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Zhou S, Rulach R, Hendry F, Stobo D, James A, Dempsey MF, Grose D, Lamb C, Schipani S, Rizwanullah M, Wilson C, Lau YC, Paterson C. Positron Emission Tomography-Computed Tomography Surveillance after (Chemo)Radiotherapy in Advanced Head and Neck Squamous Cell Cancer: Beyond the PET-NECK Protocol. Clin Oncol (R Coll Radiol) 2020; 32:665-673. [PMID: 32561027 DOI: 10.1016/j.clon.2020.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/20/2019] [Revised: 04/16/2020] [Accepted: 05/26/2020] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate the implementation of 18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) surveillance after (chemo)radiotherapy, to compare outcomes for those who achieved a complete (CR), equivocal (EQR) and incomplete (ICR) nodal response on 12-week PET-CT according to their human papillomavirus (HPV) status, and to assess the safety of ongoing surveillance beyond 12 weeks in the HPV-positive EQR group. MATERIALS AND METHODS All patients with node-positive head and neck squamous cell carcinoma (HNSCC) treated with (chemo)radiotherapy between January 2013 and September 2017 were identified. PET-CT responses were classified as CR, ICR or EQR. Patient outcomes were obtained from electronic records. RESULTS In total, 236 patients with a minimum of 2 years of follow-up were identified. The mean age was 59 years; 79.3% had N2 disease; 77.1% of patients had oropharyngeal cancer and 10.1% had squamous cell carcinoma of unknown primary, of whom 82.0% (169) were HPV positive; 78.0% received chemoradiotherapy. The median time from the end of radiotherapy to PET-CT was 91 days. Of the HPV-related HNSCC, 60.4% achieved CR, 29.0% EQR and 10.6% ICR. With a median follow-up of 41.7 months, there was no difference in survival between patients with HPV-related HNSCC achieving CR and EQR (median overall survival not reached for both, P = 0.67) despite the omission of immediate neck dissection in 98.0% of the EQR group. CONCLUSION Patients with HPV-positive HNSCC who have achieved EQR have comparable survival outcomes to those who achieved a CR despite the omission of immediate neck dissections; this shows the safety of ongoing surveillance beyond 12 weeks in this group of patients.
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Affiliation(s)
- S Zhou
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - R Rulach
- The Beatson West of Scotland Cancer Centre, Glasgow, UK; University of Glasgow, Glasgow, UK
| | - F Hendry
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - D Stobo
- West of Scotland PET Centre, Gartnavel General Hospital, Glasgow, UK
| | - A James
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M-F Dempsey
- Greater Glasgow and Clyde NHS Trust, Glasgow, UK
| | - D Grose
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Lamb
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - S Schipani
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Rizwanullah
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Wilson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Y C Lau
- Greater Glasgow and Clyde NHS Trust, Glasgow, UK
| | - C Paterson
- The Beatson West of Scotland Cancer Centre, Glasgow, UK.
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Seligmann JF, Wright-Hughes A, Pottinger A, Velikova G, Oughton JB, Murden G, Rizwanullah M, Price C, Passant H, Heudtlass P, Marshall H, Johnston S, Dodwell D. Lapatinib plus Capecitabine versus Trastuzumab plus Capecitabine in the Treatment of Human Epidermal Growth Factor Receptor 2-positive Metastatic Breast Cancer with Central Nervous System Metastases for Patients Currently or Previously Treated with Trastuzumab (LANTERN): a Phase II Randomised Trial. Clin Oncol (R Coll Radiol) 2020; 32:656-664. [PMID: 32600919 DOI: 10.1016/j.clon.2020.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 01/02/2020] [Revised: 05/14/2020] [Accepted: 06/03/2020] [Indexed: 11/12/2022]
Abstract
AIMS Brain (central nervous system; CNS) metastases occur in 30-50% of patients with human epidermal growth factor receptor 2 (HER2)-positive metastatic breast cancer (MBC). A substantive evidence base for treatment is lacking, but activity with lapatinib plus capecitabine (lap-cap) has been reported. We compared lap-cap with trastuzumab plus capecitabine (tras-cap) in patients with HER2-positive MBC with CNS metastases previously treated with trastuzumab. MATERIALS AND METHODS This open-label randomised phase II screening trial aimed to randomise 130 participants over 2 years to receive lap-cap or tras-cap. Eligible patients had HER2-positive MBC with newly diagnosed or recently progressed CNS metastases; previous, or current, treatment included: trastuzumab, a taxane or anthracycline and recent completion of local cranial therapy. The primary end point was time to progression of CNS metastases within the 24-week trial period. Secondary objectives included CNS response rate, progression-free survival, steroid use for CNS symptoms and feasibility of recruitment to a large phase III trial. RESULTS Between September 2011 and October 2013, 30 participants were randomised, 16 to lap-cap and 14 to tras-cap. Recruitment to a large phase III trial was determined not to be feasible. At 24 weeks, CNS disease progression was 41.8% (95% confidence interval 16.1-67.5%) in lap-cap and 41.2% (95% confidence interval 12.8-69.6%) in tras-cap arms; progression-free survival was 44.4% (95% confidence interval 18.1-70.8%) in lap-cap and 50.0% (95% confidence interval 20.9-79.1%) in tras-cap arms. CONCLUSION Poor recruitment confirmed that a larger phase III trial would not be feasible and prohibited a preliminary evaluation of the superiority of lap-cap over tras-cap. Descriptive statistics are presented to inform the limited evidence base and future study design.
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Affiliation(s)
- J F Seligmann
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - A Wright-Hughes
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - A Pottinger
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - G Velikova
- St James's Institute of Oncology, St James University Hospital, Leeds, UK
| | - J B Oughton
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - G Murden
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - M Rizwanullah
- Department of Clinical Oncology, The Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - C Price
- Department of Medical Oncology, University Hospitals, Bristol, UK
| | - H Passant
- Department of Medical Oncology, Velindre Hospital, Cardiff, UK
| | - P Heudtlass
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - H Marshall
- Clinical Trials Research Unit, University of Leeds, Leeds, UK
| | - S Johnston
- Department of Medical Oncology, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Dodwell
- St James's Institute of Oncology, St James University Hospital, Leeds, UK; Nuffield Department of Population Health, Oxford University, Oxford, UK.
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Paterson C, McCrea I, Hay L, Allwood-Speirs S, Devlin L, Sankaralingam M, McLoone P, Wilson C, Grose D, James A, Lamb C, Rizwanullah M, Schipani S, Nixon I, Thomson M, McJury M, Foster J, Duffton A. EP-1137 DW MRI as biomarker of response during RT for intermed/high risk SCC oropharynx: a feasibility study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31557-9] [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: 11/29/2022]
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Paterson C, Crosbie R, McLoone P, Grose D, James A, Lamb C, Rizwanullah M, Schipani S, Wilson C, Campbell F, Easton F, Thomson M. EP-1136 Management SCC unknown primary with contemporary diagnostic and radiotherapy techniques. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31556-7] [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: 11/27/2022]
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Paterson C, Morton A, Lamb C, Wilson C, Grose D, Rizwanullah M, Schipani S, Easton F, Campbell F, James A, Philip M, Thomson M. PO-060 Outcomes from concomitant cetuximab with radiotherapy in HNSCC: A retrospective cohort study. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30226-9] [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: 10/27/2022]
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Rulach R, Zhou S, Hendry F, Stobo D, Dempsey M, Grose D, Lamb C, James A, Schipani S, Rizwanullah M, Wilson C, Paterson C. OC-024 12 week PET-CTs have a low PPV for nodal residual disease in HPV positive oropharygeal cancers. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)30190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hartley A, Fong C, Sanghera P, Wong W, McConkey C, Rahman J, Nutting C, Al-Booz H, Robinson M, Junor E, Rizwanullah M, Dunn J, Mehanna H. Radiation Therapy Variation in the Randomized Phase 3 Positron Emission Tomography Neck Study. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.285] [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: 10/20/2022]
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Sanders IW, Haslett K, Correa P, Paterson C, James A, Rizwanullah M, Grose D. Sequential TPF chemotherapy followed by concurrent chemoradiotherapy in locally advanced head and neck cancer--a retrospective analysis of toxicity and outcomes. Scott Med J 2014; 59:50-5. [PMID: 24424462 DOI: 10.1177/0036933013518153] [Citation(s) in RCA: 7] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND AIMS Phase III trials have shown that the addition of a taxane to cisplatin/5FU-based induction chemotherapy (TPF) improves response rates and overall survival in unresectable stage III/IV head and neck cancer. We sought to assess the tolerability, compliance and clinical outcomes of this treatment regime. METHODS A retrospective study of patients treated within a single centre between September 2007 and November 2010. Toxicities were graded according to CTCAE version 3.0. Survival, distant metastasis and local control rates are expressed as percentages at two years using the Kaplan-Meier method. RESULTS A total of 100 patients were identified (11% stage III, 86% stage IV) and 32% of patients were admitted as an emergency after TPF. The rate of neutropenic fever was 31%, this number fell to 9% when prophylactic G-CSF was used. In addition, 89% of patients underwent radical chemoradiation. Of these, 96% completed the full radiotherapy course. However, only 64% of patients received a minimum of two cycles of concurrent platinum chemotherapy. The two-year overall survival, metastasis free survival and local control rates were 62.6%, 88.5% and 73.3%, respectively. CONCLUSIONS TPF chemotherapy can be delivered safely in a non-trial cohort of patients. There is, however, a significant reduction in concurrent chemotherapy dose intensity. The long-term impact of this remains unclear.
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Affiliation(s)
- I W Sanders
- Specialist Registrar in Clinical Oncology, Tayside Cancer Centre, Ninewells Hospital, UK
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Duffton A, Muirhead R, Rizwanullah M, Paterson C, McJury M, Tho L. OC-0253: Mid-treatment adaptive dosimetry of swallowing organs at risk(SWOAR) in head & neck cancer patients undergoing VMAT. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32559-7] [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: 10/23/2022]
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McJury M, Hanvey S, Patterson C, Rizwanullah M, Thomson M, James A, Tho L, Grose D, Glegg M, Foster J. PD-0084 EFFECTS OF MRI SCAN POSITION ON CT IMAGE REGISTRATION AND TARGET DELINEATION FOR OROPHARYNX CANCER VMAT PATIENTS. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70423-1] [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: 11/29/2022]
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Paterson C, Robertson A, Grose D, Correa P, Rizwanullah M. Neoadjuvant Chemotherapy prior to Surgery in Head and Neck Cancer. Clin Oncol (R Coll Radiol) 2012; 24:79-80. [DOI: 10.1016/j.clon.2011.09.016] [Citation(s) in RCA: 4] [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] [Received: 09/09/2011] [Accepted: 09/30/2011] [Indexed: 11/30/2022]
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Shrimali R, McPhail N, Correa P, Fraser J, Rizwanullah M. Trastuzumab-induced Radiation Recall Dermatitis — First Reported Case. Clin Oncol (R Coll Radiol) 2009; 21:634-5. [DOI: 10.1016/j.clon.2009.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 03/23/2009] [Indexed: 11/30/2022]
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MacLeod N, MacLaren V, Rizwanullah M. Erlotinib use in NSCLC – the Lanarkshire experience. Lung Cancer 2009. [DOI: 10.1016/s0169-5002(09)70012-1] [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: 11/25/2022]
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