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Clement SC, Visser WE, Lebbink CA, Albano D, Claahsen-van der Grinten HL, Czarniecka A, Dias RP, Dierselhuis MP, Dzivite-Krisane I, Elisei R, Garcia-Burillo A, Izatt L, Kanaka-Gantenbein C, Krude H, Lamartina L, Lorenz K, Luster M, Navardauskaitė R, Negre Busó M, Newbold K, Peeters RP, Pellegriti G, Piccardo A, Priego AL, Redlich A, de Sanctis L, Sobrinho-Simões M, van Trotsenburg ASP, Verburg FA, Vriens M, Links TP, Ahmed SF, van Santen HM. Development of a pediatric differentiated thyroid carcinoma registry within the EuRRECa project: rationale and protocol. Endocr Connect 2023; 12:e220306. [PMID: 37931414 PMCID: PMC9986407 DOI: 10.1530/ec-22-0306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 10/06/2023]
Abstract
Background Although differentiated thyroid carcinoma (DTC) is the most frequent endocrine pediatric cancer, it is rare in childhood and adolescence. While tumor persistence and recurrence are not uncommon, mortality remains extremely low. Complications of treatment are however reported in up to 48% of the survivors. Due to the rarity of the disease, current treatment guidelines are predominantly based on the results of small observational retrospective studies and extrapolations from results in adult patients. In order to develop more personalized treatment and follow-up strategies (aiming to reduce complication rates), there is an unmet need for uniform international prospective data collection and clinical trials. Methods and analysis The European pediatric thyroid carcinoma registry aims to collect clinical data for all patients ≤18 years of age with a confirmed diagnosis of DTC who have been diagnosed, assessed, or treated at a participating site. This registry will be a component of the wider European Registries for Rare Endocrine Conditions project which has close links to Endo-ERN, the European Reference Network for Rare Endocrine Conditions. A multidisciplinary expert working group was formed to develop a minimal dataset comprising information regarding demographic data, diagnosis, treatment, and outcome. We constructed an umbrella-type registry, with a detailed basic dataset. In the future, this may provide the opportunity for research teams to integrate clinical research questions. Ethics and dissemination Written informed consent will be obtained from all participants and/or their parents/guardians. Summaries and descriptive analyses of the registry will be disseminated via conference presentations and peer-reviewed publications.
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Affiliation(s)
- S C Clement
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital/ University Medical Center Utrecht, Utrecht, The Netherlands
| | - W E Visser
- Academic Center For Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C A Lebbink
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital/ University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - D Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili of Brescia, Brescia, Italy
| | - H L Claahsen-van der Grinten
- Department of Pediatrics, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - A Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - R P Dias
- Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Birmingham Women’s, and Children’s NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M P Dierselhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - I Dzivite-Krisane
- Department of Pediatric Endocrinology, Children's Clinical University Hospital, Riga, Latvia
| | - R Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Garcia-Burillo
- Nuclear Medicine Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Izatt
- Department of Clinical Genetics, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - C Kanaka-Gantenbein
- Division of Endocrinology, Diabetes, and Metabolism, First Department of Pediatrics National and Kapodistrian University of Athens Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - H Krude
- Institute of Experimental Pediatric Endocrinology, Charité - Universitätsmedizin, Berlin, Germany
| | - L Lamartina
- Department of Endocrine Oncology, Gustave Roussy, Villejuif, France
| | - K Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - M Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - R Navardauskaitė
- Department of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - M Negre Busó
- Nuclear Medicine Service - Institut de diagnòstic per la Imatge, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - K Newbold
- Thyroid Therapy Unit, The Royal Marsden NHS Foundation Trust Hospital, London, UK
| | - R P Peeters
- Academic Center For Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - G Pellegriti
- Endocrinology, Endocrinology Division, Garibaldi-Nesima Medical Center, Catania, Italy
| | - A Piccardo
- Department of Nuclear Medicine, EO Ospedali Galliera, Genoa, Italy
| | - A L Priego
- Department of Medicine, Division of Endocrinology, Leiden, University medical Center, Leiden, The Netherlands
| | - A Redlich
- Pediatric Oncology Department, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - L de Sanctis
- Regina Margherita Children Hospital - Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - M Sobrinho-Simões
- University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - F A Verburg
- Department of Radiology & Nuclear Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - M Vriens
- Department of Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T P Links
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - S F Ahmed
- Endocrinology, Endocrinology Division, Garibaldi-Nesima Medical Center, Catania, Italy
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Office for Rare Conditions, University of Glasgow, Glasgow, UK
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital/ University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
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2
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Lorimer C, Cheng L, Chandler R, Garcez K, Gill V, Graham K, Grant W, Sardo Infirri S, Wadsley J, Wall L, Webber N, Wong KH, Newbold K. Dabrafenib and Trametinib Therapy for Advanced Anaplastic Thyroid Cancer - Real-World Outcomes From UK Centres. Clin Oncol (R Coll Radiol) 2023; 35:e60-e66. [PMID: 36379836 DOI: 10.1016/j.clon.2022.10.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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: 08/18/2022] [Revised: 10/04/2022] [Accepted: 10/25/2022] [Indexed: 11/13/2022]
Abstract
AIMS Anaplastic thyroid cancer (ATC) is a rare but aggressive form of thyroid cancer with a median survival of 4 months. Recent advances in molecular profiling have shown that up to half of ATCs harbour the BRAF-V600E mutation. The aim of this study was to provide real-world data and experience on the use of combination therapy dabrafenib and trametinib in patients with BRAF-V600E-mutated advanced ATC. MATERIALS AND METHODS We retrospectively evaluated patients with confirmed BRAF-V600E-mutated ATC, defined as patients with locally advanced or metastatic ATC with no locoregional, radical treatment options. Outcomes measured were overall survival, progression-free survival, response rate, discontinuation rate, dose reduction rate and toxicity data. RESULTS Seventeen patients were evaluated and the mean age was 68 years. Ten patients died by the time of censoring. The median duration of follow-up was 12 months (3-43 months). The estimated median overall survival was 6.9 months (95% confidence interval 2.46 months - upper confidence interval not reached) and the median progression-free survival was 4.7 months (95% confidence interval 1.4-7.8 months). Dose interruptions and/or reductions were common, but none of the patients had to permanently discontinue treatment because of toxicities. Severe toxicities (grades 3 and 4) were uncommon. CONCLUSIONS This study supports the indication of dabrafenib and trametinib in BRAF-V600E-mutated ATC as an effective and well-tolerated treatment in an historically difficult to treat cancer.
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Affiliation(s)
- C Lorimer
- The Royal Marsden Hospital, London, UK
| | - L Cheng
- The Royal Marsden Hospital, London, UK.
| | - R Chandler
- Northern Centre for Cancer Care, Newcastle Upon Tyne, UK
| | - K Garcez
- The Christie NHS Foundation Trust, Manchester, UK
| | - V Gill
- St James's Institute of Oncology, St James's Hospital, Leeds, UK
| | - K Graham
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - W Grant
- Gloucestershire Hospitals NHS Foundation Trust, Cheltenham General Hospital, Cheltenham, UK
| | | | - J Wadsley
- Weston Park Cancer Centre, Sheffield, UK
| | - L Wall
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
| | - N Webber
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - K H Wong
- The Royal Marsden Hospital, London, UK
| | - K Newbold
- The Royal Marsden Hospital, London, UK
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3
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Filetti S, Durante C, Hartl DM, Leboulleux S, Locati LD, Newbold K, Papotti MG, Berruti A. ESMO Clinical Practice Guideline update on the use of systemic therapy in advanced thyroid cancer. Ann Oncol 2022; 33:674-684. [PMID: 35491008 DOI: 10.1016/j.annonc.2022.04.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 12/23/2022] Open
Affiliation(s)
- S Filetti
- School of Health, Unitelma Sapienza University of Rome, Rome
| | - C Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - D M Hartl
- Department of Head and Neck Oncology, Gustave Roussy, Villejuif; Université Paris Saclay, Villejuif
| | - S Leboulleux
- Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Villejuif, France; Division of Endocrinology, Diabetes, Nutrition and Therapeutic Patient Education, Geneva University Hospitals, Geneva, Switzerland
| | - L D Locati
- Translational Oncology, IRCCS ICS Maugeri, Pavia; Department of Internal Medicine and Medical Therapy, University of Pavia, Pavia, Italy
| | - K Newbold
- Thyroid Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - M G Papotti
- Department of Pathology, University of Turin, Turin
| | - A Berruti
- Department of Medical and Surgical Specialties Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, Brescia, Italy
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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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5
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Abreu C, Carnegie-Peake L, Taprogge J, Gape P, Rushforth D, Barker C, Divoli A, Gear J, McAreavey L, Murray I, Pratt B, Rojas B, Vavrova L, Wong K, Newbold K, Flux G. INSPIRE clinical dosimetry study: initial results. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00187-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Gurney-Champion O, Kieselmann J, Kee W, Ng-Cheng-Hin B, Newbold K, Harrington K, Oelfke U. OC-0344: Automatic contouring of diffusion-weighted MRI from an MR-Linac using a convolutional neural network. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00368-6] [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: 10/22/2022]
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7
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Newbold K, Schoeffski P, Hasan B, Locati L, Godbert Y, de la Fouchardiere C, Bastholt L, Fassnacht M, Reed N, Lalami Y, Chougnet C, Schvartz C, Kapiteijn E, Schlumberger M, Sents W, Sauve N, Leboulleux S. 1919P Nintedanib (BIBF1120) after first line therapy in progressive medullary thyroid cancer: A multicenter EORTC prospective randomized double-blind phase II study (NCT01788982). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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8
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Ng-Cheng-Hin B, Mcquaid D, Nutting C, Bhide S, Wong K, Harrington K, Newbold K. The impact of the MR-Linac field length on head and neck cancers patient selection. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2019.11.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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9
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Reed N, Glen H, Gerrard G, Good J, Lei M, Lyon AR, Strachan M, Wadsley J, Newbold K. Expert Consensus on the Management of Adverse Events During Treatment with Lenvatinib for Thyroid Cancer. Clin Oncol (R Coll Radiol) 2019; 32:e145-e153. [PMID: 31843241 DOI: 10.1016/j.clon.2019.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 07/09/2018] [Revised: 11/04/2019] [Accepted: 11/07/2019] [Indexed: 12/23/2022]
Abstract
AIMS Lenvatinib is an oral multi-kinase inhibitor approved for the treatment of adults with progressive, locally advanced or metastatic, differentiated thyroid carcinoma refractory to radioactive iodine. MATERIALS AND METHODS A literature review was undertaken to inform the development of consensus-based guidance for the routine management of adverse events associated with lenvatinib. PubMed was searched on 24 October 2017; the search terms were 'lenvatinib' and 'thyroid cancer'. RESULTS Hypertension, diarrhoea, weight loss, skin toxicities and cardiovascular adverse events were considered. For grade 1/2 diarrhoea, initial treatment should be loperamide with a 1-week treatment interruption if diarrhoea persists and dose reduction if diarrhoea recurs on reinitiation of lenvatinib. Blood pressure should be monitored daily in patients with pre-existing hypertension, otherwise from 1 week after the initiation of lenvatinib and weekly for the first 2 months. For patients with systolic blood pressure ≥135 mmHg to <160 mmHg or diastolic blood pressure ≥85 mmHg to <100 mmHg, lenvatinib should be continued but antihypertensive therapy initiated/intensified. For patients who remain hypertensive, a treatment break can be considered with lenvatinib reinitiated at a reduced dose once the patient's blood pressure has stabilised for at least 48 h. Weight loss of 10% of baseline body weight or the onset of anorexia should be managed with a 1-week treatment break; patients should maintain a healthy, active lifestyle. For patients with grade 2 proteinuria, lenvatinib may be continued, but an angiotensin II receptor blocker or angiotensin converting enzyme inhibitor should be commenced. For grade >3 proteinuria, lenvatinib should be interrupted until proteinuria returns to 1+. For chronic proteinuria, lenvatinib should be stopped. Skin toxicities should be managed with moisturisers or emollients and soap substitutes. CONCLUSIONS Prophylaxis, regular monitoring and symptomatic management with appropriate short treatment breaks and, for persistent adverse events, dose reductions, are recommended to enable patients to remain on the optimal dose regimen.
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Affiliation(s)
- N Reed
- Beatson West of Scotland Cancer Centre, Glasgow, UK.
| | - H Glen
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | | | - J Good
- QE Hospital, Birmingham, UK
| | - M Lei
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A R Lyon
- Royal Brompton & Harefield NHS Foundation Trust and Imperial College London, London, UK
| | | | | | - K Newbold
- Royal Marsden NHS Foundation Trust, London, UK
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Filetti S, Durante C, Hartl D, Leboulleux S, Locati LD, Newbold K, Papotti MG, Berruti A. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up†. Ann Oncol 2019; 30:1856-1883. [PMID: 31549998 DOI: 10.1093/annonc/mdz400] [Citation(s) in RCA: 471] [Impact Index Per Article: 94.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
MESH Headings
- Humans
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/epidemiology
- Adenocarcinoma, Follicular/pathology
- Adenocarcinoma, Follicular/therapy
- Carcinoma, Neuroendocrine/diagnosis
- Carcinoma, Neuroendocrine/epidemiology
- Carcinoma, Neuroendocrine/pathology
- Carcinoma, Neuroendocrine/therapy
- Follow-Up Studies
- Thyroid Cancer, Papillary/diagnosis
- Thyroid Cancer, Papillary/epidemiology
- Thyroid Cancer, Papillary/pathology
- Thyroid Cancer, Papillary/therapy
- Thyroid Carcinoma, Anaplastic/diagnosis
- Thyroid Carcinoma, Anaplastic/epidemiology
- Thyroid Carcinoma, Anaplastic/pathology
- Thyroid Carcinoma, Anaplastic/therapy
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/epidemiology
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/therapy
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Affiliation(s)
- S Filetti
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - C Durante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - D Hartl
- Department of Head and Neck Oncology, Gustave Roussy, Villejuif; Université Paris Saclay, Villejuif
| | - S Leboulleux
- Université Paris Saclay, Villejuif; Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy, Villejuif, France
| | - L D Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - K Newbold
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - M G Papotti
- Department of Pathology, University of Turin, Turin
| | - A Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Medical Oncology Unit, University of Brescia, ASST Spedali Civili, Brescia, Italy
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11
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Allin DM, Shaikh R, Carter P, Thway K, Sharabiani MTA, Gonzales-de-Castro D, O'Leary B, Garcia-Murillas I, Bhide S, Hubank M, Harrington K, Kim D, Newbold K. Circulating tumour DNA is a potential biomarker for disease progression and response to targeted therapy in advanced thyroid cancer. Eur J Cancer 2018; 103:165-175. [PMID: 30253333 DOI: 10.1016/j.ejca.2018.08.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 06/01/2018] [Revised: 08/16/2018] [Accepted: 08/19/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Conventional biomarkers in thyroid cancer are not disease specific and fluctuate in advanced disease, making interpretation difficult. Circulating tumour DNA (ctDNA) has been shown to be a useful biomarker in other solid tumours. This is a multimutational study of ctDNA over multiple timepoints, designed to test the hypothesis that ctDNA is a potential biomarker in patients with advanced thyroid cancer. METHODS Mutational analysis of archival tumour tissue was performed using NGS with a targeted gene panel. Custom TaqMan assays were designed for plasma ctDNA testing using digital droplet polymerase chain reaction. Concentrations of detected ctDNA were correlated with the conventional biomarker concentration and axial imaging status defined by the Response Evaluation Criteria in Solid Tumours criteria. RESULTS Tumour tissue from 51 patients was obtained, with the following histologies: 32 differentiated (differentiated thyroid cancer [DTC]), 15 medullary (medullary thyroid cancer [MTC]), three poorly differentiated and one anaplastic. NGS analysis detected variants in 42 (82%) of cases. Plasma was assayed for these patients in 190 samples, and ctDNA was detected in 67% of patients. Earlier detection of disease progression was noted in three patients with MTC. In two cases (PTC and ATC), where conventional biomarkers were not detectable, ctDNA was detected before disease progression. Changes in ctDNA concentration occurred earlier than conventional markers in response to disease progression in multiple patients with DTC receiving targeted therapies. CONCLUSION The majority of patients with advanced thyroid cancer had detectable ctDNA. ctDNA measurement may offer superiority over conventional markers in several scenarios: earlier detection of progression in MTC; as an alternative biomarker when conventional markers are not available; more rapid assessment of the disease status in response to targeted therapies, thereby potentially allowing prompter discontinuation of futile therapies. These early results support the hypothesis that ctDNA may be a clinically useful biomarker in thyroid cancer.
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Affiliation(s)
- D M Allin
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK.
| | - R Shaikh
- Centre for Molecular Pathology, The Royal Marsden Hospital, London, UK
| | - P Carter
- Centre for Molecular Pathology, The Royal Marsden Hospital, London, UK
| | - K Thway
- Histopathology Department, The Royal Marsden Hospital, London, UK
| | | | | | - B O'Leary
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - I Garcia-Murillas
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - S Bhide
- Head & Neck/Thyroid Oncology Department, The Royal Marsden Hospital, London, UK
| | - M Hubank
- Centre for Molecular Pathology, The Royal Marsden Hospital, London, UK
| | - K Harrington
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK; Head & Neck/Thyroid Oncology Department, The Royal Marsden Hospital, London, UK
| | - D Kim
- ENT/Head & Neck Department, St George's Hospital, London, UK
| | - K Newbold
- Radiotherapy and Imaging Division, The Institute of Cancer Research, London, UK; Head & Neck/Thyroid Oncology Department, The Royal Marsden Hospital, London, UK
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12
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Blinde S, Mohamed A, Al-Mamgani A, Newbold K, Karam I, Robbins J, Thomson D, Raaijmakers N, Fuller C, Terhaard C. Interobserver Variation in the International MRI Linear Accelerator Oropharyngeal Carcinoma Delineation Study. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2017.12.143] [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: 10/17/2022]
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13
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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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14
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Islam R, Lander F, Newbold K. Review of compliance with guidelines for risk stratification in low risk thyroid cancer at the Royal Marsden NHS Foundation Trust. Clin Oncol (R Coll Radiol) 2017. [DOI: 10.1016/j.clon.2017.04.019] [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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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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16
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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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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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18
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Newbold K, Sherman S, Wirth L, Habra M, Rietschel P, Song J, Schlumberger M, Gianoukakis A. 2862 The influence of time to objective response on lenvatinib clinical outcomes in the phase 3 SELECT trial. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31600-8] [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: 10/22/2022]
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19
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Wirth L, Tahara M, Robinson B, Francis S, Brose M, Habra M, Newbold K, Kiyota N, Dutcus C, Heras B, Zhu J, Sherman S, Schlumberger M. Treatment-Emergent Hypertension and Efficacy in the Phase 3 Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (Select). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu340.45] [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: 11/13/2022] Open
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20
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Elisei R, Schlumberger M, Tahara M, Robinson B, Brose M, Dutcus C, Heras B, Zhu J, Habra M, Newbold K, Shah M, Hoff A, Gianoukakis A, Kiyota N, Taylor M, Kim S, Krzyzanowska M, Sherman S, Wirth L. Subgroup Analyses of a Phase 3, Multicenter, Double-Blind, Placebo-Controlled Trial of Lenvatinib (E7080) in Patients with 131I-Refractory Differentiated Thyroid Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu340.48] [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: 11/12/2022] Open
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21
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Tahara M, Schlumberger M, Wirth L, Elisei R, Brose M, Habra M, Newbold K, Kiyota N, Dutcus C, Zhu J, Kadowaki T, Funahashi Y, Robinson B, Sherman S. Comprehensive Analysis of Serum Biomarker and Tumor Gene Mutation Associated with Clinical Outcomes in the Phase 3 Study of (E7080) Lenvatinib in Differentiated Cancer of the Thyroid (Select). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu438.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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Dunlop A, Welsh L, Nutting C, Harrington K, Bhide S, Newbold K. SU-E-T-198: Hippocampal-Sparing Radiotherapy (HSRT) for Patients with Head and Neck Cancer (HNC) Using Intensity-Modulated Radiation Therapy (IMRT). Med Phys 2014. [DOI: 10.1118/1.4888528] [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: 11/07/2022] Open
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23
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Schick U, Gulliford S, Zaidi S, Lal P, Franzese C, Gujral D, Newbold K, Nutting C, Harrington K, Bhide S. EP-1015: Predictors of acute dysphagia and oral mucositis in head and neck patients treated with chemoradiotherapy. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33321-1] [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: 10/23/2022]
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24
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Wilkins AC, Rosenfelder N, Schick U, Gupta S, Thway K, Nutting CM, Harrington KJ, Newbold K, Bhide SA. Equivalence of cisplatin and carboplatin-based chemoradiation for locally advanced squamous cell carcinoma of the head and neck: a matched-pair analysis. Oral Oncol 2013; 49:615-9. [PMID: 23485743 DOI: 10.1016/j.oraloncology.2013.02.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 02/07/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Carboplatin can be substituted for cisplatin in concomitant chemoradiation (CRT) for locally advanced squamous cell carcinoma of the head and neck (LASCCHN) when the latter is contraindicated. This matched-pair study aimed to compare the efficacy and acute toxicity of carboplatin and cisplatin. METHODS Patients treated with 2 cycles of concomitant carboplatin-based CRT were matched to patients treated with 2 cycles of cisplatin. Matching criteria included age, tumour site, stage, smoking status and use of induction chemotherapy. Radiation was delivered using conformal techniques. Data on weekly acute toxicity throughout CRT was compared using the chi-squared test for proportions. Kaplan Meier statistics described time to local relapse, distant relapse and overall survival, the log-rank test was used to compare 3-year survival outcomes. RESULTS Sixty-five patients who received carboplatin were matched to 65 who received cisplatin. Significant differences in toxicity included increased emesis with cisplatin and more anaemia and thrombocytopenia with carboplatin. There was no significant difference in 3-year locoregional control (87% vs. 79%, p=0.54), freedom from distant metastases (88% vs. 85%, p=0.79) and overall survival (59% vs. 68%, p=0.24) between the carboplatin and cisplatin cohorts, respectively. CONCLUSIONS When cisplatin is contraindicated, carboplatin-based CRT yields equivalent treatment outcomes in patients with LASCCHN.
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Affiliation(s)
- A C Wilkins
- Head and Neck Unit, Royal Marsden Hospital, London and Surrey, United Kingdom
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25
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Partridge M, Powell C, Koopman M, Humbert Vidan L, Newbold K. Technical note: 9-month repositioning accuracy for functional response assessment in head and neck chemoradiotherapy. Br J Radiol 2012; 85:1576-80. [PMID: 23175480 PMCID: PMC3611716 DOI: 10.1259/bjr/47081873] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 02/09/2012] [Revised: 05/03/2012] [Accepted: 05/29/2012] [Indexed: 01/08/2023] Open
Abstract
The use of thermoplastic immobilisation masks in head and neck radiotherapy is now common practice. The accuracy of these systems has been widely studied, but always within the context and time frame of the radiation delivery-some 6-8 weeks. There is growing current interest in the use of functional imaging to assess the response to treatment, particularly in the head and neck. It is therefore of interest to determine the accuracy with which functional images can be registered to baseline CT over the extended periods of time used for functional response assessment: 3-6 months after radiotherapy. In this study, repeated contrast-enhanced diagnostic quality CT and mid-quality localisation CT from a positron emission tomography/CT scanner were available for five time points over a period of 9 months (before, during and up to 6 months after chemoradiotherapy) for a series of eight patients enrolled in a clinical pilot study. All images were acquired using thermoplastic immobilisation masks. The overall set-up accuracy obtained from this 9-month study of 5.5 ± 3.2 mm (1 standard deviation) and 1.9 ± 1.3° (1 standard deviation) is in agreement with published data acquired over 6-8 weeks. No statistically significant change in set-up error was seen with time. This work indicates that thermoplastic immobilisation masks can be used to accurately align multimodality functional image data for assessment of the response to treatment in head and neck patients over extended follow-up periods.
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Affiliation(s)
- M Partridge
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, Sutton, UK.
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26
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Schlumberger M, Jarzab B, Cabanillas M, Robinson B, Furio P, Ball D, McCaffrey J, Newbold K, Allison R, Martins R, Licitra L, Shah M, Bodenner D, Elisei R, Burmeister L, Funahashi Y, Sellecchia R, Andresen C, O'Brien J, Sherman S. A Phase II Trial of the Multi-Targeted Kinase Inhibitor Lenvatinib (E7080) in Advanced Medullary Thyroid Cancer (MTC). Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)32016-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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27
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Lal P, Miah A, Bhide S, Guerrero-Urbano M, Newbold K, Harrington K, Nutting C. EP-1208 TOXICITY AND SURVIVAL OUTCOMES OF NASOPHARYNGEAL CANCERS TREATED BY CHEMO- IMRT IN A PHASE II TRIAL. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71541-4] [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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Abstract
It is increasingly being recognized that oral cavity cancer incidences are rising globally. Furthermore, these tumors represent a high risk group of tumors comparative to other head and neck tumor sub-sites and have a high preponderance of occult nodal metastases. Surgery alone leads to excellent outcomes in early stage disease. Advanced tumors require adjuvant radiotherapy with or without concomitant chemotherapy. Irradiation using 3D conformal radiotherapy results in high incidence of late radiation side-effects. Xersostomia and mandibular osteoradionecrosis result in most significant effects on patients' quality of life. Intensity modulated radiotherapy (IMRT) is an advanced approach to 3-D treatment planning and conformal therapy (3D-CRT). It optimizes the delivery of irradiation to irregularly-shaped volumes and has the ability to produce concavities in radiation treatment volumes and hence enables sparing of normal tissue while delivering adequate doses to the tumor volumes. In this manuscript, we discuss the advantages of IMRT based on review of published peer reviewed literature.
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Affiliation(s)
- S A Bhide
- Head and Neck Unit, Royal Marsden Hospital, SW3 6JJ London, United Kingdom.
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29
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Zaidi S, Miah A, Bhide S, Urbano MG, Clark C, Newbold K, Harrington K, Nutting C. 8555 POSTER Radiotherapy for High-risk Thyroid Malignancies – Report of Acute Toxicities of a Phase I Sequential Cohort Dose-escalation IMRT Study. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72197-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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30
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Sherman SI, Jarzab B, Cabanillas ME, Licitra LF, Pacini F, Martins R, Robinson B, Ball D, McCaffrey J, Shah MH, Bodenner D, Allison R, Newbold K, Elisei R, O'Brien JP, Schlumberger M. A phase II trial of the multitargeted kinase inhibitor E7080 in advanced radioiodine (RAI)-refractory differentiated thyroid cancer (DTC). J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.5503] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Mian A, Gulliford S, Bhide S, Newbold K, Harrington K, Nutting C. DOSE VOLUME HISTOGRAM ATLASES OF XEROSTOMIA INCIDENCE: AN ALTERNATIVE PREDICTOR OF RECOVERY OF SALIVARY FUNCTION. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)71769-8] [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: 11/29/2022]
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32
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Powell C, Schmidt M, Borri M, Koh D, Riddeil A, Nutting C, Harrington K, Bhide S, Newbold K. INVESTIGATING FUNCTIONAL MRI AS A SURROGATE MARKER OF EARLY RESPONSE TO CHEMORADIATION IN HEAD AND NECK CANCER. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70120-7] [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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33
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Miah A, Guiliford S, Bhide S, Harrington K, Newbold K, Nutting C. A COMPARISON OF WHOLE PAROTID AND PARTIAL PAROTID GLAND SPARING IMRT TECHNIQUES IN HEAD AND NECK CANCERS. Radiother Oncol 2011. [DOI: 10.1016/s0167-8140(11)70115-3] [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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34
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Dandekar P, Partridge M, Kazi R, Nutting C, Harrington K, Newbold K. Challenges in integrating 18FDG PET-CT into radiotherapy planning of head and neck cancer. Indian J Cancer 2010; 47:260-6. [PMID: 20587900 DOI: 10.4103/0019-509x.64717] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Radiotherapy forms one of the major treatment modalities for head and neck cancers (HNC), and precision radiotherapy techniques, such as intensity-modulated radiotherapy require accurate target delineation to ensure success of the treatment. Conventionally used imaging modalities, such as X-ray computed tomography (CT) and magnetic resonance imaging are used to delineate the tumor. Imaging, such as positron emission tomography (PET)-CT, which combines the functional and anatomic modalities, is increasingly being used in the management of HNC. Currently, 18-fluorodeoxyglucose is the most commonly used radioisotope, which is accumulated in areas of high glucose uptake, such as the tumor tissue. Because most disease recurrences are within the high-dose radiotherapy volume, defining a biological target volume for radiotherapy boost is an attractive approach to improve the results. There are many challenges in employing the PET-CT for radiotherapy planning, such as patient positioning, target edge definition, and use of new PET tracers, which represent various functional properties, such as hypoxia, protein synthesis, and proliferation. The role of PET-CT for radiotherapy planning is ever expanding and more clinical data underlining the advantages and challenges in this approach are emerging. In this article, we review the current clinical evidence for the application of functional imaging to radiotherapy planning and discuss some of the current challenges and possible solutions that have been suggested to date.
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Affiliation(s)
- P Dandekar
- Head and Neck Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, United Kingdom
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Abstract
Intensity-modulated radiotherapy (IMRT) has been a significant technological advance in the field of radiotherapy in recent years. IMRT allows sparing of normal tissue while delivering radical radiation doses to the target volumes. The role of IMRT for parotid salivary gland sparing in head and neck cancer is well established. The utility of IMRT for pharyngeal constrictor muscle and cochlear sparing requires investigation in clinical trials. The current evidence supporting the use of IMRT in various head and neck subsites has been summarized. Sparing of organs at risk allows for dose-escalation to the target volumes, taking advantage of the steep dose-response relationship for squamous cell carcinomas to improve treatment outcomes in advanced head and neck cancers. However, dose-escalation could result in increased radiation toxicity (acute and late), which has to be studied in detail. The future of IMRT in head and neck cancers lies in exploring the use of biological imaging for dose-escalation using targeted dose painting.
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Affiliation(s)
- S A Bhide
- Head and Neck Unit, The Institute of Cancer Research and The Royal Marsden Hospital, London and Surrey, United Kingdom
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36
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Powell C, Newbold K, Harrington K, Bhide S, Nutting C. External Beam Radiotherapy for Differentiated Thyroid Cancer. Clin Oncol (R Coll Radiol) 2010; 22:456-63. [DOI: 10.1016/j.clon.2010.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 03/22/2010] [Indexed: 11/26/2022]
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Harrington KJ, Kazi R, Bhide SA, Newbold K, Nutting CM. Novel therapeutic approaches to squamous cell carcinoma of the head and neck using biologically targeted agents. Indian J Cancer 2010; 47:248-59. [DOI: 10.4103/0019-509x.64711] [Citation(s) in RCA: 11] [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: 11/04/2022]
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38
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Bhide S, Gulliford S, A'Hern R, Hall E, Newbold K, Harrington K, Nutting C. Quantitative Estimates of the Effects of Concomitant Chemotherapy on Acute Dysphagia in Patients Receiving Radical Treatment for Head and Neck Cancer. Int J Radiat Oncol Biol Phys 2009. [DOI: 10.1016/j.ijrobp.2009.07.1400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Miah A, Bhide S, Urbano MG, Newbold K, Harrington K, Nutting C. INTENSITY MODULATED RADIOTHERAPY (IMRT) FOR NASOPHARYNGEAL CANCERS-ACUTE TOXICITIES AND EARLY TREATMENT OUTCOMES. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(12)72869-4] [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: 11/27/2022]
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40
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Bhide S, Miah A, Barbachano Y, Harrington K, Newbold K, Nutting C. Radical radiotherapy for treatment of malignant parotid tumours: A single centre experience 1995–2005. Br J Oral Maxillofac Surg 2009; 47:284-9. [DOI: 10.1016/j.bjoms.2008.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2008] [Indexed: 11/26/2022]
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Bhide S, Gulliford S, A'Hern R, Hall E, Newbold K, Harrington K, Nutting C. Quantitative estimates of the effects of concomitant chemotherapy on acute dysphagia in patients receiving radical treatment for head and neck cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22134 Purpose: To generate quantitative parameters describing the effect of concomitant chemotherapy on incidence of grade 3 dysphagia (CTCAE v3.0, assisted feeding) using dose response curves in patients receiving radical treatment for head and neck cancer. Methods: Patients treated at a single centre in prospective phase I and II trials of concomitant chemo-IMRT (CRT) (n=85) and the phase III trial of IMRT vs. conventional radiotherapy (PARSPORT) (n=82) formed the basis of this non-randomized comparison. Patients in the PARSPORT trial received radiation alone (RT). Radiation dose for all patients was radiobiologically equivalent to at least 70Gy in 35 fractions. Concomitant chemotherapy was cisplatin (100 mg/m2) on days 1 and 29. G3 dysphagia was recorded prospectively. Dose volume histograms (DVH) were generated for the pharyngeal mucosa. The mean dose (converted to equivalent dose in 2Gy/fraction, MD2) was used as a univariate descriptor of the DVH, for the generation of the dose response curves. A logistic function of the form p=1/[1+(MD50/D)k] was fitted where, p is the probability of the incidence of toxicity, D is the mean dose, MD50 is the mean dose at which 50% of patients experience toxicity and k describes the increase in incidence with increasing dose. The dose response curves were fitted using non-linear logistic regression. Results: The mean MD2 to the pharyngeal mucosa were 56Gy and 55.8Gy respectively, in the CRT and RT groups. There was a statistically significant difference of 25% (95% CI: 10–38, p=0.002) in the incidence of G3 dysphagia between the CRT (68%) and RT (43%) groups. Fitting dose response curves to the clinical data yielded parameter values (95% CIs) of MD50=46 Gy (42–49), k=4.8 (2.3–7.2) for the CRT group and MD50= 58 Gy (55–61), k=3 (1.6-.45) for RT group. Dose response gradients for CRT and RT showed approximately 1.95% and 1.3% increase (respectively) in probability of G3 dysphagia resulting from an increase in mean dose of 1Gy between doses of 30Gy to 70Gy. Conclusions: Addition of concomitant chemotherapy increases the incidence of G3 dysphagia by 0.65% for every 1 Gy increase in radiation dose. The observed MD50 for G3 dysphagia is lower for RT alone (46 Gy vs. 58 Gy). No significant financial relationships to disclose.
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Affiliation(s)
- S. Bhide
- University College Hospitals, London, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; ICR-CTSU, Sutton, United Kingdom; Royal Marsden Hospital & ICR, London, United Kingdom; Rotal Marsden Hospital, London, United Kingdom
| | - S. Gulliford
- University College Hospitals, London, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; ICR-CTSU, Sutton, United Kingdom; Royal Marsden Hospital & ICR, London, United Kingdom; Rotal Marsden Hospital, London, United Kingdom
| | - R. A'Hern
- University College Hospitals, London, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; ICR-CTSU, Sutton, United Kingdom; Royal Marsden Hospital & ICR, London, United Kingdom; Rotal Marsden Hospital, London, United Kingdom
| | - E. Hall
- University College Hospitals, London, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; ICR-CTSU, Sutton, United Kingdom; Royal Marsden Hospital & ICR, London, United Kingdom; Rotal Marsden Hospital, London, United Kingdom
| | - K. Newbold
- University College Hospitals, London, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; ICR-CTSU, Sutton, United Kingdom; Royal Marsden Hospital & ICR, London, United Kingdom; Rotal Marsden Hospital, London, United Kingdom
| | - K. Harrington
- University College Hospitals, London, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; ICR-CTSU, Sutton, United Kingdom; Royal Marsden Hospital & ICR, London, United Kingdom; Rotal Marsden Hospital, London, United Kingdom
| | - C. Nutting
- University College Hospitals, London, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom; ICR-CTSU, Sutton, United Kingdom; Royal Marsden Hospital & ICR, London, United Kingdom; Rotal Marsden Hospital, London, United Kingdom
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Harrington K, Hingorani M, Tanay M, Matthews J, Newbold K, Renouf L, Coffin RS, McNeish I, Nutting C. Phase I/II dose escalation study of OncoVex GM-CSF and chemoradiotherapy (CRT) in untreated stage III/IV squamous cell cancer of the head and neck (SCCHN). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.6018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
6018 Background: OncoVEXGM-CSF is a gene deleted (ICP34.5-/ICP47) oncolytic HSV-1 that encodes human GM-CSF. OncoVEXGM-CSF causes direct oncolytic tumour cell destruction and immune activation by releasing tumour antigens and GM-CSF, effects that may co-operate with CRT to increase loco-regional control in SCCHN. Methods: Patients (pts): Stage III/IVA SCCHN, N1-N3, ECOG 0–1, normal haematologic, biochemical, immune function. Pts received CRT (70 Gy/35 fractions with concomitant cisplatin 100 mg/m2 (d 1, 22, 43) and dose-escalating (106, 106, 106, 106 pfu/mL [cohort 1]; 106, 107, 107, 107 [cohort 2]; 106, 108, 108, 108 [cohort 3]) OncoVEXGM-CSF by intratumoral injection (d 1, 22, 43, 64). Pts underwent neck dissection 6–10 weeks after CRT. Primary endpoints were safety and recommended dose/schedule for future study. Secondary endpoints were anti-tumor activity, viral replication and HSV antibody levels. Results: 17 pts were treated, 9 at the top dose (15 males, median 58 years). DLT and MTD were not reached. There were no delays to CRT delivery. 13 pts had PR or CR by CT, 5 pts achieving rapid CR following only 2 or 3 viral doses. Pathological CR was observed in 94% of pts at neck dissection. Transient low level injection site viral shedding was seen in 3 pts. HSV was detected in injected and adjacent uninjected tumors by qPCR and immunohistochemistry, including at levels higher than the input dose, indicating replication. All seronegative pts seroconverted. 11 of 17 (65%) pts remain in remission at median follow-up of 23 months. No pts had local relapse, 1 pt had a new primary tumor, 3 pts distant metastatic disease, 1 pt intercurrent disease, 1 pt lost to follow up. Conclusions: OncoVEXGM-CSF combined with cisplatin-based CRT is well tolerated in pts with SCCHN. Viral replication was confirmed. Long-term locoregional control was achieved in 100% of pts, 65% of pts remaining in complete remission. Further study is warranted. [Table: see text]
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Affiliation(s)
- K. Harrington
- Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, London, United Kingdom; BioVex, Inc., Woburn, MA; Barts and The London Hospital, London, United Kingdom
| | - M. Hingorani
- Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, London, United Kingdom; BioVex, Inc., Woburn, MA; Barts and The London Hospital, London, United Kingdom
| | - M. Tanay
- Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, London, United Kingdom; BioVex, Inc., Woburn, MA; Barts and The London Hospital, London, United Kingdom
| | - J. Matthews
- Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, London, United Kingdom; BioVex, Inc., Woburn, MA; Barts and The London Hospital, London, United Kingdom
| | - K. Newbold
- Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, London, United Kingdom; BioVex, Inc., Woburn, MA; Barts and The London Hospital, London, United Kingdom
| | - L. Renouf
- Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, London, United Kingdom; BioVex, Inc., Woburn, MA; Barts and The London Hospital, London, United Kingdom
| | - R. S. Coffin
- Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, London, United Kingdom; BioVex, Inc., Woburn, MA; Barts and The London Hospital, London, United Kingdom
| | - I. McNeish
- Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, London, United Kingdom; BioVex, Inc., Woburn, MA; Barts and The London Hospital, London, United Kingdom
| | - C. Nutting
- Royal Marsden Hospital, London, United Kingdom; Institute of Cancer Research, London, United Kingdom; BioVex, Inc., Woburn, MA; Barts and The London Hospital, London, United Kingdom
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Prasad D, Harmer C, Harrington K, Nutting C, Rhys-Evans P, Barbachano Y, Newbold K. Hyperfractionated Accelerated Radiotherapy for Anaplastic Thyroid Cancer. Int J Radiat Oncol Biol Phys 2008. [DOI: 10.1016/j.ijrobp.2008.06.1299] [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: 10/21/2022]
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Bhide SA, Ahmed M, Barbachano Y, Newbold K, Harrington KJ, Nutting CM. Sequential induction chemotherapy followed by radical chemo-radiation in the treatment of locoregionally advanced head-and-neck cancer. Br J Cancer 2008; 99:57-62. [PMID: 18560402 PMCID: PMC2453042 DOI: 10.1038/sj.bjc.6604444] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [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] [Indexed: 12/21/2022] Open
Abstract
We describe a retrospective series of patients with advanced head-and-neck cancer who were treated with induction chemotherapy followed by radical chemo-radiation. Patients treated with two cycles of induction chemotherapy followed by definitive chemo-radiation for squamous cell carcinoma of the head-and-neck region, from 2001 – 2006 at the Royal Marsden Hospital, formed the basis of this study. Cisplatin (75 mg m−2) on day 1 and 5-FU (1000 mg m−2) day 1 – 4 was the standard regimen used for induction treatment. Cisplatin (100 mg m−2) on day 1 and day 29 was used for concomitant treatment. The radiation was delivered using conformal technique. Tissues containing macroscopic and microscopic disease were treated to doses of 65 Gray (Gy) in 30 fractions and 50 Gy in 25 fractions, respectively. Data on patterns of relapse and acute toxicity (NCICTCv.3.0) were collected. A total of 129 patients were included, median age was 58 (range: 27 – 78). The site of tumour was: oropharynx 70 (54%), larynx 30 (23%), hypopharynx 24 (19%) and other 5 (4%). The median follow-up was 19 months (range: 4 – 58). Local control, disease-specific survival and overall survival at 2 years were 71%, 68% and 63%, respectively. The distant recurrence rate at 2 years was 9%. Ten patients required dose reduction during induction chemotherapy due to toxicity. The dose of 5-FU was reduced in six patients and that of cisplatin in four patients. The incidence of grade 3/4 toxicity was: neutropenia 5%, thrombocytopenia 1%, nausea and vomiting 3%. One cycle of concurrent cisplatin was omitted in 23 patients due to toxicity. Full-dose radiotherapy was administered to 98% of patients. The incidence of grade 3/4 toxicity was: skin 20%, dysphagia 65%, mucositis 60%, neutropenia 3%, anaemia 1%, nausea and vomiting 4%, nephrotoxicity 1%. Induction chemotherapy followed by radical chemo-radiation is a safe and tolerable regimen in the treatment of advanced head-and-neck cancer. Distant recurrence rates are lower with equivalent local control and survival compared to chemo-radiation alone (historical controls).
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Affiliation(s)
- S A Bhide
- Head and Neck Unit, Royal Marsden Hospital, London SW3 6JJ, UK
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Bhide SA, Ahmed M, Powell C, Newbold K, Nutting CM, Harrington K. Anemia during sequential induction chemotherapy and chemo-radiation for head and neck cancer: The impact of blood transfusion on treatment outcome. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6018] [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: 11/20/2022] Open
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Ahmed M, Barbachano Y, Riddell AM, Whittaker S, Newbold K, Harrington K, Marais R, Nutting CM. Preliminary results of an open labelled phase 2 study evaluating the safety and efficacy of sorafenib in metastatic advanced thyroid cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.6060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Newbold K, Partridge M, Cook G, Sohaib SA, Charles-Edwards E, Rhys-Evans P, Harrington K, Nutting C. Advanced imaging applied to radiotherapy planning in head and neck cancer: a clinical review. Br J Radiol 2006; 79:554-61. [PMID: 16823059 DOI: 10.1259/bjr/48822193] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Head and neck squamous cell carcinoma represents an ideal model to investigate the application of recent advances in medical imaging to radiotherapy planning. Tumours usually remain localized, and are potentially curable with local radiation. The steep radiation dose-response relationships support the strategies of radiation dose escalation to increase local control. Two-dimensional simulator-based planning and CT planning have significant drawbacks in terms of accurate target volume definition. MRI has enhanced soft tissue delineation, but has to be fused with CT to allow dose calculation. Functional imaging using dynamic contrast enhanced CT or MRI sequences may allow improved knowledge of tumour function. Positron emission tomography (PET) may allow further physiological information to be determined. This review summarizes the current techniques in clinical development in this area.
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Affiliation(s)
- K Newbold
- The Royal Marsden NHS Trust, Fulham Road, London SW3 6JJ, UK
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Bowen JM, Newbold K, Blake P, Wild G, Egner W, Norman AR, Andreyev HJN. Do serum levels of eosinophil granule-derived protein change in patients undergoing pelvic radiotherapy? Clin Oncol (R Coll Radiol) 2005; 17:382-4. [PMID: 16097571 DOI: 10.1016/j.clon.2005.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS Eosinophils have an important role in the pathogenesis of inflammatory bowel disease, with faecal levels of the eosinophil granule proteins, eosinophil cationic protein (ECP) and eosinophil protein X (EPX) reflecting disease activity. Eosinophil crypt abscesses are a characteristic histological finding in acute gastrointestinal radiation-induced mucosal damage. This pilot study aimed to investigate changes in serum levels of ECP/EPX during pelvic radiotherapy. MATERIALS AND METHODS Patients with no history of inflammatory bowel disease, starting a 5-week course of pelvic radiotherapy, had serum ECP/EPX levels measured before radiotherapy and during the fourth week of treatment. Bowel toxicity was graded at week 4 using the Common Toxicity Criteria Scale. RESULTS Fifteen patients who were to undergo adjuvant radiotherapy for gynaecological cancer were recruited. The mean serum levels of ECP and EPX before treatment were 17.3 microg/l (range 2.0-49.3 microg/l) and 37.3 microg/l (range 12.0-94.0 microg/l), respectively. The mean serum levels during week 4 of radiotherapy for ECP and EPX were 43.0 microg/l (range 2.4-164.0 microg/l) and 38.7 microg/l (range 9.0-79.0 microg/l), respectively. Serum ECP levels increased at week 4 compared with levels before radiotherapy (P = 0.02). Acute bowel toxicity was seen in 12 patients (80%) at week 4: Grade 1 in 25% patients and Grade 2 in 75%. In this small study, no correlation was seen between acute bowel toxicity at week 4 and serum ECP or EPX levels. CONCLUSIONS Serum ECP levels increase in response to pelvic irradiation. This may reflect the known involvement of eosinophils in the acute response to radiotherapy. Further study is required to determine when levels start to rise and their relationship to the degree of acute bowel toxicity.
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Affiliation(s)
- J M Bowen
- Department of Oncology, East Gloucestershire NHS Trust, Cheltenham, UK
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Hyer SL, Newbold K, Harmer C. Familial medullary thyroid cancer: clinical aspects and prognosis. Eur J Surg Oncol 2005; 31:415-9. [PMID: 15837050 DOI: 10.1016/j.ejso.2004.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2004] [Revised: 10/18/2004] [Accepted: 11/03/2004] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess clinical features and long-term results of treatment of familial medullary thyroid carcinoma (FMTC). DESIGN Retrospective analysis of all patients with familial forms of MTC diagnosed between 1949-2000 and treated in our unit. RESULTS Fifty five patients (25 males, 30 females) were identified with at least two first-degree relatives affected by medullary thyroid cancer; 26 were classified as MEN 2A, 1 as MEN 2B and 28 as FMTC. Median age at diagnosis was 35 years (MEN 2A), 25 (MEN 2B) and 47.5 (FMTC). Median follow-up was 9 years (range: 4-24). Total or near-total thyroidectomy was performed in all patients and 11 received adjuvant external beam radiotherapy. Cause specific survival was 89% at 10 years and 77% at 20 years for MEN patients, 51% and 32% for those with sporadic MTC, and 46% and 26% for those with FMTC. In multivariate analysis, factors predicting survival were presence of metastases, nodal status and age at diagnosis. CONCLUSIONS Improved survival rates associated with familial types of MTC can be accounted for by the earlier stage at which disease is detected and the younger age at presentation. These observations emphasize the need for early detection in those at risk.
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Affiliation(s)
- S L Hyer
- Thyroid Unit, Royal Marsden Hospital, London, UK.
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Newbold K, Nutting C. Clinical trials in cancer. Principles and practice. By D Girling, M Parmar, S Stenning, R Stephens and L Stewart, pp xvii + 367, 2003 (Oxford University Press, New York, NY), £49.95 ISBN 0 19 262959 X. Br J Radiol 2004. [DOI: 10.1259/bjr.77.923.770978a] [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: 11/05/2022] Open
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