1
|
Armstrong S, Makris A, Belessiotis-Richards K, Abdul-Latif M, Ostler P, Shah N, Miles D, Tsang YM. Treatment Outcomes of Stereotactic Ablative Body Radiotherapy on Extra-cranial Oligometastatic and Oligoprogressive Breast Cancer: Mature Results from a Single Institution Experience. Clin Oncol (R Coll Radiol) 2024; 36:362-369. [PMID: 38575431 DOI: 10.1016/j.clon.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/08/2024] [Accepted: 03/13/2024] [Indexed: 04/06/2024]
Abstract
AIMS Evidence shows stereotactic ablative body radiotherapy (SABR) is used as a non-invasive ablative therapy in the treatment of multisite oligometastatic (OM) and oligoprogressive (OP) diseases originating from metastatic breast cancer. This study aims to report the treatment outcomes and to investigate what factors that are prognostic in terms of local control, progression-free survival (PFS) and overall survival (OS) in patients receiving SABR for extracranial OM and OP diseases originating from metastatic breast cancer. MATERIALS AND METHODS A retrospective review on treatment records of patients with OM and OP from metastatic breast cancer who underwent SABR at a single was carried out. SABR was performed with daily image-guided radiotherapy (IGRT) using a dedicated robotic SABR machine. Local control, PFS and OS were calculated using Kaplan-Meier statistics and the post-treatment toxicity data was scored following the CTCAE v4.0 protocol. Univariate and multivariate Cox regression tests were used in the subgroup analysis of prognostic factors on PFS and OS including patients' age, types of follow-up imaging (staging CT only vs whole-body MR/PET), metastases status (OM vs OP), primary breast cancer tumour grade, hormone receptors (ER/PR/HER2) status, change of systemic treatments at SABR, number of metastases, SABR treatment sites and doses. RESULTS 56 metastatic breast cancer patients (38 patients with OM and 18 patients with OP) were involved in this retrospective review. The median follow-up was 35.6 months (range 4.0-132.9 months). The estimated local control at 1 , 2 and 5 years were 90.9%, 88.7% and 88.7%, respectively. The estimated median PFS was 19.2 months (95%CI 10.3-28.1 months); the PFS at 1, 2 and 5 years were 63.3%, 44.4% and 33.2%. The estimated OS at 1, 2 and 5 years were 98.0%, 91.9% and 74.3%, respectively with the estimated median OS of 105.1 months (95%CI 51.5-158.7 months). The vast majority of patients tolerated the treatment well with the commonest acute side effects as grade 1 fatigue. There were no statistically significant factors found in OS regression analysis. The types of follow-up imaging, metastases status, oestrogen receptor status, and number of metastases for SABR were statistically significant factors (p < 0.05) in the multivariate Cox regression analysis on PFS. CONCLUSION There are limited studies published on the efficacy and post-treatment toxicities of metastatic breast cancer OM and OP SABR with adequate length of follow-up. This study confirmed that SABR was a safe, non-invasive treatment option for patients with extracranial OM and OP diseases originated from primary breast cancer in terms of the acceptable post-treatment toxicities.
Collapse
Affiliation(s)
- S Armstrong
- Lismore Base Hospital, North Coast Cancer Institute, New South Wales, Australia
| | - A Makris
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | | | - M Abdul-Latif
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - P Ostler
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - N Shah
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - D Miles
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK
| | - Y M Tsang
- Mount Vernon Cancer Centre, Northwood, Middlesex, UK; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Canada.
| |
Collapse
|
2
|
Parker CC, Petersen PM, Cook AD, Clarke NW, Catton C, Cross WR, Kynaston H, Parulekar WR, Persad RA, Saad F, Bower L, Durkan GC, Logue J, Maniatis C, Noor D, Payne H, Anderson J, Bahl AK, Bashir F, Bottomley DM, Brasso K, Capaldi L, Cooke PW, Chung C, Donohue J, Eddy B, Heath CM, Henderson A, Henry A, Jaganathan R, Jakobsen H, James ND, Joseph J, Lees K, Lester J, Lindberg H, Makar A, Morris SL, Oommen N, Ostler P, Owen L, Patel P, Pope A, Popert R, Raman R, Ramani V, Røder A, Sayers I, Simms M, Srinivasan V, Sundaram S, Tarver KL, Tran A, Wells P, Wilson J, Zarkar AM, Parmar MKM, Sydes MR. Timing of Radiotherapy (RT) After Radical Prostatectomy (RP): Long-term outcomes in the RADICALS-RT trial [NCT00541047]. Ann Oncol 2024:S0923-7534(24)00105-4. [PMID: 38583574 DOI: 10.1016/j.annonc.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND The optimal timing of radiotherapy (RT) after radical prostatectomy for prostate cancer has been uncertain. RADICALS-RT compared efficacy and safety of adjuvant RT versus an observation policy with salvage RT for PSA failure. METHODS RADICALS-RT was a randomised controlled trial enrolling patients with ≥1 risk factor (pT3/4, Gleason 7-10, positive margins, pre-op PSA≥10ng/ml) for recurrence after radical prostatectomy. Patients were randomised 1:1 to adjuvant RT ("Adjuvant-RT") or an observation policy with salvage RT for PSA failure ("Salvage-RT") defined as PSA≥0.1ng/ml or 3 consecutive rises. Stratification factors were Gleason score, margin status, planned RT schedule (52.5Gy/20 fractions or 66Gy/33 fractions) and treatment centre. The primary outcome measure was freedom-from-distant metastasis, designed with 80% power to detect an improvement from 90% with Salvage-RT (control) to 95% at 10yr with Adjuvant-RT. Secondary outcome measures were bPFS, freedom-from-non-protocol hormone therapy, safety and patient-reported outcomes. Standard survival analysis methods were used; HR<1 favours Adjuvant-RT. FINDINGS Between Oct-2007 and Dec-2016, 1396 participants from UK, Denmark, Canada and Ireland were randomised: 699 Salvage-RT, 697 Adjuvant-RT. Allocated groups were balanced with median age 65yr. 93% (649/697) Adjuvant-RT reported RT within 6m after randomisation; 39% (270/699) Salvage-RT reported RT during follow-up. Median follow-up was 7.8 years. With 80 distant metastasis events, 10yr FFDM was 93% for Adjuvant-RT and 90% for Salvage-RT: HR=0.68 (95%CI 0·43-1·07, p=0·095). Of 109 deaths, 17 were due to prostate cancer. Overall survival was not improved (HR=0.980, 95%CI 0.667-1.440, p=0.917). Adjuvant-RT reported worse urinary and faecal incontinence one year after randomisation (p=0.001); faecal incontinence remained significant after ten years (p=0.017). INTERPRETATION Long-term results from RADICALS-RT confirm adjuvant RT after radical prostatectomy increases the risk of urinary and bowel morbidity, but does not meaningfully improve disease control. An observation policy with salvage RT for PSA failure should be the current standard after radical prostatectomy.
Collapse
Affiliation(s)
- C C Parker
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - P M Petersen
- Dept of Oncology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A D Cook
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - N W Clarke
- Dept of Urology, The Christie and Salford Royal Hospitals, Manchester, UK; The University of Manchester, Manchester, UK
| | - C Catton
- Dept of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada
| | - W R Cross
- Dept of Urology, St James's University Hospital, Leeds, UK
| | - H Kynaston
- Division of Cancer and Genetics, Cardiff University, Cardiff, UK
| | - W R Parulekar
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - R A Persad
- Dept of Urology, Bristol Urological Institute, Bristol, UK
| | - F Saad
- Dept of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - L Bower
- Guy's and St Thomas' NHS Foundation Trust, London, UK; Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - G C Durkan
- Dept of Urology, University Hospital Galway, Galway, Ireland
| | - J Logue
- Dept of Oncology, The Christie Hospital NHS FT, Wilmslow Road, Manchester, UK
| | - C Maniatis
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - D Noor
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - H Payne
- The Prostate Centre, London, UK
| | - J Anderson
- St James's Institute of Oncology, Leeds, UK
| | - A K Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol & Weston NHS Trust, Bristol, UK
| | - F Bashir
- Queen's Centre for Oncology, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, Cottingham, UK
| | | | - K Brasso
- Dept of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Dept of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - L Capaldi
- Worcester Oncology Centre, Worcestershire Acute NHS Hospitals Trust, Worcester, UK
| | - P W Cooke
- Dept of Urology, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - C Chung
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - J Donohue
- Dept of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - B Eddy
- East Kent University Hospitals Foundation Trust, Kent, UK
| | - C M Heath
- Dept of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A Henderson
- Dept of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - A Henry
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - R Jaganathan
- Dept of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H Jakobsen
- Dept of Urology, Herlev University Hospital, Herlev, Denmark
| | - N D James
- Institute of Cancer Research, Royal Marsden NHS Foundation Trust, London, UK
| | - J Joseph
- Leeds Teaching Hospitals, UK; York and Scarborough Teaching Hospitals, UK
| | - K Lees
- Dept of Oncology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - J Lester
- South West Wales Cancer Centre, Singleton Hospital, Swansea, UK
| | - H Lindberg
- Dept of Oncology, Herlev University Hospital, Herlev, Denmark
| | - A Makar
- Dept of Urology, Worcestershire Acute Hospitals Trust, Worcester, UK
| | - S L Morris
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - N Oommen
- Wrexham Maelor Hospital, Wrexham, UK
| | - P Ostler
- Mount Vernon Cancer Centre, Northwood, UK
| | - L Owen
- Bradford Royal Infirmary, Bradford, UK; Leeds Cancer Centre, Leeds, UK
| | - P Patel
- Dept of Urology, University College London Hospitals, London, UK
| | - A Pope
- Mount Vernon Cancer Centre, Northwood, UK
| | - R Popert
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - R Raman
- Kent Oncology Centre, Kent & Canterbury Hospital, Canterbury, UK
| | - V Ramani
- Dept of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - A Røder
- Dept of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - I Sayers
- Deanesly Centre, New Cross Hospital, Wolverhampton, UK
| | - M Simms
- Dept of Urology, Hull University Hospitals NHS Trust, UK
| | - V Srinivasan
- Glan Clwyd Hospital, Betsi Cadwaladr University Health Board, Rhyl, UK
| | - S Sundaram
- Dept of Urology, Mid Yorkshire Teaching Hospital, Pontefract, UK
| | - K L Tarver
- Dept of Oncology, Queen's Hospital, Romford, UK
| | - A Tran
- Dept of Oncology, The Christie Hospital NHS FT, Wilmslow Road, Manchester, UK
| | - P Wells
- St Bartholomews Hospital, London UK
| | - J Wilson
- Royal Gwent Hospital, Newport, UK
| | - A M Zarkar
- Dept of Oncology, University Hospitals Birmingham, Birmingham, UK
| | - M K M Parmar
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK
| | - M R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, London, UK.
| |
Collapse
|
3
|
Rojas AM, Ostler P, Hughes R, Alonzi R, Lowe G, Hoskin P. Single Dose vs. Fractionated High-Dose Rate Brachytherapy in Localized Prostate Cancer: Long Term Results. Int J Radiat Oncol Biol Phys 2023; 117:S110. [PMID: 37784290 DOI: 10.1016/j.ijrobp.2023.06.436] [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: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) To evaluate long-term freedom from biochemical relapse (FFbR) and overall survival (OS) after single-dose high-dose-rate brachytherapy (HDR-BT) compared with 2 or 3 fraction schedules. MATERIALS/METHODS HDR-BT, delivering 1 × 19 Gy or 1 × 20 Gy (A = 49), 2 × 13 Gy (B = 138) or 3 × 10.5 Gy (C = 106), was given to patients with intermediate or high-risk prostate cancer as their sole treatment. Patients were staged with pelvic MRI and isotope bone scan. Transperineal transrectal ultrasound guided implantation was followed by MRI based CTV definition based on GEC ESTRO guidelines. Biochemical relapse was assessed using the Phœnix definition (PSA nadir plus 2 µg/L). Patients were evaluated prospectively from 6 months after implant and bi-annually thereafter. Estimates of freedom from biochemical relapse, and overall survival (OS) were calculated using the Kaplan-Meier (K-M) method and the log-rank test to test for significance. Univariate and multivariate hazard ratios (HR) were obtained using Cox's proportional hazard model. For multivariate modelling a stepwise reduction method was used. RESULTS Median follow-up was 123, 116 and 120 months (p = 0.4), (A, B, C, respectively). Neo-adjuvant and adjuvant androgen deprivation treatment was given to 80% of all patients, median duration was 9 months for A and 6 months for B and C. K-M estimates of FFbR, at 8 and 10 years, were 67% and 64% (Group A), 78% and 72% (Group B), and 80% and 76% (Group C). Differences in FFbR between dose groups was not significant (p = 0.2). Similarly, no significant difference was seen in OS. Eight and 10-year estimates were 81% and 75% (A), 85% and 74% (B), and 90% and 83% (C); p = 0.5. Hazard Ratios for risk of biochemical recurrence were significant for ADT administration (yes/no) and overall risk category, in multivariate analyses. Only the latter was significant in univariate analysis for risk of death, Gleason risk (low, intermediate, high), MRI tumor stage risk and overall risk category were significant in univariate analyses. Only tumor stage and Gleason risk were significant in multivariate analyses. CONCLUSION Concerns around the efficacy of 19-20 Gy single dose HDR BT as monotherapy, based on early data, may have been unfounded. Long-term outcome data up to 10 years show no significant difference in PSA control and overall survival compared to 2 and 3 fractions of HDR-BT.
Collapse
Affiliation(s)
- A M Rojas
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - P Ostler
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - R Hughes
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - R Alonzi
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - G Lowe
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, United Kingdom; Division of Cancer Sciences, University of Manchester, Manchester, United Kingdom
| |
Collapse
|
4
|
Ostler P, Hoskin P, Martin A. Should We be Offering Our Patients With Oligometastases Stereotactic Ablative Body Radiotherapy? Clin Oncol (R Coll Radiol) 2021; 33:747-748. [PMID: 34642067 DOI: 10.1016/j.clon.2021.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 09/02/2021] [Accepted: 09/20/2021] [Indexed: 10/20/2022]
Affiliation(s)
- P Ostler
- Mount Vernon Cancer Centre, Northwood, UK.
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; University of Manchester, Manchester, UK
| | - A Martin
- Addenbrooke's Hospital, Cambridge, UK
| |
Collapse
|
5
|
Tree A, Hall E, Ostler P, van der Voet H, Loblaw A, Chu W, Ford D, Tolan S, Jain S, Martin A, Staffurth J, Camilleri P, Kancherla K, Frew J, Brand D, Chan A, Dayes I, Brown S, Pugh J, Burnett S, Dufton A, Griffin C, Mahmud M, Naismith O, van As N, of the O. OC-0289 Comparison of side effects at 2 years in the randomised PACE-B trial (SBRT vs standard radiotherapy). Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06839-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
6
|
Tsang Y, Tharmalingam H, Belessiotis-Richards K, Armstrong S, Ostler P, Hughes R, Alonzi R, Hoskin P. OC-0040 Ultrafractionated radiotherapy(RT) in localised prostate cancer:HDR brachytherapy vs stereotactic RT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06282-4] [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: 11/29/2022]
|
7
|
Chitmanee P, Tsang Y, Tharmalingam H, Hamada M, Alonzi R, Ostler P, Hughes R, Lowe G, Hoskin P. Single-Dose Focal Salvage High Dose Rate Brachytherapy for Locally Recurrent Prostate Cancer. Clin Oncol (R Coll Radiol) 2020; 32:259-265. [DOI: 10.1016/j.clon.2019.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 10/08/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
|
8
|
Kosmin M, Padhani A, Gogbashian A, Woolf D, Ah-See ML, Ostler P, Sutherland S, Miles D, Noble J, Marshall A, Dunn J, Makris A. Response evaluation of cancer therapeutics in metastatic breast cancer to the bone: A single arm phase II study of whole-body magnetic resonance imaging. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.311] [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: 11/13/2022] Open
|
9
|
Chowdhury S, McDermott R, Piulats J, Shapiro J, Mejlholm I, Morris D, Ostler P, Hussain A, Dumbadze I, Goldfischer E, Pintus E, Benjelloun A, Gross M, Tejwani S, Chatta G, Font A, Loehr A, Simmons A, Watkins S, Abida W. Genomic profiling of circulating tumour DNA (ctDNA) and tumour tissue for the evaluation of rucaparib in metastatic castration-resistant prostate cancer (mCRPC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy284.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
10
|
Tsang Y, Ostler P, Shah N, Kudhail J, Hoskin P. The Impact of a Consultant Radiographer on Stereotactic Radiotherapy Service. J Med Imaging Radiat Sci 2018. [DOI: 10.1016/j.jmir.2018.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
11
|
Tsang Y, Nariyangadu P, Shah N, Ostler P, Hoskin P. EP-1856: The impact of waiting time on survival of Lung Stereotactic Ablative Body Radiotherapy patients. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)32291-0] [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]
|
12
|
Hoskin P, Rojas A, Ostler P, Hughes R, Alonzi R, Lowe G. OC-0269: Single Dose Compared to Fractionated High-Dose Rate Brachytherapy for Localised Prostate Cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30712-0] [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]
|
13
|
Henderson D, Ostler P, Tree A, Hoskin P, Dankulchai P, Taylor H, Khoo V, van As N. First UK Prostate Stereotactic Body Radiotherapy (SBRT) Cohort: Prospective Outcomes with 2.5 Years’ Median Follow-up. Clin Oncol (R Coll Radiol) 2016. [DOI: 10.1016/j.clon.2015.12.007] [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]
|
14
|
Tsang Y, Ostler P, Shah N, Kudhail J, Hoskin P. OC-0371: Introduction of a consultant radiographer to stereotactic radiotherapy service. Radiother Oncol 2016. [DOI: 10.1016/s0167-8140(16)31620-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Bhattacharya I, Hussain T, Kadam M, Sutherland S, Ho A, Bernhardt V, Ah-See M, Shah N, Ostler P, Miles D, Makris A. Eligibility for Entry into First Line Metastatic Trials in Patients with Disease Recurrence within 12 Months of Adjuvant Chemotherapy for Early Stage Breast Cancer. Clin Oncol (R Coll Radiol) 2015. [DOI: 10.1016/j.clon.2015.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
16
|
Bhattacharya I, Shah N, Ostler P. Role of Stereotactic Body Radiotherapy (SBRT) in the Management of Oligometastatic (OM) Breast Carcinoma – UK Experience. Clin Oncol (R Coll Radiol) 2015. [DOI: 10.1016/j.clon.2015.01.015] [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]
|
17
|
Tsang Y, Bhattacharya I, Nariyangadu P, Venables K, Shah N, Ostler P, Harrison M, Hughes R, Hoskin P. EP-1295: Lymph node oligometastases treated with SABR: effect of dosimetric parameters on treatment outcomes. Radiother Oncol 2015. [DOI: 10.1016/s0167-8140(15)41287-3] [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: 10/23/2022]
|
18
|
Bhattacharya IS, Woolf DK, Hughes RJ, Shah N, Harrison M, Ostler PJ, Hoskin PJ. Stereotactic body radiotherapy (SBRT) in the management of extracranial oligometastatic (OM) disease. Br J Radiol 2015; 88:20140712. [PMID: 25679321 DOI: 10.1259/bjr.20140712] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE A review of stereotactic body radiotherapy (SBRT) for oligometastases defined as three or fewer sites of isolated metastatic disease. The aim was to identify local control, overall survival (OS) and progression-free survival (PFS) of patients receiving SBRT for oligometastatic (OM) disease. METHODS Data were analysed for SBRT delivered between 01 September 2010 and 31 March 2014. End points included local control, PFS, OS and toxicity. RESULTS 76 patients received SBRT. The median age was 60 years (31-89 years). 44 were male. Median follow-up was 12.3 months (0.2-36.9 months). Major primary tumour sites included colorectal (38%), the breast (18%) and the prostate (12%). The treatment sites included lymph nodes (42%), the bone and spine (29%) and soft tissue (29%). 42% were previously treated with conventional radiotherapy. 45% were disease free after SBRT. 4% had local relapse, 45% had distant relapse, and 6% had local and distant relapse. Local control was 89%. The OS was 84.4% at 1 year and 63.2% at 2 years. PFS was 49.1% at 1 year and 26.2% at 2 years. Toxicities included duodenal ulcer and biliary stricture formation. CONCLUSION SBRT can achieve durable control of OM lesions and results in minimal radiation-induced morbidity. ADVANCES IN KNOWLEDGE This cohort is one of the largest reported to date and contributes to the field of SBRT in oligometastases that is emerging as an important research area. It is the only study reported from the UK and uses a uniform technique throughout. The efficacy and low toxicity with durable control of local disease with this approach is shown, setting the foundations for future randomized studies.
Collapse
|
19
|
Tree AC, Ostler P, Hoskin P, Dankulchai P, Nariyangadu P, Hughes RJ, Wells E, Taylor H, Khoo VS, van As NJ. Prostate stereotactic body radiotherapy—first UK experience. Clin Oncol (R Coll Radiol) 2014; 26:757-61. [PMID: 25193299 DOI: 10.1016/j.clon.2014.08.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 02/18/2014] [Revised: 07/31/2014] [Accepted: 08/05/2014] [Indexed: 01/16/2023]
Abstract
AIMS Stereotactic body radiotherapy (SBRT) combines image-guided radiotherapy with hypofractionation, both of which will probably result in improvements in patient outcomes in prostate cancer. Most clinical experience with this technique resides in North America. Here we present the first UK cohort to receive SBRT for prostate cancer. MATERIALS AND METHODS Fifty-one prostate cancer patients (10 low risk, 35 intermediate risk and 6 high risk) were treated with 36.25 Gy in five fractions over 1-2 weeks and gold seed image guidance. All patients had toxicity International Prostate Symptom score (IPSS) and Radiation Therapy Oncology Group recorded prospectively and prostate-specific antigen was measured 3-6 monthly during follow-up. RESULTS The median IPSS was 6, 11, 8 and 5 at baseline, 1-3 weeks, 4-6 weeks and 7-12 weeks after treatment. Radiation Therapy Oncology Group genitourinary and gastrointestinal toxicity of grade 2 was seen in 22% and 14%, respectively, at 1-3 weeks after treatment; no patient had grade 3+ toxicity at this time point, although two patients had grade 3 urinary frequency recorded during treatment. The median follow-up for the 42 patients who did not receive androgen deprivation was 14.5 months. Prostate-specific antigen at 13-18 months after treatment was 1.3 ng/ml. CONCLUSION Prostate SBRT is a promising treatment for organ-confined prostate cancer and is currently being investigated in a UK-led phase III trial.
Collapse
Affiliation(s)
- A C Tree
- Royal Marsden NHS Foundation Trust, London, UK.
| | - P Ostler
- Mount Vernon Cancer Centre, Middlesex, UK
| | - P Hoskin
- Mount Vernon Cancer Centre, Middlesex, UK
| | | | | | - R J Hughes
- Mount Vernon Cancer Centre, Middlesex, UK
| | - E Wells
- Royal Marsden NHS Foundation Trust, London, UK
| | - H Taylor
- Royal Marsden NHS Foundation Trust, London, UK
| | - V S Khoo
- Royal Marsden NHS Foundation Trust, London, UK; Institute of Cancer Research, London, UK
| | - N J van As
- Royal Marsden NHS Foundation Trust, London, UK
| |
Collapse
|
20
|
Tree A, Ostler P, Hoskin P, Dankulchai P, Khoo V, van As N. First UK Cohort of Prostate Stereotactic Body Radiotherapy (SBRT): Acute Toxicity and Early Prostate-specific Antigen (PSA) Outcomes. Clin Oncol (R Coll Radiol) 2014. [DOI: 10.1016/j.clon.2013.11.021] [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]
|
21
|
Tree A, Ostler P, van As N. New Horizons and Hurdles for UK Radiotherapy: Can Prostate Stereotactic Body Radiotherapy Show the Way? Clin Oncol (R Coll Radiol) 2014; 26:1-3. [DOI: 10.1016/j.clon.2013.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 10/26/2022]
|
22
|
Tree A, Aluwini S, Bryant H, Hall E, Incrocci L, Kaplan I, Ostler P, Sanda M, Thompson A, van As N. Successful Patient Acceptance of Randomization Within the Pace Study (Prostate Advances in Comparative Evidence). Int J Radiat Oncol Biol Phys 2013. [DOI: 10.1016/j.ijrobp.2013.06.959] [Citation(s) in RCA: 7] [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] [Indexed: 11/30/2022]
|
23
|
Hoskin P, Rojas A, Ostler P, Hughes R, Bryant L, Lowe G. OC-0263: HDR brachytherapy dosimetric predictors of biochemical control of prostate cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)32569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
24
|
Hoskin P, Rojas A, Ostler P, Hughes R, Alonzi R, Bryant L, Lowe G. OC-25 HIGH-DOSE RATE AFTERLOADING BRACHYTHERAPY USING ONE OR TWO FRACTIONS FOR LOCALISED PROSTATE CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71993-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: 10/28/2022]
|
25
|
Yip K, Taylor J, Hoskin P, Shah N, Ostler P, Simcock I, Stirling J, Collins D, Padhani A, Alonzi R. OC-0387 MULTIPARAMETRIC MRI IMAGING IN PATIENTS UNDERGOING ULTRA-HYPOFRACTIONATED RT FOR LOCALISED PROSTATE CANCER. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70726-0] [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]
|
26
|
De Ieso P, Schick U, Ward D, Hughes R, Ostler P, Hoskin P. Pelvic External Beam Radiotherapy and High Dose Rate Image Guided Interstitial Brachytherapy Boost for High Risk Prostate Cancer. Clin Oncol (R Coll Radiol) 2012. [DOI: 10.1016/j.clon.2011.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
27
|
Makris A, Li SP, Ravichandran D, Ostler PJ, Pittam M. P3-14-12: Local Control of Primary Breast Cancer Treated with Radical Radiotherapy Alone after Neoadjuvant Chemotherapy. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-14-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: The aim of this retrospective study was to evaluate the local recurrence rates in a cohort of patients who achieved a complete clinical response (cCR) to neoadjuvant chemotherapy and did not have surgery.
Materials and Methods: 148 women who achieved a cCR to neoadjuvant chemotherapy were identified from a prospectively maintained database (1995-2011) of 667 patients. 122 patients went on to have surgery (either wide local excision or mastectomy) followed by radiotherapy. In 26 patients (median age 49, range 35–72 years; T2-T4, N0-N3, M0), no surgery was performed but all received radical radiotherapy. Surgery was avoided due to either physician or patient choice. Recurrence was defined as first relapse of disease, either local (ipsilateral breast and/or axilla) or distant.
Results: All 26 patients who avoided surgery had neoadjuvant chemotherapy with 20 patients (77%) receiving anthracycline-based (FEC, FAC, ECF), 5 (19%) MMM and 1 (4%) CMF chemotherapy. The median number of cycles was 6 (range 4–8). Chemotherapy was followed by radical external beam radiotherapy to the breast +/− supraclavicular fossa and axilla (median dose delivered, 60Gy in 2Gy fractions). All were identified as operable at diagnosis including 3 patients who had supraclavicular lymphadenopathy. All 26 patients achieved a final cCR in the breast to chemotherapy. 21 patients had imaging with mammography and/or ultrasonography to assess radiological response at the end of neoadjuvant chemotherapy, of which 19 had a complete response and 2, a partial response. After a median follow-up of 144 months, 10/26 (38%) patients experienced local disease recurrence (2 also had distant recurrence) and 4/26 (15%) patients with distant metastases only. Patients with local recurrence only, went on to have a mastectomy whilst those with distant disease received systemic therapy. There were 10 deaths, 9 of which were breast cancer related (33%).
Conclusions: Local recurrence rates were high in patients achieving a cCR following neoadjuvant chemotherapy and who avoided surgery. Our practice has subsequently changed to include clip insertion and surgical excision on completion of chemotherapy. With increasing pathologic complete response rates to more active chemotherapy schedules (including taxanes +/− herceptin), it is being proposed that surgery could be avoided in selected patients. Our study shows that caution should be exercised.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-14-12.
Collapse
Affiliation(s)
- A Makris
- 1Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Luton and Dunstable, Luton, United Kingdom
| | - SP Li
- 1Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Luton and Dunstable, Luton, United Kingdom
| | - D Ravichandran
- 1Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Luton and Dunstable, Luton, United Kingdom
| | - PJ Ostler
- 1Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Luton and Dunstable, Luton, United Kingdom
| | - M Pittam
- 1Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; Luton and Dunstable, Luton, United Kingdom
| |
Collapse
|
28
|
Li SP, Burcombe R, Beresford MJ, Kornbrot DE, Seah ML, Ostler PJ, Wilson GD, Makris A. Abstract PD07-04: Predicting Outcome with Ki67 in Primary Breast Cancer in the Neoadjuvant Setting. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd07-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The proliferation antigen Ki67 has been shown to be a reliable predictive marker of treatment efficacy in the neoadjuvant treatment of breast cancer but its prognostic significance remains uncertain. This study assesses Ki67 before and after neoadjuvant chemotherapy (NAC) in relation to long-term outcome. Methods: 117 patients with primary breast cancer due to undergo NAC were studied (median age 48 years, range 25-78; T2-4, N0-3, M0) and information gathered from a prospectively maintained database. Immunohistochemically derived Ki67 expression was obtained from pretreatment core biopsy and surgical specimens. Their relationship to DFS and OS was analyzed along with known prognostic variables (age, ER/PR/HER2 status, clinical and pathologic T and N stage, grade), NAC regimen, response and adjuvant treatment. Survival curves were estimated using the Kaplan-Meier method and a log-rank test used to determine significance using a two-tailed p-value of 0.05. A multivariate Cox proportional hazards regression model performed in a stepwise fashion was used to determine the prognostic value of each signifcant variable. Results: 84 patients with matched biopsy and surgical samples were assessable for pre and post NAC Ki67 levels. The majority (90%) received anthracycline based NAC (median number of cycles 6, range 2-6). On univariate analysis, the only significant pretreatment predictive factor for shorter DFS was higher clinical nodal stage (cN) (P<0.001). Posttreatment variables that predicted for worse DFS were: Ki67 at surgery (HR 1.52, p=0.048), pathologic nodal stage (pN) (p=0.001) and grade (p=0.013). On multivariate analysis, pN was the most powerful predictor for DFS (chi-squared test 19.8, 3 df, P<0.001). Univariate analysis of pretherapy factors for OS revealed that Ki67 at biopsy (HR 2.06, p=0.039), cN (HR 4.44, P<0.001) and PR positivity (HR 0.41, p=0.012) were significant. Significant posttreatment variables for OS were Ki67 at surgery (HR 2.01, p=0.006), pN (p=0.001), and grade (p=0.009). PR status and pN remained important predictors of OS on multivariate analyses. Conclusions: The expression of Ki67 is a widely accepted marker of cellular proliferation in breast cancer. Ki67 levels after NAC were a better predictor for long-term outcome than pretherapy Ki67, although nodal status appears to be the most powerful determinant overall. High Ki67 levels post NAC may identify patients with poorer outcomes who are candidates for further systemic therapy.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD07-04.
Collapse
Affiliation(s)
- SP Li
- Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; University of Hertfordshire, Herts, United Kingdom; William Beaumont Hospital, Royal Oak, MI
| | - R Burcombe
- Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; University of Hertfordshire, Herts, United Kingdom; William Beaumont Hospital, Royal Oak, MI
| | - MJ Beresford
- Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; University of Hertfordshire, Herts, United Kingdom; William Beaumont Hospital, Royal Oak, MI
| | - DE Kornbrot
- Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; University of Hertfordshire, Herts, United Kingdom; William Beaumont Hospital, Royal Oak, MI
| | - M-L Seah
- Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; University of Hertfordshire, Herts, United Kingdom; William Beaumont Hospital, Royal Oak, MI
| | - PJ Ostler
- Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; University of Hertfordshire, Herts, United Kingdom; William Beaumont Hospital, Royal Oak, MI
| | - GD Wilson
- Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; University of Hertfordshire, Herts, United Kingdom; William Beaumont Hospital, Royal Oak, MI
| | - A. Makris
- Mount Vernon Cancer Centre, Northwood, Middlesex, United Kingdom; University of Hertfordshire, Herts, United Kingdom; William Beaumont Hospital, Royal Oak, MI
| |
Collapse
|
29
|
Hoskin P, Ostler P, Hughes R, Bryant L, Chapman C, Lowe G. 35 oral: Hig Dose Rate Brachytherapy as Monotherapy for Localised Prostate Cancer: A Phase II Dose Escalation Study. Radiother Oncol 2009. [DOI: 10.1016/s0167-8140(15)34293-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
Rodriguez AA, Makris A, Harrison MK, Ostler PJ, Froehlich A, Pavlick A, Wong H, Tsimelzon A, Sexton K, Hilsenbeck SG, Lewis MT, Rimawi M, Osborne CK, Chang JC. BRCA1 gene expression signature predicts for anthracycline-chemosensitivity in triple-negative breast cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-6039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #6039
Background: We used a previously published gene expression signature that can identify tumors from BRCA1 mutation carriers to evaluate its predictive value in triple-negative breast cancer as a marker for chemosensitivity to anthracycline-based chemotherapy. We proposed that based on preclinical evidence suggesting that BRCA1-deficient breast cancer cells are sensitive to DNA damaging drugs such as cisplatin and anthracyclines this gene expression profile may identify tumors with anthracycline chemosensitivity. Two previously published studies defined a gene expression signature associated with BRCA1 germline mutation.(1,2) In these studies, sporadic tumors were misclassified as BRCA1 tumors and further analysis revealed methylation of the BRCA1 promoter region and decreased BRCA1 gene expression. This finding suggests the possibility of identifying sporadic tumors with decreased BRCA1 activity.
 Methods: We selected from our database of a locally advanced breast cancer neoadjuvant trial all cases of triple negative breast cancer that received 4 cycles of doxorubicin/cyclophosphamide(AC, 60/200 mg/m2, every 3 weeks) prior to surgery. Pathologic response to chemotherapy was disappearance of all invasive cancer or microscopic residual disease. Tumoral gene expression profile previously obtained using Affymetrix U133A Chip was analyzed for an optimal set of 100 most differentially expressed genes distinguishing BRCA1 and sporadic triple negative tumors according to the previously identified gene signature by van't Veer et al.1 We performed unsupervised clustering to determine if this signature could classify a subtype of triple-negative tumors with "BRCAness" and to test our hypothesis that BRCA1-like tumors are more sensitive to AC. We then performed a supervised analysis to determine the most differentially expressed genes that could prospectively identify triple-negative sporadic tumors with “BRCAness” and tumors from BRCA1 germline carriers that are sensitive to anthracyclines.
 Results: Of the 66 patients enrolled in our neoadjuvant trial, 12 patient's tumors were triple negative and received preoperative AC. By unsupervised clustering, the gene expression pattern associated with BRCA1 cancers subdivided these sporadic cancers in to two groups: Group A(6/7 pathologic responders), and group B(5/5 non-pathologic responders). By supervised analysis, the most differentially overexpressed gene from the BRCA1 profile for AC sensitivity was YWHAH(14-3-3 eta polypeptide), while DKK3(Inhibitor of Wnt and Notch signaling pathway) and RPL23A were most overexpressed in all cases with adriamycin-resistance(p<0.01).
 Discussion: Triple negative sporadic breast cancer displaying “BRCAness” appear to be sensitive to AC chemotherapy. YWHAH, DKK3, and RPL23A are differentially expressed in anthracycline-sensitive versus resistant tumors. These three genes can potentially identify triple-negative breast cancers that exhibit “BRCAness” and sensitivity to DNA-damaging chemotherapy such as cisplatin, anthracycline, or PARP inhibitors.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6039.
Collapse
Affiliation(s)
| | - A Makris
- 2 Mount Vernon Hospital, Middlesex, UK
| | | | - PJ Ostler
- 2 Mount Vernon Hospital, Middlesex, UK
| | | | - A Pavlick
- 1 Baylor College of Medicine, Houston, TX
| | - H Wong
- 1 Baylor College of Medicine, Houston, TX
| | | | - K Sexton
- 1 Baylor College of Medicine, Houston, TX
| | | | - MT Lewis
- 1 Baylor College of Medicine, Houston, TX
| | - M Rimawi
- 1 Baylor College of Medicine, Houston, TX
| | - CK Osborne
- 1 Baylor College of Medicine, Houston, TX
| | - JC Chang
- 1 Baylor College of Medicine, Houston, TX
| |
Collapse
|
31
|
Mitchell D, Mandall P, Bottomley D, Hoskin P, Logue J, Ash D, Ostler P, Elliott T, Henry A, Wylie J. Report on the Early Efficacy and Tolerability of I125 Permanent Prostate Brachytherapy from a UK Multi-institutional Database. Clin Oncol (R Coll Radiol) 2008; 20:738-44. [DOI: 10.1016/j.clon.2008.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Revised: 09/01/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
|
32
|
Temel JS, Greer J, Goldberg SB, Ostler P, Vogel PD, Pirl WF, Lynch TJ, Christiani DC, Smith MR. A pilot study of an exercise program for patients with advanced non-small cell lung cancer. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.9593] [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
|
33
|
|
34
|
Glynne-Jones R, Ostler P, Lumley-Graybow S, Chait I, Hughes R, Grainger J, Leverton TJ. Can I look at my list? An evaluation of a 'prompt sheet' within an oncology outpatient clinic. Clin Oncol (R Coll Radiol) 2006; 18:395-400. [PMID: 16817331 DOI: 10.1016/j.clon.2006.01.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [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: 10/24/2022]
Abstract
AIMS We introduced a patient 'prompt sheet' into our clinic between January 2004 and January 2005. The aim was to determine whether it would facilitate communication and help patients in obtaining their desired level of information about their illness, and assist with decision making. We conducted an audit survey to investigate the way follow-up takes place in our oncology clinic, to determine what works and what does not work in the clinic, and to examine how patients access the most useful information and to assess the utility of, and patient satisfaction with, a locally developed pilot prompt sheet. MATERIALS AND METHODS A single questionnaire was designed to elicit information on patients' information needs, overall satisfaction with the oncology clinic, and uptake and perceived usefulness of the prompt sheet. We carried out an audit survey in the form of a Likert-scale questionnaire (33 questions), followed immediately afterwards by a semi-structured interview. A specialist nurse asked a range of open questions about what was good and bad about the clinic and the prompt sheets. RESULTS Despite efforts to ensure that all patients received the prompt-sheet leaflets, only 254 out of 300 (85%) received them. Of these, 195 (65%) felt that they were 'very helpful', and 30 (10%) found them 'fairly helpful'. However, 15 (5%) had no strong feelings and only three found them either fairly or completely unhelpful. One-third of the patients were able to ask more questions about their disease as a result of the prompt sheet, although they felt the doctor was busy and did not want to take up too much of their time. Men with prostate cancer found the prompt sheet particularly helpful to ask questions. CONCLUSION This satisfaction audit suggests that our pilot prompt sheet is helpful to patients attending oncology outpatient appointments, particularly for men with prostate cancer. We aim to adapt the present prompt sheet on the basis of the replies obtained, and re-audit in the future.
Collapse
|
35
|
Chin YS, Bullard J, Bryant L, Bownes P, Ostler P, Hoskin PJ. High Dose Rate Iridium-192 Brachytherapy as a Component of Radical Radiotherapy for the Treatment of Localised Prostate Cancer. Clin Oncol (R Coll Radiol) 2006; 18:474-9. [PMID: 16909971 DOI: 10.1016/j.clon.2006.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [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: 11/18/2022]
Abstract
AIMS To assess the treatment outcomes and toxicity of conformal high dose rate (HDR) brachytherapy boost as a means of radiation dose escalation in patients with localised prostate cancer. MATERIALS AND METHODS Between December 1998 and July 2004, 65 consecutive patients with localised prostate cancer (magnetic resonance imaging-staged T1-3 N0 M0) were treated with external beam radiation therapy (EBRT) followed by two fractions of HDR iridium-192 brachytherapy. The patients selected this treatment modality in preference to entering an ongoing randomised phase 3 trial. Any pre-treatment serum prostate-specific antigen (PSA) and Gleason score were included. The primary end point was biochemical disease-free progression. Late treatment-related morbidity was graded according to the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer criteria. RESULTS The median patient age was 67.3 years (range 47.9-80). Sixty patients (92.3%) had intermediate- to high-risk disease defined by clinical stage, presenting PSA and Gleason score/World Health Organisation (WHO) grade. With a median follow-up of 3.5 years (range 0.6-5.8), two patients had died of metastatic disease and another four patients had PSA relapse, giving a 3-year actuarial biochemical disease-free progression of 90.8%. Three patients (4.6%) had acute grade 3 genitourinary toxicity, in the form of urinary retention. Late grade 3 and 4 genitourinary toxicities occurred in four patients (6.2%) and one patient (1.5%), respectively. No late gastrointestinal toxicities were observed. CONCLUSIONS These results suggest that the combined modality of conformal HDR brachytherapy and EBRT is a feasible treatment modality with acceptable acute and late toxicities, comparable with those of EBRT alone. It offers an attractive conformal treatment modality with the potential of further dose escalation in the treatment of localised prostate cancer.
Collapse
Affiliation(s)
- Y S Chin
- Mount Vernon Centre for Cancer Treatment, Northwood, Middlesex, UK
| | | | | | | | | | | |
Collapse
|
36
|
Glynne-Jones R, Grainger J, Harrison M, Ostler P, Makris A. Neoadjuvant chemotherapy prior to preoperative chemoradiation or radiation in rectal cancer: should we be more cautious? Br J Cancer 2006; 94:363-71. [PMID: 16465172 PMCID: PMC2361136 DOI: 10.1038/sj.bjc.6602960] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Neoadjuvant chemotherapy (NACT) is a term originally used to describe the administration of chemotherapy preoperatively before surgery. The original rationale for administering NACT or so-called induction chemotherapy to shrink or downstage a locally advanced tumour, and thereby facilitate more effective local treatment with surgery or radiotherapy, has been extended with the introduction of more effective combinations of chemotherapy to include reducing the risks of metastatic disease. It seems logical that survival could be lengthened, or organ preservation rates increased in resectable tumours by NACT. In rectal cancer NACT is being increasingly used in locally advanced and nonmetastatic unresectable tumours. Randomised studies in advanced colorectal cancer show high response rates to combination cytotoxic therapy. This evidence of efficacy coupled with the introduction of novel molecular targeted therapies (such as Bevacizumab and Cetuximab), and long waiting times for radiotherapy have rekindled an interest in delivering NACT in locally advanced rectal cancer. In contrast, this enthusiasm is currently waning in other sites such as head and neck and nasopharynx cancer where traditionally NACT has been used. So, is NACT in rectal cancer a real advance or just history repeating itself? In this review, we aimed to explore the advantages and disadvantages of the separate approaches of neoadjuvant, concurrent and consolidation chemotherapy in locally advanced rectal cancer, drawing on theoretical principles, preclinical studies and clinical experience both in rectal cancer and other disease sites. Neoadjuvant chemotherapy may improve outcome in terms of disease-free or overall survival in selected groups in some disease sites, but this strategy has not been shown to be associated with better outcomes than postoperative adjuvant chemotherapy. In particular, there is insufficient data in rectal cancer. The evidence for benefit is strongest when NACT is administered before surgical resection. In contrast, the data in favour of NACT before radiation or chemoradiation (CRT) is inconclusive, despite the suggestion that response to induction chemotherapy can predict response to subsequent radiotherapy. The observation that spectacular responses to chemotherapy before radical radiotherapy did not result in improved survival, was noted 25 years ago. However, multiple trials in head and neck cancer, nasopharyngeal cancer, non-small-cell lung cancer, small-cell lung cancer and cervical cancer do not support the routine use of NACT either as an alternative, or as additional benefit to CRT. The addition of NACT does not appear to enhance local control over concurrent CRT or radiotherapy alone. Neoadjuvant chemotherapy before CRT or radiation should be used with caution, and only in the context of clinical trials. The evidence base suggests that concurrent CRT with early positioning of radiotherapy appears the best option for patients with locally advanced rectal cancer and in all disease sites where radiation is the primary local therapy.
Collapse
Affiliation(s)
- R Glynne-Jones
- Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK.
| | | | | | | | | |
Collapse
|
37
|
Seguist L, Fidias P, Temel J, Kennedy E, Ostler P, Rabin M, Huberman M, Keck J, Brown G, Lynch T. P-572 Phase I–II trial of TLK286 (telcyta), carboplatin (C), and paclitaxel(P) as first-line treatment for advanced non-small cell lung cancer (NSCLC). Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81065-7] [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: 11/28/2022]
|
38
|
Jackman D, Lucca J, Fidias P, Rabin M, Lynch T, Ostler P, Skarin A, Temel J, Johnson B, Janne P. O-188 Phase II study of the EGFR tyrosine kinase inhibitor erlotinib (Tarceva) in patients >70 years of age with previously untreated advanced non-small cell lung carcinoma. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)80322-8] [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: 10/25/2022]
|
39
|
Temel J, Jackson V, Bilings A, Dahlin C, Fidias P, Buss M, Block S, Ostler P, Kornblith A, Lynch T. P-847 Early palliative care (EPC) in patients with advanced non-smallcell lung cancer (NSCLC) is feasible. Lung Cancer 2005. [DOI: 10.1016/s0169-5002(05)81340-6] [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: 10/25/2022]
|
40
|
Beresford MJ, Ah-See ML, Burcombe R, Dixon J, Ostler P, Harrison M, Pittam M, Ravichandran R, Makris A. Do pre-treatment haemoglobin levels predict for response to neoadjuvant chemotherapy in breast cancer? J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M. J. Beresford
- Mount Vernon Cancer Ctr, Middlesex, United Kingdom; Luton and Dunstable Hosp, Luton, United Kingdom
| | - M.-L. Ah-See
- Mount Vernon Cancer Ctr, Middlesex, United Kingdom; Luton and Dunstable Hosp, Luton, United Kingdom
| | - R. Burcombe
- Mount Vernon Cancer Ctr, Middlesex, United Kingdom; Luton and Dunstable Hosp, Luton, United Kingdom
| | - J. Dixon
- Mount Vernon Cancer Ctr, Middlesex, United Kingdom; Luton and Dunstable Hosp, Luton, United Kingdom
| | - P. Ostler
- Mount Vernon Cancer Ctr, Middlesex, United Kingdom; Luton and Dunstable Hosp, Luton, United Kingdom
| | - M. Harrison
- Mount Vernon Cancer Ctr, Middlesex, United Kingdom; Luton and Dunstable Hosp, Luton, United Kingdom
| | - M. Pittam
- Mount Vernon Cancer Ctr, Middlesex, United Kingdom; Luton and Dunstable Hosp, Luton, United Kingdom
| | - R. Ravichandran
- Mount Vernon Cancer Ctr, Middlesex, United Kingdom; Luton and Dunstable Hosp, Luton, United Kingdom
| | - A. Makris
- Mount Vernon Cancer Ctr, Middlesex, United Kingdom; Luton and Dunstable Hosp, Luton, United Kingdom
| |
Collapse
|
41
|
Jackman D, Lucca J, Fidias P, Rabin MS, Lynch TJ, Ostler P, Skarin AT, Temel J, Johnson BE, Janne PA. Phase II study of the EGFR tyrosine kinase erlotinib in patients ≥ 70 years of age with previously untreated advanced non-small cell lung carcinoma. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.7148] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- D. Jackman
- Dana-Farber Cancer Inst, Boston, MA; MA Gen Hosp, Boston, MA
| | - J. Lucca
- Dana-Farber Cancer Inst, Boston, MA; MA Gen Hosp, Boston, MA
| | - P. Fidias
- Dana-Farber Cancer Inst, Boston, MA; MA Gen Hosp, Boston, MA
| | - M. S. Rabin
- Dana-Farber Cancer Inst, Boston, MA; MA Gen Hosp, Boston, MA
| | - T. J. Lynch
- Dana-Farber Cancer Inst, Boston, MA; MA Gen Hosp, Boston, MA
| | - P. Ostler
- Dana-Farber Cancer Inst, Boston, MA; MA Gen Hosp, Boston, MA
| | - A. T. Skarin
- Dana-Farber Cancer Inst, Boston, MA; MA Gen Hosp, Boston, MA
| | - J. Temel
- Dana-Farber Cancer Inst, Boston, MA; MA Gen Hosp, Boston, MA
| | - B. E. Johnson
- Dana-Farber Cancer Inst, Boston, MA; MA Gen Hosp, Boston, MA
| | - P. A. Janne
- Dana-Farber Cancer Inst, Boston, MA; MA Gen Hosp, Boston, MA
| |
Collapse
|
42
|
Johnson BE, Lucca J, Rabin MS, Lynch TJ, Ostler P, Skarin AT, Temel J, Liu G, Janne PA. Preliminary results from a phase II study of the epidermal growth factor receptor tyrosine kinase inhibitor erlotinib in patients > 70 years of age with previously untreated advanced non-small cell lung carcinoma. J Clin Oncol 2004. [DOI: 10.1200/jco.2004.22.90140.7080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- B. E. Johnson
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - J. Lucca
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - M. S. Rabin
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - T. J. Lynch
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - P. Ostler
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - A. T. Skarin
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - J. Temel
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - G. Liu
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA
| | - P. A. Janne
- Dana Farber Cancer Institute, Boston, MA; Massachusetts General Hospital, Boston, MA
| |
Collapse
|
43
|
Fidias P, Supko JG, Martins R, Boral A, Carey R, Grossbard M, Shapiro G, Ostler P, Lucca J, Johnson BE, Skarin A, Lynch TJ. A phase II study of weekly paclitaxel in elderly patients with advanced non-small cell lung cancer. Clin Cancer Res 2001; 7:3942-9. [PMID: 11751486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
PURPOSE Our aim was to evaluate the efficacy, toxicity, and pharmacokinetic behavior of single-agent paclitaxel given weekly to elderly patients with lung cancer. EXPERIMENTAL DESIGN Previously untreated patients with stage IIIB/IV non-small cell lung cancer were eligible for the study if they were at least 70 years of age and had preserved organ function. Paclitaxel was administered over 1 h at a dose of 90 mg/m(2) for 6 consecutive weeks on an 8-week cycle. The pharmacokinetics of paclitaxel were assessed during the first and sixth week of therapy in a subgroup of eight patients. RESULTS A total of 35 patients (median age, 76 years; range, 70-85) were enrolled. The overall response rate was 23%. Median time to failure was 5.2 months, whereas the median survival time was 10.3 months. Survival rates after 1 and 2 years were 45 and 22%, respectively. Grade 3/4 toxicities included neutropenia (5.8%), hyperglycemia (17.6%), neuropathy (5.8%), and infection (8.8%). Two patients died from treatment-related toxicity. There was no significant difference (P = 0.18) between the total body clearance of paclitaxel on the first (17.4 +/- 2.9 liters/h/m(2), mean +/- SD) and sixth (15.8 +/- 4.1 liters/h/m(2)) week of therapy. CONCLUSION Paclitaxel administered as a weekly 1-h infusion at a dose of 90 mg/m(2) is a safe and effective therapy for elderly patients with advanced non-small cell lung cancer. Its pharmacokinetics in elderly patients do not appear to differ from historical data for younger patients, and there was no suggestion of a change in drug clearance after repeated weekly dosing.
Collapse
Affiliation(s)
- P Fidias
- Division of Hematology-Oncology, Massachusetts General Hospital, 100 Blossom Street, Cox 201, Boston, MA 02114, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Burcombe RJ, Ostler PJ, Ayoub AW, Hoskin PJ. The role of staging CT scans in the treatment of prostate cancer: a retrospective audit. Clin Oncol (R Coll Radiol) 2000; 12:32-5. [PMID: 10749017 DOI: 10.1053/clon.2000.9107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 11/11/2022]
Abstract
A retrospective audit was performed to review the use of diagnostic and planning computed tomographic (CT) scans in the management of patients treated with radical radiotherapy for prostate cancer at Mount Vernon Hospital. All 97 patients had a planning CT scan. In addition, 85 also underwent a diagnostic scan for staging purposes. Fifty-one (60%) had both pelvic and abdominal imaging. Twenty abnormalities were detected in 19 patients. Although 13 of these were 'malignant' abnormalities considered to represent metastatic disease, only four altered the treatment intent. Overall, only 4% of patients were denied radical treatment on the basis of CT findings. Malignant intra-abdominal disease was not identified in the absence of metastatic disease in the pelvis. This study confirms that abdominal CT scans contribute very little useful prognostic information in men with prostate cancer, and are not necessary for routine staging prior to radiotherapy. We propose that a single CT scan of the pelvis in patients who are suitable for radical radiotherapy can provide adequate information for both staging and planning purposes, resulting in significant reductions in cost, radiation exposure and scanner time.
Collapse
Affiliation(s)
- R J Burcombe
- Centre for Cancer Treatment, Mount Vernon Hospital, Northwood, Middlesex, UK
| | | | | | | |
Collapse
|
45
|
Ostler PJ, Patel N, Grant HR, Gaze MN. Syringomyelia after chemotherapy and radiotherapy for advanced oropharyngeal carcinoma: cause or coincidence? Clin Oncol (R Coll Radiol) 1998; 10:324-6. [PMID: 9848335 DOI: 10.1016/s0936-6555(98)80088-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 11/22/2022]
Abstract
A patient presented with syringomyelia 18 months after the completion of treatment with both chemotherapy and radiotherapy for an advanced oropharyngeal carcinoma. The link with therapy is discussed.
Collapse
Affiliation(s)
- P J Ostler
- Meyerstein Institute of Oncology, Middlesex Hospital, London, UK
| | | | | | | |
Collapse
|
46
|
Clarke DP, Ostler P, Watkinson A, Collis C, Berger L. Case report: Magnetic resonance imaging in primary cervical lymphoma: the role in diagnosis and follow-up. Clin Radiol 1998; 53:383-5. [PMID: 9630282 DOI: 10.1016/s0009-9260(98)80016-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- D P Clarke
- Department of Diagnostic Radiology, Royal Free NHS Trust, London, UK
| | | | | | | | | |
Collapse
|
47
|
Abstract
Superior vena cava obstruction (SVCO) is a distressing syndrome. The condition may present to specialists in many branches of medicine, but patients have traditionally been referred on to clinical oncologists for management, as malignancy is the main aetiological factor. Treatment without a histological diagnosis is no longer justified, because management needs to be tailored to the underlying disease. This article reviews the causes, symptoms, methods of diagnosis and therapy options. The role of stenting in SVCO is discussed and a management algorithm is proposed.
Collapse
Affiliation(s)
- P J Ostler
- Meyerstein Institute of Oncology, Middlesex Hospital, London, UK
| | | | | | | |
Collapse
|