proton beam therapy and customised bite blocks reduced dose to the gustatory field and subsequent loss of taste. CONCLUSIONS Taste dysfunction following RT is common and negatively affects patients' nutritional status and QoL. Decisions about treatment strategies, including choice of RT modality, dose distribution across the gustatory field and the use of adjuncts like bite blocks may be beneficial. However, evidence is limited. There is a pressing need for randomised studies or large prospective cohort studies with sufficient adjustment for confounders.
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Affiliation(s)
- Lucinda Gunn
- Head and Neck Unit, The Royal Marsden London, London, UK.
| | | | | | - Heba Soliman
- Head and Neck Unit, The Royal Marsden London, London, UK
| | - Kate Newbold
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Shree Bhide
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Kee Howe Wong
- Head and Neck Unit, The Royal Marsden London, London, UK
| | - Kevin Harrington
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
| | - Chris Nutting
- Head and Neck Unit, The Royal Marsden London, London, UK; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK
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19
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Fong C, Mistry P, Roques T, Evans M, Yang H, O'Toole L, Sanghera P, Nutting C, Foran B, Sen M, Al Booz H, Fulton-Lieuw T, Dalby M, Dunn J, Hartley A, Mehanna H. OC-0573: Improvement in late dysphagia following clinical target volume reduction in the De-ESCALaTE study. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00595-8] [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: 11/16/2022]
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20
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Tsobanoudis A, Li H, Li J, Rosemurgy A, Bastidas J, Zervos E, Goldin S, Muscarella P, Nutting C, Edil B, Malek R, Agah R. 4:12 PM Abstract No. 135 Transarterial chemotherapy for treatment of locally advanced pancreatic cancer: treatment factors impacting survival. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.167] [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: 10/25/2022] Open
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21
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Kosmin M, Ledsam J, Romera-Paredes B, Mendes R, Moinuddin S, de Souza D, Gunn L, Kelly C, Hughes C, Karthikesalingam A, Nutting C, Sharma R. Rapid advances in auto-segmentation of organs at risk and target volumes in head and neck cancer. Radiother Oncol 2019; 135:130-140. [DOI: 10.1016/j.radonc.2019.03.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/10/2019] [Accepted: 03/04/2019] [Indexed: 11/25/2022]
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22
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Graham D, Prue G, Baker P, Nutting C, Greenhouse P, Lawler M. Early detection of HPV-associated oropharyngeal cancer-Authors' reply. Lancet 2019; 393:2123-2124. [PMID: 31226047 DOI: 10.1016/s0140-6736(19)30291-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 01/14/2019] [Indexed: 11/22/2022]
Affiliation(s)
| | - Gillian Prue
- School of Nursing and Midwifery, Queen's University Belfast, Belfast BT9 7AE, UK; Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast BT9 7AE, UK
| | | | | | | | - Mark Lawler
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast BT9 7AE, UK; European Cancer Organisation Oncopolicy Forum, Brussels, Belgium.
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Affiliation(s)
- Gilliam Prue
- School of Nursing and Midwifery, Belfast, BT9 7BL, UK; Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, BT9 7BL, UK; Royal Marsden Hospital, London, UK
| | | | - Donna Graham
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, BT9 7BL, UK
| | | | | | - Mark Lawler
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, BT9 7BL, UK; Royal Marsden Hospital, London, UK; European Cancer Concord/European Cancer Organisation Oncopolicy Forum, Brussels, Belgium.
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24
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Hague C, Foran B, Hall E, Guild S, Joseph O, Moule R, Nutting C, Parsons S, Prestwich R, Slevin N, West C, Thomson D. Patient Involvement in the Design of a Phase III Trial Comparing Intensity-modulated Proton Therapy and Intensity-modulated Radiotherapy for Oropharyngeal Cancer. Clin Oncol (R Coll Radiol) 2018; 30:274-276. [PMID: 29459100 DOI: 10.1016/j.clon.2018.01.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/26/2018] [Accepted: 01/29/2018] [Indexed: 11/24/2022]
Affiliation(s)
- C Hague
- The Christie NHS Foundation Trust, Manchester, UK
| | - B Foran
- Weston Park Hospital, Sheffield, UK
| | - E Hall
- The Institute of Cancer Research, Clinical Trials and Statistics Unit, London, UK
| | - S Guild
- Patient Representative, Leeds, UK
| | - O Joseph
- Manchester University NHS Foundation Trust, The University of Manchester, Public Programmes Team, Manchester, UK
| | - R Moule
- The University College London Hospital, London, UK
| | - C Nutting
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S Parsons
- Manchester University NHS Foundation Trust, The University of Manchester, Public Programmes Team, Manchester, UK
| | | | - N Slevin
- The Christie NHS Foundation Trust, Manchester, UK
| | - C West
- Division of Cancer Science, The University of Manchester, Manchester Academic Health Science Centre, Christie Hospital, Manchester, UK
| | - D Thomson
- The Christie NHS Foundation Trust, Manchester, UK.
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25
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Petkar I, Bhide S, Newbold K, Harrington K, Nutting C. Practice patterns for the radical treatment of nasopharyngeal cancer by head and neck oncologists in the United Kingdom. Br J Radiol 2018; 91:20170590. [PMID: 29360397 PMCID: PMC6190791 DOI: 10.1259/bjr.20170590] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 01/10/2018] [Accepted: 01/17/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Advances in radiation delivery, imaging techniques, and chemotherapy have significantly improved treatment options for non-metastatic nasopharyngeal cancers (NPC). However, their impact on the practice in the United Kingdom (UK), where this tumour is rare, is unknown. This study examined the current attitudes of UK head and neck oncologists to the treatment of NPC. METHODS UK head and neck oncologists representing 19/23 cancer networks were sent an invitation email with a personalised link to a web-based survey designed to identify the influence of tumour and nodal staging on current NPC management practices. RESULTS 26/42 (61%) of clinicians responded. Induction chemotherapy followed by concomitant chemoradiation was the treatment of choice for Stage III (69%) and IVa/b (96%), with cisplatin and 5-fluorouracil combination being the most commonly used induction chemotherapy regimen (88%). 16 centres (61%) used a geometric approach, adding variable margins of 0-10 mm to the gross tumour volume to define their therapeutic dose clinical target volume. 54% of respondents used 3 radiotherapy (RT) prescription doses to treat NPC. Retropharyngeal nodal region irradiation policy was inconsistent, with nearly one-quarter treating the entire group to a radical dose. CONCLUSION Significant heterogeneity currently exists in the RT practice of NPC in the UK. A consensus regarding the optimal curative, function-sparing treatment paradigm for NPC is necessary to ensure cancer survivors have satisfactory long-term health-related quality of life. Advances in knowledge: This is the first study to highlight the significant variation in RT practice of NPC in the UK.
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Affiliation(s)
| | | | - Kate Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Chris Nutting
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
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26
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Nutting C. SP-0117: Strategies to minimize post-RT late effects on swallowing and QOL. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30427-4] [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: 11/28/2022]
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27
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Fong C, McConkey C, Sanghera P, Hartley A, Rahman J, Nutting C, Al-Booz H, Robinson M, Mehanna H. OC-0274: Effect of radiotherapy technique/fractionation on 2-year primary local control in the PET-NECK study. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30584-x] [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: 10/14/2022]
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28
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Hague C, Foran B, Hall E, Lee L, Mackay R, McPartlin A, Nutting C, Ofuya M, Parsons S, Prestwich R, Slevin N, West C, Thomson D. EP-1180: Public involvement in design of a phase III trial comparing IMPT and IMRT for oropharyngeal cancer. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31490-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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29
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Brown S, Van Herk M, Chuter R, Falk S, Kirkby K, Mackay R, Harrington K, Cosgrove V, Gray A, Hall E, Hawkins M, Hawkes D, Henry A, Maughan T, Nutting C, Oelfke U, Royle G, Sebag-Montefiore D, Sharma R, Van Den Heuvel F, Faivre-Finn C. Advanced Radiotherapy Technologies Network in the UK (ART-NET) – focus on lung cancer. Lung Cancer 2018. [DOI: 10.1016/s0169-5002(18)30166-1] [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: 10/18/2022]
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30
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Crabb SJ, Martin K, Abab J, Ratcliffe I, Thornton R, Lineton B, Ellis M, Moody R, Stanton L, Galanopoulou A, Maishman T, Geldart T, Bayne M, Davies J, Lamb C, Popat S, Joffe JK, Nutting C, Chester J, Hartley A, Thomas G, Ottensmeier C, Huddart R, King E. COAST (Cisplatin ototoxicity attenuated by aspirin trial): A phase II double-blind, randomised controlled trial to establish if aspirin reduces cisplatin induced hearing-loss. Eur J Cancer 2017; 87:75-83. [PMID: 29128692 PMCID: PMC5729023 DOI: 10.1016/j.ejca.2017.09.033] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 07/22/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Cisplatin is one of the most ototoxic chemotherapy drugs, resulting in a permanent and irreversible hearing loss in up to 50% of patients. Cisplatin and gentamicin are thought to damage hearing through a common mechanism, involving reactive oxygen species in the inner ear. Aspirin has been shown to minimise gentamicin-induced ototoxicity. We, therefore, tested the hypothesis that aspirin could also reduce ototoxicity from cisplatin-based chemotherapy. METHODS A total of 94 patients receiving cisplatin-based chemotherapy for multiple cancer types were recruited into a phase II, double-blind, placebo-controlled trial and randomised in a ratio of 1:1 to receive aspirin 975 mg tid and omeprazole 20 mg od, or matched placebos from the day before, to 2 days after, their cisplatin dose(s), for each treatment cycle. Patients underwent pure tone audiometry before and at 7 and 90 days after their final cisplatin dose. The primary end-point was combined hearing loss (cHL), the summed hearing loss at 6 kHz and 8 kHz, in both ears. RESULTS Although aspirin was well tolerated, it did not protect hearing in patients receiving cisplatin (p-value = 0.233, 20% one-sided level of significance). In the aspirin arm, patients demonstrated mean cHL of 49 dB (standard deviation [SD] 61.41) following cisplatin compared with placebo patients who demonstrated mean cHL of 36 dB (SD 50.85). Women had greater average hearing loss than men, and patients treated for head and neck malignancy experienced the greatest cHL. CONCLUSIONS Aspirin did not protect from cisplatin-related ototoxicity. Cisplatin and gentamicin may therefore have distinct ototoxic mechanisms, or cisplatin-induced ototoxicity may be refractory to the aspirin regimen used here.
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Affiliation(s)
- Simon J Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom
| | - Karen Martin
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Julia Abab
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Ian Ratcliffe
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Roger Thornton
- NHS Research, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Ben Lineton
- Institute of Sound and Vibration Research, University of Southampton, Southampton, United Kingdom
| | - Mary Ellis
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Ronald Moody
- Patient and Public Involvement Representative, United Kingdom
| | - Louise Stanton
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Angeliki Galanopoulou
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Tom Maishman
- Southampton Clinical Trials Unit, University of Southampton, Southampton, United Kingdom
| | - Thomas Geldart
- Royal Bournemouth and Christchurch NHS Foundation Trust, Bournemouth, United Kingdom
| | - Mike Bayne
- Poole Hospital NHS Foundation Trust, Poole, United Kingdom
| | - Joe Davies
- Poole Hospital NHS Foundation Trust, Poole, United Kingdom
| | - Carolynn Lamb
- The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Sanjay Popat
- Institute of Cancer Research and Royal Marsden Foundation Trust, London, United Kingdom
| | | | - Chris Nutting
- Institute of Cancer Research and Royal Marsden Foundation Trust, London, United Kingdom
| | - John Chester
- College of Biomedical and Life Sciences, Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom
| | | | - Gareth Thomas
- Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom
| | | | - Robert Huddart
- Institute of Cancer Research and Royal Marsden Foundation Trust, London, United Kingdom
| | - Emma King
- Cancer Sciences Unit, University of Southampton, Southampton, United Kingdom; Poole Hospital NHS Foundation Trust, Poole, United Kingdom.
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31
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Harrington K, Hall E, Hawkins M, Henry A, MacKay R, Maughan T, McDonald A, Nutting C, Oelfke U, Sebag-Montefiore D, Sharma RA, van Herk M, Faivre-Finn C. Introducing the Cancer Research UK Advanced Radiotherapy Technologies Network (ART-NET). Clin Oncol (R Coll Radiol) 2017; 29:707-710. [PMID: 28807360 PMCID: PMC6155492 DOI: 10.1016/j.clon.2017.07.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 06/30/2017] [Accepted: 07/08/2017] [Indexed: 12/25/2022]
Affiliation(s)
| | - E Hall
- Institute of Cancer Research, London, UK
| | - M Hawkins
- Cancer Research UK/MRC Oxford Institute for Radiation Oncology, Oxford, UK
| | - A Henry
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; University of Leeds, Leeds, UK
| | - R MacKay
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | | | - A McDonald
- Institute of Cancer Research, London, UK
| | - C Nutting
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U Oelfke
- Institute of Cancer Research, London, UK
| | - D Sebag-Montefiore
- Leeds Teaching Hospitals NHS Trust, Leeds, UK; University of Leeds, Leeds, UK
| | - R A Sharma
- University College London, London, UK; NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - M van Herk
- University of Manchester, Manchester, UK
| | - C Faivre-Finn
- University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
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Petkar I, Bhide S, Newbold K, Harrington K, Nutting C. Dysphagia-optimised Intensity-modulated Radiotherapy Techniques in Pharyngeal Cancers: Is Anyone Going to Swallow it? Clin Oncol (R Coll Radiol) 2017; 29:e110-e118. [PMID: 28242166 DOI: 10.1016/j.clon.2017.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 10/20/2022]
Abstract
Dysphagia after primary chemoradiotherapy or radiation alone in pharyngeal cancers can have a devastating impact on a patient's physical, social and emotional state. Establishing and validating efficient dysphagia-optimised radiotherapy techniques is, therefore, of paramount importance in an era where health-related quality of life measures are increasingly influential determinants of curative management strategies, particularly as the incidence of good prognosis, human papillomavirus-driven pharyngeal cancer in younger patients continues to rise. The preferential sparing achievable with intensity-modulated radiotherapy (IMRT) of key swallowing structures implicated in post-radiation dysfunction, such as the pharyngeal constrictor muscles (PCM), has generated significant research into toxicity-mitigating strategies. The lack of randomised evidence, however, means that there remains uncertainty about the true clinical benefits of the dosimetric gains offered by technological advances in radiotherapy. As a result, we feel that IMRT techniques that spare PCM cannot be incorporated into routine practice. In this review, we discuss the swallowing structures responsible for functional impairment, analyse the studies that have explored the dose-response relationship between these critical structures and late dysphagia, and consider the merits of reported dysphagia-optimised IMRT (Do-IMRT) approaches, thus far. Finally, we discuss the dysphagia/aspiration-related structures (DARS) study (ISRCTN 25458988), which is the first phase III randomised controlled trial designed to investigate the impact of swallow-sparing strategies on improving long-term function. To maximise patient benefits, improvements in radiation delivery will need to integrate with novel treatment paradigms and comprehensive rehabilitation strategies to eventually provide a patient-centric, personalised treatment plan.
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Affiliation(s)
- I Petkar
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - S Bhide
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - K Newbold
- The Royal Marsden NHS Foundation Trust, London, UK
| | - K Harrington
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - C Nutting
- The Royal Marsden NHS Foundation Trust, London, UK
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Mehanna H, McConkey CC, Rahman JK, Wong WL, Smith AF, Nutting C, Hartley AG, Hall P, Hulme C, Patel DK, Zeidler SVV, Robinson M, Sanghera B, Fresco L, Dunn JA. PET-NECK: a multicentre randomised Phase III non-inferiority trial comparing a positron emission tomography-computerised tomography-guided watch-and-wait policy with planned neck dissection in the management of locally advanced (N2/N3) nodal metastases in patients with squamous cell head and neck cancer. Health Technol Assess 2017; 21:1-122. [PMID: 28409743 PMCID: PMC5410631 DOI: 10.3310/hta21170] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Planned neck dissection (ND) after radical chemoradiotherapy (CRT) for locally advanced nodal metastases in patients with head and neck squamous cell carcinoma (HNSCC) remains controversial. Thirty per cent of ND specimens show histological evidence of tumour. Consequently, a significant proportion of clinicians still practise planned ND. Fludeoxyglucose positron emission tomography (PET)-computerised tomography (CT) scanning demonstrated high negative predictive values for persistent nodal disease, providing a possible alternative paradigm to ND. Evidence is sparse and drawn mainly from retrospective single-institution studies, illustrating the need for a prospective randomised controlled trial. OBJECTIVES To determine the efficacy and cost-effectiveness of PET-CT-guided surveillance, compared with planned ND, in a multicentre, prospective, randomised setting. DESIGN A pragmatic randomised non-inferiority trial comparing PET-CT-guided watch-and-wait policy with the current planned ND policy in HNSCC patients with locally advanced nodal metastases and treated with radical CRT. Patients were randomised in a 1 : 1 ratio. Primary outcomes were overall survival (OS) and cost-effectiveness [incremental cost per incremental quality-adjusted life-year (QALY)]. Cost-effectiveness was assessed over the trial period using individual patient data, and over a lifetime horizon using a decision-analytic model. Secondary outcomes were recurrence in the neck, complication rates and quality of life. The recruitment of 560 patients was planned to detect non-inferior OS in the intervention arm with a 90% power and a type I error of 5%, with non-inferiority defined as having a hazard ratio (HR) of no higher than 1.50. An intention-to-treat analysis was performed by Cox's proportional hazards model. SETTINGS Thirty-seven head and neck cancer-treating centres (43 NHS hospitals) throughout the UK. PARTICIPANTS Patients with locally advanced nodal metastases of oropharynx, hypopharynx, larynx, oral or occult HNSCC receiving CRT and fit for ND were recruited. INTERVENTION Patients randomised to planned ND before or after CRT (control), or CRT followed by fludeoxyglucose PET-CT 10-12 weeks post CRT with ND only if PET-CT showed incomplete or equivocal response of nodal disease (intervention). Balanced by centre, planned ND timing, CRT schedule, disease site and the tumour, node, metastasis stage. RESULTS In total, 564 patients were recruited (ND arm, n = 282; and surveillance arm, n = 282; 17% N2a, 61% N2b, 18% N2c and 3% N3). Eighty-four per cent had oropharyngeal cancer. Seventy-five per cent of tested cases were p16 positive. The median time to follow-up was 36 months. The HR for OS was 0.92 [95% confidence interval (CI) 0.65 to 1.32], indicating non-inferiority. The upper limit of the non-inferiority HR margin of 1.50, which was informed by patient advisors to the project, lies at the 99.6 percentile of this estimate (p = 0.004). There were no differences in this result by p16 status. There were 54 NDs performed in the surveillance arm, with 22 surgical complications, and 221 NDs in the ND arm, with 85 complications. Quality-of-life scores were slightly better in the surveillance arm. Compared with planned ND, PET-CT surveillance produced an incremental net health benefit of 0.16 QALYs (95% CI 0.03 to 0.28 QALYs) over the trial period and 0.21 QALYs (95% CI -0.41 to 0.85 QALYs) over the modelled lifetime horizon. LIMITATIONS Pragmatic randomised controlled trial with a 36-month median follow-up. CONCLUSIONS PET-CT-guided active surveillance showed similar survival outcomes to ND but resulted in considerably fewer NDs, fewer complications and lower costs, supporting its use in routine practice. FUTURE WORK PET-CT surveillance is cost-effective in the short term, and long-term cost-effectiveness could be addressed in future work. TRIAL REGISTRATION Current Controlled Trials ISRCTN13735240. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 17. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Hisham Mehanna
- Institute of Head & Neck Studies and Education, University of Birmingham, Birmingham, UK
| | - Chris C McConkey
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Joy K Rahman
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Wai-Lup Wong
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - Alison F Smith
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | | | | | - Peter Hall
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Claire Hulme
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - Dharmesh K Patel
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | | | - Max Robinson
- Centre for Oral Health Research, Newcastle University, Newcastle upon Tyne, UK
| | - Bal Sanghera
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, UK
| | - Lydia Fresco
- University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
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Nutting C, Morden J, Beasley M, Bhide S, Emson M, Evans M, Fresco L, Gujral D, Harrington K, Lemon C, Neupane R, Newbold K, Prestwich R, Robinson M, Sanghera P, Sivaramalingam M, Sydenham M, Wells E, Witts S, Hall E. PO-093: COSTAR trial results: 3-D Conformal Radiotherapy vs Cochlea-Sparing IMRT in parotid cancer patients. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30227-x] [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: 11/25/2022]
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Guerreiro F, Burgos N, Dunlop A, Wong K, Petkar I, Nutting C, Harrington K, Bhide S, Newbold K, Dearnaley D, deSouza NM, Morgan VA, McClelland J, Nill S, Cardoso MJ, Ourselin S, Oelfke U, Knopf AC. Evaluation of a multi-atlas CT synthesis approach for MRI-only radiotherapy treatment planning. Phys Med 2017; 35:7-17. [PMID: 28242137 PMCID: PMC5368286 DOI: 10.1016/j.ejmp.2017.02.017] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 09/20/2016] [Revised: 01/27/2017] [Accepted: 02/14/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND PURPOSE Computed tomography (CT) imaging is the current gold standard for radiotherapy treatment planning (RTP). The establishment of a magnetic resonance imaging (MRI) only RTP workflow requires the generation of a synthetic CT (sCT) for dose calculation. This study evaluates the feasibility of using a multi-atlas sCT synthesis approach (sCTa) for head and neck and prostate patients. MATERIAL AND METHODS The multi-atlas method was based on pairs of non-rigidly aligned MR and CT images. The sCTa was obtained by registering the MRI atlases to the patient's MRI and by fusing the mapped atlases according to morphological similarity to the patient. For comparison, a bulk density assignment approach (sCTbda) was also evaluated. The sCTbda was obtained by assigning density values to MRI tissue classes (air, bone and soft-tissue). After evaluating the synthesis accuracy of the sCTs (mean absolute error), sCT-based delineations were geometrically compared to the CT-based delineations. Clinical plans were re-calculated on both sCTs and a dose-volume histogram and a gamma analysis was performed using the CT dose as ground truth. RESULTS Results showed that both sCTs were suitable to perform clinical dose calculations with mean dose differences less than 1% for both the planning target volume and the organs at risk. However, only the sCTa provided an accurate and automatic delineation of bone. CONCLUSIONS Combining MR delineations with our multi-atlas CT synthesis method could enable MRI-only treatment planning and thus improve the dosimetric and geometric accuracy of the treatment, and reduce the number of imaging procedures.
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Affiliation(s)
- F Guerreiro
- Faculty of Sciences, University of Lisbon, Campo Grande, Portugal; Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom.
| | - N Burgos
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, United Kingdom.
| | - A Dunlop
- Royal Marsden Hospital, London, United Kingdom
| | - K Wong
- Royal Marsden Hospital, London, United Kingdom
| | - I Petkar
- Royal Marsden Hospital, London, United Kingdom
| | - C Nutting
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - K Harrington
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - S Bhide
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - K Newbold
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - D Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - N M deSouza
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - V A Morgan
- Royal Marsden Hospital, London, United Kingdom
| | - J McClelland
- Centre for Medical Image Computing, Dept. Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - S Nill
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - M J Cardoso
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, United Kingdom
| | - S Ourselin
- Translational Imaging Group, Centre for Medical Imaging Computing, University College London, London, United Kingdom
| | - U Oelfke
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Royal Marsden Hospital, London, United Kingdom
| | - A C Knopf
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
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Howard J, Masterson L, Dwivedi RC, Riffat F, Benson R, Jefferies S, Jani P, Tysome JR, Nutting C. Minimally invasive surgery versus radiotherapy/chemoradiotherapy for small-volume primary oropharyngeal carcinoma. Cochrane Database Syst Rev 2016; 12:CD010963. [PMID: 27943254 PMCID: PMC6463943 DOI: 10.1002/14651858.cd010963.pub2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND More than 400,000 cases of oropharyngeal squamous cell carcinoma (OPSCC) are diagnosed each year worldwide and the incidence is rising, partly as a result of human papillomavirus. Human papillomavirus-associated OPSCC affects younger patients and often presents at a higher stage; however, it is associated with a better prognosis.Until recently, first-line management of OPSCC involved chemoradiotherapy, as research had demonstrated comparable survival outcomes when compared with open surgery, with significantly decreased morbidity. However, interventions have now evolved with computerised planning and intensity-modulated radiotherapy, and the advent of endoscopic head and neck surgery, which provide the potential for decreased treatment-associated morbidity.The oropharynx plays an essential role in swallowing, speech and protecting the airway as it is situated at the bifurcation of the respiratory and digestive tracts. Treatment modality recommendations are based on survival outcomes. Given the younger patient demographic, establishing the safety of modalities that potentially have better functional outcome is becoming increasingly important. OBJECTIVES To assess the efficacy of endoscopic head and neck surgery (transoral robotic surgery or transoral laser microsurgery) for small-volume, primary (T1-2, N0-2) oropharyngeal squamous cell carcinoma (OPSCC) in comparison to radiotherapy/chemoradiotherapy. SEARCH METHODS The Cochrane ENT Information Specialist searched the ENT Trials Register; Central Register of Controlled Trials (CENTRAL 2016, Issue 10); PubMed; EMBASE; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 8 November 2016. SELECTION CRITERIA Randomised controlled trials in patients with carcinoma in the oropharynx subsite (as defined by the World Health Organization classification C09, C10). Cancers included were primary squamous cell carcinomas arising from the oropharyngeal mucosa. The tumours were classified as T1-T2 with or without nodal disease and with no evidence of distant metastatic spread. The intervention was transoral, minimally invasive surgery with or without adjuvant radiotherapy or adjuvant chemoradiotherapy. The comparator was primary radiotherapy with or without induction or concurrent chemotherapy for the tumour. The treatments received and compared were of curative intent and patients had not undergone prior intervention, other than diagnostic biopsy. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. Our primary outcomes were overall survival (disease-related mortality was to be studied where possible), locoregional control, disease-free survival and progression-free survival or time to recurrence. All outcomes were to be measured at two, three and five years after diagnosis. Our secondary outcomes included quality of life, harms associated with treatment, patient satisfaction and xerostomia score. MAIN RESULTS No completed studies met the inclusion criteria for the review. Two ongoing trials fulfilled the selection criteria, however neither are complete.'Early-stage squamous cell carcinoma of the oropharynx: radiotherapy versus trans-oral robotic surgery (ORATOR)' is a phase II randomised controlled trial comparing primary radiation therapy with primary transoral robotic surgery for small-volume primary (T1-2, N0-2) OPSCC. It is currently in progress with an estimated completion date of June 2021.'European Organisation for Research and Treatment of Cancer 1420 (EORTC 1420-HNCG-ROG)' is a phase III, randomised study assessing the "best of" radiotherapy compared to transoral robotic surgery/transoral laser microsurgery in patients with T1-T2, N0 squamous cell carcinoma of the oropharynx and base of tongue. It was due to start accrual mid-2016. AUTHORS' CONCLUSIONS The role of endoscopic head and neck surgery in the management of OPSCC is clearly expanding as evidenced by its more overt incorporation into the current National Comprehensive Cancer Network guidelines. Data are mounting regarding its outcomes both in terms of survival and lower morbidity. As confidence increases, it is being used in the management of more advanced OPSCC.Based on this review, there is currently no high-quality evidence from randomised controlled trials regarding clinical outcomes for patients with oropharyngeal cancer receiving endoscopic head and neck surgery compared with primary chemoradiotherapy.
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Affiliation(s)
- James Howard
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Liam Masterson
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - Raghav C Dwivedi
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | | | - Richard Benson
- Addenbrooke's HospitalOncology CentreBox 193CambridgeUKCB2 2QQ
| | - Sarah Jefferies
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Piyush Jani
- Cambridge University Hospitals NHS Foundation TrustENT DepartmentHills RoadCambridgeUKCB2 0QQ
| | - James R Tysome
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Chris Nutting
- Royal Marsden HospitalHead and Neck UnitFulham RoadLondonUKSW3 6JJ
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Wong KH, Panek R, Welsh L, Mcquaid D, Dunlop A, Riddell A, Murray I, Du Y, Chua S, Koh DM, Bhide S, Nutting C, Oyen WJG, Harrington K, Newbold KL. The Predictive Value of Early Assessment After 1 Cycle of Induction Chemotherapy with 18F-FDG PET/CT and Diffusion-Weighted MRI for Response to Radical Chemoradiotherapy in Head and Neck Squamous Cell Carcinoma. J Nucl Med 2016; 57:1843-1850. [PMID: 27417648 DOI: 10.2967/jnumed.116.174433] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 05/31/2016] [Indexed: 01/30/2023] Open
Abstract
The objective of this study was to assess the predictive value of early assessment (after 1 cycle of induction chemotherapy [IC]) with 18F-FDG PET/CT and diffusion-weighted (DW) MRI for subsequent response to radical chemoradiotherapy in locally advanced head and neck squamous cell carcinoma (HNSCC). METHODS Twenty patients with stage III-IVa HNSCC prospectively underwent 18F-FDG PET/CT and DW MRI before and 2 wk after each cycle of IC (first cycle, IC1; second cycle, IC2). Response was assessed 3 mo after completion of chemoradiotherapy with clinical examination, MRI, and 18F-FDG PET/CT. Patients with persistent disease were classed as nonresponders. Changes in functional and molecular imaging parameters after IC1 were compared between responders and nonresponders with the Mann-Whitney U test. The significance threshold was set at a P value of less than 0.05. RESULTS Responders showed a significantly greater reduction in metabolic tumor volume (P = 0.03) and total lesion glycolysis (P = 0.04) after IC1 than nonresponders. Responders also showed a tendency toward a larger but statistically nonsignificant increase in apparent diffusion coefficient after IC1. There was no significant difference in the changes from baseline between the IC1 and IC2 for all functional and molecular imaging parameters, indicating that most biologic response to IC measured by 18F-FDG PET/CT and DW MRI was observed early after the first cycle of IC. CONCLUSION Our preliminary data indicate that the 18F-FDG PET/CT-derived metabolic tumor volume or total lesion glycolysis, acquired after IC1, are early predictive biomarkers for ultimate response to subsequent chemoradiotherapy. These early biomarkers enable identification of patients at risk of treatment failure at an early time point, permitting treatment individualization and consideration of alternative strategies such as radiotherapy dose escalation or surgery.
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Affiliation(s)
- Kee H Wong
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
- The Institute of Cancer Research, Sutton and London, United Kingdom
| | - Rafal Panek
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
- The Institute of Cancer Research, Sutton and London, United Kingdom
| | - Liam Welsh
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
| | - Dualta Mcquaid
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
| | - Alex Dunlop
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
| | - Angela Riddell
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
| | - Iain Murray
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
- The Institute of Cancer Research, Sutton and London, United Kingdom
| | - Yong Du
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
| | - Sue Chua
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
| | - Dow-Mu Koh
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
- The Institute of Cancer Research, Sutton and London, United Kingdom
| | - Shreerang Bhide
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
- The Institute of Cancer Research, Sutton and London, United Kingdom
| | - Chris Nutting
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
| | - Wim J G Oyen
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
- The Institute of Cancer Research, Sutton and London, United Kingdom
| | - Kevin Harrington
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
- The Institute of Cancer Research, Sutton and London, United Kingdom
| | - Kate L Newbold
- The Royal Marsden NHS Foundation Trust, Sutton and London, United Kingdom; and
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Brose M, Jarzab B, Elisei R, Giannetta L, Bastholt L, Fouchardiere C, Pacini F, Paschke R, Nutting C, Shong Y, Sherman S, Smit J, Chung J, Meinhardt G, Schlumberger M, Kappeler C. Final overall survival analysis of patients with locally advanced or metastatic radioactive iodine-refractory differentiated thyroid cancer (RAI-rDTC) treated with sorafenib in the phase 3 DECISION trial: An exploratory crossover adjustment analyses. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw376.06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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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Tyler J, Bernstein D, Rooney K, Nutting C. PO-0858: Development of dysphagia optimised IMRT for head and neck cancer treatment in the DARS trial. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)32108-9] [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: 10/21/2022]
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40
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Wong K, Welsh L, Mcquaid D, Dunlop A, Murray I, Du Y, Chua S, Panek R, Riddell A, Koh D, Bhide S, Nutting C, Harrington K, Newbold K. Metabolic Tumor Volume Changes Measured by 18F-FDG-PET/CT After 1 Cycle of Induction Chemotherapy Is an Early Predictor of Radical Chemoradiation Therapy Outcome in Head and Neck Squamous Cell Carcinoma. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2015.12.165] [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: 11/24/2022]
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Ness AR, Waylen A, Hurley K, Jeffreys M, Penfold C, Pring M, Leary SD, Allmark C, Toms S, Ring S, Peters TJ, Hollingworth W, Worthington H, Nutting C, Fisher S, Rogers SN, Thomas SJ. Recruitment, response rates and characteristics of 5511 people enrolled in a prospective clinical cohort study: head and neck 5000. Clin Otolaryngol 2016; 41:804-809. [PMID: 26436654 PMCID: PMC5111771 DOI: 10.1111/coa.12548] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2015] [Indexed: 11/28/2022]
Affiliation(s)
- A R Ness
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - A Waylen
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - K Hurley
- Surgical Research Team, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - M Jeffreys
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - C Penfold
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - M Pring
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - S D Leary
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - C Allmark
- National Cancer Research Institute Consumer Liaison Group (NCRI CLG), Independent Cancer Patients Voice (ICPV), London, UK
| | - S Toms
- School of Oral and Dental Sciences, National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - S Ring
- MRC Integrative Epidemiology Unit and Avon Longitudinal Study of Parents and Children, School of Social and Community Medicine, Bristol, UK
| | - T J Peters
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - W Hollingworth
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - H Worthington
- Cochrane Oral Health Group, School of Dentistry, University of Manchester, Manchester, UK
| | - C Nutting
- Royal Marsden Hospital and the Institute for Cancer Research, London, UK
| | - S Fisher
- Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, UK
| | - S N Rogers
- Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - S J Thomas
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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Mehanna H, Wong W, McConkey C, Rahman J, Robinson M, Hartley A, Nutting C, Powell N, Al-Booz H, Robinson M, Junor E, Hulme C, Smith A, Hall P, Dunn J. 11LBA Differences in the quality of life (QoL) and functional outcomes of treatment between HPV associated (HPV+) and HPV- patients receiving primary chemoradiotherapy in PET-NECK - a multi-centre randomized phase III controlled trial (RCT) comparing PETCT guided active surveillance with planned neck dissection (ND) for locally advanced (N2/N3) nodal metastases (LANM) in patients with head and neck squamous cell cancer (HNC) treated with primary radical chemoradiotherapy (CRT). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31936-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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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Aitken K, Tree A, Thomas K, Nutting C, Hawkins M, Tait D, Mandeville H, Ahmed M, Lalondrelle S, Miah A, Taylor A, Ross G, Khoo V, van As N. Initial UK Experience of Stereotactic Body Radiotherapy for Extracranial Oligometastases: Can We Change the Therapeutic Paradigm? Clin Oncol (R Coll Radiol) 2015; 27:411-9. [PMID: 25912366 DOI: 10.1016/j.clon.2015.03.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/10/2015] [Accepted: 03/19/2015] [Indexed: 12/21/2022]
Abstract
AIMS To retrospectively review the toxicity and early outcome data from patients who have received stereotactic body radiotherapy (SBRT) for extracranial oligometastases at a single UK institution. MATERIALS AND METHODS Eligible patients had ≤3 extracranial metastases and performance status ≤2. Prior systemic therapy and radical treatment of oligometastastic relapse with any standard treatment modality was permitted. Patients with synchronous metastatic disease were excluded unless they had evidence of controlled primary disease after radical therapy. Follow-up consisted of clinical examination, biochemical and radiological assessments in accordance with standard clinical care. Progression events were defined using RECIST. Toxicity was evaluated using CTCAE v4.0. Local control, progression-free survival (PFS), freedom from widespread distant metastasis (defined as disease not amenable to further radical salvage therapy) and overall survival were calculated. RESULTS Between July 2011 and April 2014, 73 patients with 87 metastases received SBRT (range 1-3 per patient). The median follow-up was 14.5 months (range 0-26.4). The median PFS was 14.5 months (1 year PFS 57%, 2 year 28%); 1 year overall survival 96%, 2 year 79.8%; 2 year local control 88%. At 2 years, 46% of patients were free from widespread distant metastases. No ≥ grade 3 acute or late toxicity was observed. CONCLUSION At this time point, observed toxicity is minimal with excellent local control rates. This promising treatment paradigm requires further investigation in the context of a randomised controlled trial to establish if the addition of SBRT to standard care improves survival outcomes.
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Affiliation(s)
- K Aitken
- Department of Radiotherapy, Royal Marsden Hospital, London, UK.
| | - A Tree
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - K Thomas
- Department of Statistics, Royal Marsden Hospital, London, UK
| | - C Nutting
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - M Hawkins
- Gray Institute for Radiation Oncology and Biology, University of Oxford, Oxford, UK
| | - D Tait
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - H Mandeville
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - M Ahmed
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - S Lalondrelle
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - A Miah
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - A Taylor
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - G Ross
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - V Khoo
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
| | - N van As
- Department of Radiotherapy, Royal Marsden Hospital, London, UK
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Owadally W, Baines H, Evans M, Jones G, Henderson J, Miles E, Dunn J, Nutting C, Mehanna H, Palaniappan N. EP-1156 Dosimetric impact of anatomic and volumetric methods of target outlining on normal structures in a UK clinical trial. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41148-x] [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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Yang H, Baines H, Conibear J, Evans M, Hartley A, Henderson J, Nutting C, Roques T, Mehanna H. PO-0643: Volumetric versus anatomical outlining: target delineation conformity in a multi-centre head and neck trial. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40635-8] [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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Nutting C. SP-0533: Combined modality treatment: risk-adapted intensified strategies and quality of life. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)40528-6] [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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Dunlop A, Welsh L, McQuaid D, Dean J, Gulliford S, Hansen V, Bhide S, Nutting C, Harrington K, Newbold K. Brain-sparing methods for IMRT of head and neck cancer. PLoS One 2015; 10:e0120141. [PMID: 25781636 PMCID: PMC4364536 DOI: 10.1371/journal.pone.0120141] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 01/19/2015] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Radical radiotherapy for head and neck cancer (HNC) may deliver significant doses to brain structures. There is evidence that this may cause a decline in neurocognitive function (NCF). Radiation dose to the medial temporal lobes, and particularly to the hippocampi, seems to be critical in determining NCF outcomes. We evaluated the feasibility of two alternative intensity-modulated radiotherapy (IMRT) techniques to generate hippocampus- and brain-sparing HNC treatment plans to preserve NCF. METHODS AND MATERIALS A planning study was undertaken for ten patients with HNC whose planning target volume (PTV) included the nasopharynx. Patients had been previously treated using standard (chemo)-IMRT techniques. Bilateral hippocampi were delineated according to the RTOG atlas, on T1w MRI co-registered to the RT planning CT. Hippocampus-sparing plans (HSRT), and whole-brain/hippocampus-sparing fixed-field non-coplanar IMRT (BSRT) plans, were generated. DVHs and dose difference maps were used to compare plans. NTCP calculations for NCF impairment, based on hippocampal dosimetry, were performed for all plans. RESULTS Significant reductions in hippocampal doses relative to standard plans were achieved in eight of ten cases for both HSRT and BSRT. EQD2 D40% to bilateral hippocampi was significantly reduced from a mean of 23.5 Gy (range 14.5-35.0) in the standard plans to a mean of 8.6 Gy (4.2-24.7) for HSRT (p = 0.001) and a mean of 9.0 Gy (4.3-17.3) for BSRT (p < 0.001). Both HSRT and BSRT resulted in a significant reduction in doses to the whole brain, brain stem, and cerebellum. CONCLUSION We demonstrate that IMRT plans for HNC involving the nasopharynx can be successfully optimised to significantly reduce dose to the bilateral hippocampi and whole brain. The magnitude of the achievable dose reductions results in significant reductions in the probability of radiation-induced NCF decline. These results could readily be translated into a future clinical trial.
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Affiliation(s)
- Alex Dunlop
- Joint Department of Physics, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Liam Welsh
- The Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Dualta McQuaid
- Joint Department of Physics, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jamie Dean
- The Institute of Cancer Research, London, United Kingdom
| | - Sarah Gulliford
- Joint Department of Physics, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Vibeke Hansen
- Joint Department of Physics, Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Shreerang Bhide
- The Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | | | - Kevin Harrington
- The Royal Marsden Hospital, London, United Kingdom
- The Institute of Cancer Research, London, United Kingdom
| | - Kate Newbold
- The Royal Marsden Hospital, London, United Kingdom
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Paschke R, Schlumberger M, Nutting C, Jarzab B, Elisei R, Siena S, Bastholt L, de la Fouchardiere C, Pacini F, Shong YK, Sherman SI, Smit J, Kappeler C, Molnar I, Brose MF. Exploratory analysis of outcomes for patients with locally advanced or metastatic radioactive iodine-refractory differentiated thyroid cancer (RAI-RDTC) receiving open-label Sorafenib post-progression on the phase III decision trial. Exp Clin Endocrinol Diabetes 2015. [DOI: 10.1055/s-0035-1547632] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ness AR, Waylen A, Hurley K, Jeffreys M, Penfold C, Pring M, Leary S, Allmark C, Toms S, Ring S, Peters TJ, Hollingworth W, Worthington H, Nutting C, Fisher S, Rogers SN, Thomas SJ. Establishing a large prospective clinical cohort in people with head and neck cancer as a biomedical resource: head and neck 5000. BMC Cancer 2014; 14:973. [PMID: 25519023 PMCID: PMC4301458 DOI: 10.1186/1471-2407-14-973] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 12/10/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Head and neck cancer is an important cause of ill health. Survival appears to be improving but the reasons for this are unclear. They could include evolving aetiology, modifications in care, improvements in treatment or changes in lifestyle behaviour. Observational studies are required to explore survival trends and identify outcome predictors. METHODS We are identifying people with a new diagnosis of head and neck cancer. We obtain consent that includes agreement to collect longitudinal data, store samples and record linkage. Prior to treatment we give participants three questionnaires on health and lifestyle, quality of life and sexual history. We collect blood and saliva samples, complete a clinical data capture form and request a formalin fixed tissue sample. At four and twelve months we complete further data capture forms and send participants further quality of life questionnaires. DISCUSSION This large clinical cohort of people with head and neck cancer brings together clinical data, patient-reported outcomes and biological samples in a single co-ordinated resource for translational and prognostic research.
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Affiliation(s)
- Andrew Robert Ness
- />National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Andrea Waylen
- />School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Katrina Hurley
- />Surgical Research Team, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Mona Jeffreys
- />School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Chris Penfold
- />National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Miranda Pring
- />School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Sam Leary
- />National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Christine Allmark
- />National Cancer Research Institute Consumer Liaison Group (NCRI CLG) and Independent Cancer Patients Voice (ICPV), London, UK
| | - Stu Toms
- />National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - Susan Ring
- />MRC Integrative Epidemiology Unit and Avon Longitudinal Study of Parents and Children, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Tim J Peters
- />School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Will Hollingworth
- />School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Worthington
- />Cochrane Oral Health Group, School of Dentistry, University of Manchester, Manchester, UK
| | - Chris Nutting
- />Royal Marsden Hospital and the Institute for Cancer Research, London, UK
| | - Sheila Fisher
- />Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, UK
| | - Simon N Rogers
- />Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Steven J Thomas
- />School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - The Head and Neck 5000 Study Team
- />National Institute for Health Research (NIHR) Biomedical Research Unit in Nutrition, Diet and Lifestyle at the University Hospitals Bristol NHS Foundation Trust and the University of Bristol and School of Oral and Dental Sciences, University of Bristol, Bristol, UK
- />School of Oral and Dental Sciences, University of Bristol, Bristol, UK
- />Surgical Research Team, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- />School of Social and Community Medicine, University of Bristol, Bristol, UK
- />National Cancer Research Institute Consumer Liaison Group (NCRI CLG) and Independent Cancer Patients Voice (ICPV), London, UK
- />MRC Integrative Epidemiology Unit and Avon Longitudinal Study of Parents and Children, School of Social and Community Medicine, University of Bristol, Bristol, UK
- />School of Clinical Sciences, University of Bristol, Bristol, UK
- />Cochrane Oral Health Group, School of Dentistry, University of Manchester, Manchester, UK
- />Royal Marsden Hospital and the Institute for Cancer Research, London, UK
- />Leeds Institute for Cancer and Pathology, University of Leeds, Leeds, UK
- />Evidence-Based Practice Research Centre (EPRC), Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
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Barbieri M, Weatherly HLA, Ara R, Basarir H, Sculpher M, Adams R, Ahmed H, Coles C, Guerrero-Urbano T, Nutting C, Powell M. What is the quality of economic evaluations of non-drug therapies? A systematic review and critical appraisal of economic evaluations of radiotherapy for cancer. Appl Health Econ Health Policy 2014; 12:497-510. [PMID: 25060829 PMCID: PMC4175431 DOI: 10.1007/s40258-014-0115-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Breast, cervical and colorectal cancers are the three most frequent cancers in women, while lung, prostate and colorectal cancers are the most frequent in men. Much attention has been given to the economic evaluation of pharmaceuticals for treatment of cancer by the National Institute for Health and Care Excellence (NICE) in the UK and similar authorities internationally, while economic analysis developed for other types of anti-cancer interventions, including radiotherapy and surgery, are less common. OBJECTIVES Our objective was to review methods used in published cost-effectiveness studies evaluating radiotherapy for breast, cervical, colorectal, head and neck and prostate cancer, and to compare the economic evaluation methods applied with those defined in the guidelines used by the NICE technology appraisal programme. METHODS A systematic search of seven databases (MEDLINE, EMBASE, CDSR, NHSEED, HTA, DARE, EconLit) as well as research registers, the NICE website and conference proceedings was conducted in July 2012. Only economic evaluations of radiotherapy interventions in individuals diagnosed with cancer that included quality-adjusted life-years (QALYs) or life-years (LYs) were included. Included studies were appraised on the basis of satisfying essential, preferred and UK-specific methods requirements, building on the NICE Reference Case for economic evaluations and on other methods guidelines. RESULTS A total of 29 studies satisfied the inclusion criteria (breast 14, colorectal 2, prostate 10, cervical 0, head and neck 3). Only two studies were conducted in the UK (13 in the USA). Among essential methods criteria, the main issue was that only three (10%) of the studies used clinical-effectiveness estimates identified through systematic review of the literature. Similarly, only eight (28%) studies sourced health-related quality-of-life data directly from patients with the condition of interest. Other essential criteria (e.g. clear description of comparators, patient group indication and appropriate time horizon) were generally fulfilled, while most of the UK-specific requirements were not met. CONCLUSION Based on this review there is a dearth of up-to-date, robust evidence on the cost effectiveness of radiotherapy in cancer suitable to support decision making in the UK. Studies selected did not fully satisfy essential method standards currently recommended by NICE.
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Affiliation(s)
- M Barbieri
- Centre for Health Economics (CHE), University of York, Heslington, York, YO10 5DD, UK,
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