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Danson SJ, Conner J, Edwards JG, Blyth KG, Fisher PM, Muthana M, Salawu A, Taylor F, Hodgkinson E, Joyce P, Roman J, Simpson K, Graham A, Learmonth K, Woll PJ. Oncolytic herpesvirus therapy for mesothelioma - A phase I/IIa trial of intrapleural administration of HSV1716. Lung Cancer 2020; 150:145-151. [PMID: 33160198 DOI: 10.1016/j.lungcan.2020.10.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/14/2020] [Accepted: 10/10/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Malignant Pleural Mesothelioma (MPM) remains a major oncological challenge with limited therapeutic options. HSV1716 is a replication restricted oncolytic herpes simplex virus with anti-tumor effects in multiple cell lines including MPM. Intrapleural treatment appeals because MPM is typically multifocal but confined to the pleura, and distant metastases are uncommon. We assessed the safety and possible efficacy of intrapleural HSV1716 for inoperable MPM. MATERIALS AND METHODS Patients with MPM received 1 × 107iu HSV1716 injected via an indwelling intrapleural catheter (IPC) on one, two or four occasions a week apart. The primary endpoint was the safety and tolerability of HSV1716. Secondary endpoints were assessment of HSV1716 replication, detection of immune response and evaluation of tumor response. RESULTS Of thirteen patients enrolled, five had received previous pemetrexed-cisplatin chemotherapy, and eight were chemotherapy naïve. Three patients were enrolled to receive one dose, three patients to two doses and seven patients to four doses. The treatment was well-tolerated with few virus-related adverse events and no dose limiting toxicities. Twelve patients were evaluable for response, as one patient withdrew early after a catheter fracture. There was evidence of viral replication/persistence in pleural fluid in seven of the twelve patients. Induction of Th1 cytokine responses to HSV1716 treatment occurred in eight patients and four patients developed novel anti-tumor IgG. No objective responses were observed but disease stabilization was reported in 50 % of patients at 8 weeks. CONCLUSIONS Intrapleural HSV1716 was well-tolerated and demonstrated an anti-tumor immune response in MPM patients. These results provide a rationale for further studies with this agent in MPM and in combination with other therapies.
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Affiliation(s)
- Sarah J Danson
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK.
| | - Joe Conner
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - John G Edwards
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Kevin G Blyth
- Pleural Disease Unit, Queen Elizabeth University Hospital, Glasgow, UK; Institute of Infection, Immunity and Inflammation, University of Glasgow, UK
| | - Patricia M Fisher
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Munitta Muthana
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Abdulazeez Salawu
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Fiona Taylor
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Elizabeth Hodgkinson
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Patrick Joyce
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
| | - Jennifer Roman
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Kathleen Simpson
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Alexander Graham
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Kirsty Learmonth
- Virttu Biologics/Sorrento Therapeutics, Biocity Scotland, Newhouse, UK
| | - Penella J Woll
- Sheffield Experimental Cancer Medicine Centre and Weston Park Cancer Centre, University of Sheffield, Weston Park Hospital, Sheffield, UK
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Robinson SD, Tahir BA, Absalom KAR, Lankathilake A, Das T, Lee C, Fisher PM, Bates E, Hatton MQF. Radical accelerated radiotherapy for non-small cell lung cancer (NSCLC): A 5-year retrospective review of two dose fractionation schedules. Radiother Oncol 2019; 143:37-43. [PMID: 31563408 DOI: 10.1016/j.radonc.2019.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/22/2019] [Accepted: 08/29/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Numerous fractionation regimes are used for inoperable NSCLC patients not suitable for stereotactic ablative radiotherapy. Continuous hyperfractionated accelerated radiotherapy (CHART, 54 Gy, 36 fractions over 12 days) and hypofractionated accelerated radiotherapy (55 Gy, 20 fractions over 4 weeks) are recommended UK schedules. In this single-centre retrospective analysis, we compare both fractionation schemes for patients treated at our institution from 2010 to 15. MATERIALS AND METHODS Clinical demographic, tumour and survival data were collected alongside radiotherapy dosimetric data from the Varian Eclipse Scripting application programming interface. Differences were assessed using independent samples t-tests. Multivariate survival analysis was performed using Cox regression. RESULTS We identified 563 eligible patients; 43% received CHART and 57% hypofractionated radiotherapy. Median age was 71 years, 56% were male, 95% PET staged with 53% WHO performance status 0-1. 30%, 14%, 50% and 6% were stage I, II, III and IV, respectively. 38% of patients underwent induction chemotherapy. 99% completed their prescribed radiotherapy treatment. Overall response rate was 50% with a 6.5% 90-day mortality rate. Median disease-free survival was 19 months, 50% recurred locally. Median overall survival was 22.5 months with 48% alive at 2 years. Multivariate analysis identified histology, stage, performance status, chemotherapy and radiotherapy response as independent predictors of survival; no significant differences between radiotherapy regimes were observed. CONCLUSION In our centre, CHART and hypofractionated accelerated radiotherapy produce similar outcomes. Dose escalation studies are in progress to develop these schedules to match outcomes reported in concurrent chemo-radiation studies.
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Affiliation(s)
- Stephen D Robinson
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Bilal A Tahir
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Katherine A R Absalom
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Amila Lankathilake
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Tathagata Das
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Caroline Lee
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Patricia M Fisher
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Emma Bates
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom
| | - Matthew Q F Hatton
- Academic Unit of Clinical Oncology, Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, United Kingdom.
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Stenbæk DS, Fisher PM, Budtz-Jørgensen E, Pinborg A, Hjordt LV, Jensen PS, Knudsen GM, Frokjaer VG. Sex hormone manipulation slows reaction time and increases labile mood in healthy women. Psychoneuroendocrinology 2016; 68:39-46. [PMID: 26943343 DOI: 10.1016/j.psyneuen.2016.02.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 11/26/2015] [Revised: 01/23/2016] [Accepted: 02/22/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Women show increased risk of depressive symptoms in life phases where ovarian steroid hormone levels fluctuate or decline rapidly. The risk mechanisms may include changes in mental state and affective cognition possibly mediated by serotonergic neurotransmission. METHODS In a randomized controlled double-blinded trial, 61 healthy women (mean age 24.3±4.9 years) were tested with measures of affective verbal memory, reaction time, mental distress, and serotonin transporter binding at baseline and at follow-up after receiving gonadotropin-releasing hormone agonist (GnRHa) or placebo intervention. Women also reported daily mood profiles during intervention. We tested direct effects of intervention and indirect effects through changes in serotonin transporter binding on verbal affective memory, simple reaction time and self-reported measures of mental distress, and further effects of GnRHa on daily mood. RESULTS GnRHa induced an increase in simple reaction time (p=0.03) and more pronounced fluctuations in daily self-reported mood in a manner dependent on baseline mood (p=0.003). Verbal affective memory recall, overall self-perceived mental distress, and serotonin transporter binding were not affected. CONCLUSIONS In healthy women transient sex-steroid hormone fluctuations decrease speed of information processing and further produce more labile mood only in women with elevated levels of mood disturbances at baseline.
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Affiliation(s)
- D S Stenbæk
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - P M Fisher
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - E Budtz-Jørgensen
- Department of Biostatistics, University of Copenhagen, Oster Farimagsgade 5, 1014 Copenhagen K, Denmark.
| | - A Pinborg
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark; Fertility Department, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - L V Hjordt
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - P S Jensen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
| | - G M Knudsen
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark.
| | - V G Frokjaer
- Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen O, Denmark.
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White MG, Bogdan R, Fisher PM, Muñoz KE, Williamson DE, Hariri AR. FKBP5 and emotional neglect interact to predict individual differences in amygdala reactivity. Genes Brain Behav 2013; 11:869-78. [PMID: 22979952 DOI: 10.1111/j.1601-183x.2012.00837.x] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Individual variation in physiological responsiveness to stress mediates risk for mental illness and is influenced by both experiential and genetic factors. Common polymorphisms in the human gene for FK506 binding protein 5 (FKBP5), which is involved in transcriptional regulation of the hypothalamic-pituitary-adrenal (HPA) axis, have been shown to interact with childhood abuse and trauma to predict stress-related psychopathology. In the current study, we examined if such gene-environment interaction effects may be related to variability in the threat-related reactivity of the amygdala, which plays a critical role in mediating physiological and behavioral adaptations to stress including modulation of the HPA axis. To this end, 139 healthy Caucasian youth completed a blood oxygen level-dependent functional magnetic resonance imaging probe of amygdala reactivity and self-report assessments of emotional neglect (EN) and other forms of maltreatment. These individuals were genotyped for 6 FKBP5 polymorphisms (rs7748266, rs1360780, rs9296158, rs3800373, rs9470080 and rs9394309) previously associated with psychopathology and/or HPA axis function. Interactions between each SNP and EN emerged such that risk alleles predicted relatively increased dorsal amygdala reactivity in the context of higher EN, even after correcting for multiple testing. Two different haplotype analyses confirmed this relationship as haplotypes with risk alleles also exhibited increased amygdala reactivity in the context of higher EN. Our results suggest that increased threat-related amygdala reactivity may represent a mechanism linking psychopathology to interactions between common genetic variants affecting HPA axis function and childhood trauma.
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Affiliation(s)
- M G White
- Laboratory of NeuroGenetics, Department of Psychology & Neuroscience, Duke University, Durham, NC, USA
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5
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Abstract
Identifying neurobiological mechanisms mediating the emergence of individual differences in behavior is critical for advancing our understanding of relative risk for psychopathology. Neuroreceptor positron emission tomography (PET) and functional magnetic resonance imaging (fMRI) can be used to assay in vivo regional brain chemistry and function, respectively. Typically, these neuroimaging modalities are implemented independently despite the capacity for integrated data sets to offer unique insight into molecular mechanisms associated with brain function. Through examples from the serotonin and dopamine system and its effects on threat- and reward-related brain function, we review evidence for how such a multimodal neuroimaging strategy can be successfully implemented. Furthermore, we discuss how multimodal PET-fMRI can be integrated with techniques such as imaging genetics, pharmacological challenge paradigms and gene-environment interaction models to more completely map biological pathways mediating individual differences in behavior and related risk for psychopathology and inform the development of novel therapeutic targets.
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Affiliation(s)
- P M Fisher
- Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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6
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Murray LJ, Higham J, Suvarna SK, Craig GT, Bridgewater CH, Fisher PM, Thornhill MH. Oral presentation of malignant mesothelioma. ACTA ACUST UNITED AC 2011; 111:e21-6. [DOI: 10.1016/j.tripleo.2010.05.009] [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: 01/15/2010] [Revised: 05/05/2010] [Accepted: 05/07/2010] [Indexed: 10/19/2022]
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7
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Pemberton LS, Din OS, Fisher PM, Hatton MQ. Accelerated radical radiotherapy for non-small cell lung cancer using two common regimens: a single-centre retrospective study of outcome. Clin Oncol (R Coll Radiol) 2008; 21:161-7. [PMID: 19111452 DOI: 10.1016/j.clon.2008.11.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2008] [Revised: 11/17/2008] [Accepted: 11/18/2008] [Indexed: 12/17/2022]
Abstract
AIMS A variety of radical radiotherapy regimens are in use for non-small cell lung cancer. Continuous hyperfractionated accelerated radiotherapy (CHART: 54 Gy in 36 fractions over 12 days) and accelerated hypofractionated radiotherapy using 55 Gy in 20 fractions over 4 weeks are standard fractionations in our centre. The primary aim of this retrospective study was to evaluate survival outcome seen in routine clinical practice. MATERIALS AND METHODS All case notes and radiotherapy records of radically treated patients between 1999 and 2004 were retrospectively reviewed. Basic patient demographics, tumours, characteristics, radiotherapy and survival data were collected. RESULTS In total, 277 patients received radical radiotherapy: 137 and 140 patients received CHART and hypofractionated radiotherapy, respectively. There were differences noted in the demographics between the two treatment schedules: median age 65 years (range 41-83) vs 73 years (range 33-87); histological confirmation rates 90% vs 76%; prior chemotherapy 34% vs 19% for CHART and hypofractionated treatment, respectively. For CHART patients, stages I, II, III and unclassified were 12, 8, 68 and 12% and the staging for the hypofractionated regimen was 54, 11, 34 and 2%, respectively. The median overall survival from the time of diagnosis was 20.4 months with a 40% 2-year survival rate. For the two fractionations the median survival was 16.6 months vs 21.4 months and 34% vs 45% of patients were alive at 2 years in the CHART and hypofractionated groups, respectively. On multivariate analysis, stage was the only factor affecting overall survival - no difference was seen according to radiotherapy regimen. CONCLUSION This single-centre study reflects the outcome of unselected consecutively treated non-small cell lung cancer patients. Adjusting for stage, there was no significant difference in survival seen according to regimen. Encouragingly, CHART outcome shows reproducibility with the original CHART paper. Our hypofractionated outcome is similar to that previously reported, but despite this being the UK's most common regimen, 55 Gy in 20 daily fractions remains unvalidated by phase III trial data.
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Affiliation(s)
- L S Pemberton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK.
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8
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Fisher PM, Meltzer CC, Ziolko SK, Price JC, Moses-Kolko EL, Berga SL, Hariri AR. Erratum: Corrigendum: Capacity for 5-HT1A–mediated autoregulation predicts amygdala reactivity. Nat Neurosci 2007. [DOI: 10.1038/nn0207-263a] [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: 11/09/2022]
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9
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Fisher PM, Meltzer CC, Ziolko SK, Price JC, Moses-Kolko EL, Berga SL, Hariri AR. Capacity for 5-HT1A–mediated autoregulation predicts amygdala reactivity. Nat Neurosci 2006; 9:1362-3. [PMID: 17013380 DOI: 10.1038/nn1780] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [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: 05/09/2006] [Accepted: 09/08/2006] [Indexed: 11/09/2022]
Abstract
We examined the contribution of 5-HT1A autoreceptors (with [11C]WAY100635 positron emission tomography) to amygdala reactivity (with blood oxygenation level-dependent functional magnetic resonance imaging) in 20 healthy adult volunteers. We found a significant inverse relationship wherein 5-HT1A autoreceptor density predicted a notable 30-44% of the variability in amygdala reactivity. Our data suggest a potential molecular mechanism by which a reduced capacity for negative feedback regulation of 5-HT release is associated with increased amygdala reactivity.
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Affiliation(s)
- P M Fisher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15213, USA
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10
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Clenton SJ, Fisher PM, Conway J, Kirkbride P, Hatton MQ. The use of lung dose-volume histograms in predicting post-radiation pneumonitis after non-conventionally fractionated radiotherapy for thoracic carcinoma. Clin Oncol (R Coll Radiol) 2006; 17:599-603. [PMID: 16372484 DOI: 10.1016/j.clon.2005.07.016] [Citation(s) in RCA: 16] [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] [Indexed: 10/25/2022]
Abstract
AIMS To assess the use of lung dose-volume histogram (DVH) parameters (specifically V20Gy) in the prediction of radiation pneumonitis for non-conventional fraction sizes used in the treatment of lung cancer. MATERIALS AND METHODS Patients requiring computed tomography planning for thoracic radiotherapy between January 1999 and January 2002 were identified. The patients receiving radical or high-dose palliative radiotherapy had DVH produced routinely during planning. These were retrospectively reviewed and the case notes accessed for additional pre-treatment parameters, demographics and evidence of radiation pneumonitis. The severity of the pneumonitis was then scored using Radiation Therapy Oncology Group criteria. Data were analysed using the SPSS computer program. RESULTS One hundred and sixty consecutive patients were reviewed. Ninety patients received hypofractionated treatment (fraction size > 2.5 Gy) and 57 continuous hyperfractionated accelerated radiation therapy (CHART) (fraction size 1.5 Gy). Lung V20Gy values ranged from 3% to 53%, with a median value of 24%. Only six patients reported grade 2, and 16 patients grade 3 pneumonitis. Two patients developed fatal, grade 5 pneumonitis. No correlation between pneumonitis score and V20Gy or other possible predictive factors was found. CONCLUSION The 15% grade 2-5 pneumonitis rate we document is at the lower end of the spectrum reported in other studies. This suggests that using published data on limiting V20Gy values to reduce the risk of radiation pneumonitis can be extrapolated to planning treatment with non-conventionally fractionated radiotherapy.
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Affiliation(s)
- S J Clenton
- Department of Clinical Oncology, Weston Park Hospital, Sheffield, UK.
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Martin-Ucar AE, Passera E, Hatton M, Quereshi N, Fisher PM, Hopkinson D, Rocco G. P-241 Pulmonary resection after neoadjuvant chemotherapy increases the use of resources with acceptable outcomes. Lung Cancer 2003. [DOI: 10.1016/s0169-5002(03)92210-0] [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: 10/26/2022]
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12
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Welch IM, Fisher PM, Stoddard CJ, Wyman A. Neoadjuvant chemoradiotherapy for operable oesophageal carcinoma: preliminary results from Sheffield. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.2001.01730-8.x] [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]
Abstract
Abstract
Background
Surgical resection is the mainstay of treatment for potentially curable oesophageal carcinoma but the long-term survival rate remains 10–20 per cent. Neoadjuvant administration of chemoradiotherapy (NCR) may improve these values. In this study the authors reviewed their preliminary experience with NCR in Sheffield.
Methods
Twenty-five patients with potentially resectable oesophageal carcinoma embarked on a regimen of NCR, with resection planned 4–6 weeks later. Chemotherapy incorporated two cycles of intravenous cis-platinum and 5-fluorouracil with external-beam radiotherapy administered synchronously (30–45 Gy).
Results
Twenty-two of the 25 patients suffered side-effects from NCR, including one death, and seven patients failed to complete NCR as planned. The median interval from diagnosis to surgery was 121 days. Twelve out of 24 patients had significant postoperative complications, including two deaths. Seven patients had a complete histological response to NCR (three out of 15 for adenocarcinoma, four out of nine for squamous carcinoma).
Conclusion
The complete histological response rate to NCR in these patients compares favourably with previous studies, as does the postoperative mortality, but this was at the expense of substantial morbidity and was associated with long delays from diagnosis to operation. At present it is not possible to predict which patients will respond favourably to NCR and whether they will benefit with improved survival.
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Affiliation(s)
- I McL Welch
- The Sheffield Unit for Oesophagogastric Cancer, c/o Royal Hallamshire Hospital, Sheffield, UK
| | - P M Fisher
- The Sheffield Unit for Oesophagogastric Cancer, c/o Royal Hallamshire Hospital, Sheffield, UK
| | - C J Stoddard
- The Sheffield Unit for Oesophagogastric Cancer, c/o Royal Hallamshire Hospital, Sheffield, UK
| | - A Wyman
- The Sheffield Unit for Oesophagogastric Cancer, c/o Royal Hallamshire Hospital, Sheffield, UK
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Mudhar HS, Fisher PM, Wallace WAH. No relationship between tumour infiltrating lymphocytes and overall survival is seen in malignant mesothelioma of the pleura. Eur J Surg Oncol 2002; 28:564-5. [PMID: 12217312 DOI: 10.1053/ejso.2002.1294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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McJury M, Fisher PM, Pledge S, Brown G, Anthony C, Hatton MQ, Conway J, Robinson MH. The impact of virtual simulation in palliative radiotherapy for non-small-cell lung cancer. Radiother Oncol 2001; 59:311-8. [PMID: 11369073 DOI: 10.1016/s0167-8140(01)00308-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [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: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Radiotherapy is widely used to palliate local symptoms in non-small-cell lung cancer. Using conventional X-ray simulation, it is often difficult to accurately localize the extent of the tumour. We report a randomized, double blind trial comparing target localization with conventional and virtual simulation. METHODS Eighty-six patients underwent both conventional and virtual simulation. The conventional simulator films were compared with digitally reconstructed radiographs (DRRs) produced from the computed tomography (CT) data. The treatment fields defined by the clinicians using each modality were compared in terms of field area, position and the implications for target coverage. RESULTS Comparing fields defined by each study arm, there was a major mis-match in coverage between fields in 66.2% of cases, and a complete match in only 5.2% of cases. In 82.4% of cases, conventional simulator fields were larger (mean 24.5+/-5.1% (95% confidence interval)) than CT-localized fields, potentially contributing to a mean target under-coverage of 16.4+/-3.5% and normal tissue over-coverage of 25.4+/-4.2%. CONCLUSIONS CT localization and virtual simulation allow more accurate definition of the target volume. This could enable a reduction in geographical misses, while also reducing treatment-related toxicity.
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Affiliation(s)
- M McJury
- Department of Radiotherapy Physics, Weston Park NHS Trust, Whitham Road, S10 2SJ, Sheffield, UK
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15
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Affiliation(s)
- P M Fisher
- YCRC Department of Clinical Oncology, Weston Park Hospital, Sheffield, U.K
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16
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Fisher PM, Hancock BW. Hodgkin's disease in the pregnant patient. Br J Hosp Med (Lond) 1996; 56:529-32. [PMID: 8958407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- P M Fisher
- YCRC Department of Clinical Oncology, Weston Park Hospital, Sheffield
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Cormack DV, Fisher PM, Till JE. A study of waiting times and waiting lists for radiation therapy patients. Can J Oncol 1996; 6:427-434. [PMID: 8853515] [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] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A simple mathematical model based on queueing theory is introduced, and used to obtain a sensitive measure of the capacity of a radiation therapy centre to provide service. The model illustrates the relationships among the relevant variables: the patient waiting time, the number on the waiting list, the rate at which requests for radiation therapy are received and the rate at which courses of treatment are commenced. In particular, the rate at which the waiting time increases is equal to the difference between the request rate and the start rate, expressed as a fraction of the start rate, and is therefore a measure of the deficiency in service capacity of a facility. A study of the records of patients treated on the linear accelerators of the Tom Baker Cancer Centre from January 1991 to June 1994 shows that this relationship holds to a high degree of accuracy for average values of the various parameters in spite of the considerable variation in these values, and particularly variation in the individual waiting times. This finding suggests that such an approach would be useful in assessing and comparing the performance of radiation therapy facilities.
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Affiliation(s)
- D V Cormack
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta
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18
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Abstract
Two cases of malignant schwannoma are reported 13 and 15 years following combined modality treatment for Hodgkin's disease. Both patients survived for only 15 months. The aetiology of this rare condition is discussed.
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Anderson DJ, Flannelly GM, Kitchener HC, Fisher PM, Mann EM, Campbell MK, Templeton A. Mild and moderate dyskaryosis: can women be selected for colposcopy on the basis of social criteria? BMJ 1992; 305:84-7. [PMID: 1638252 PMCID: PMC1882624 DOI: 10.1136/bmj.305.6845.84] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To describe the distribution of cervical intraepithelial neoplasia grades among women with mild and moderate dyskaryosis after a single cervical smear and to determine whether social criteria could help identify women who are at increased risk of grade II or III disease. DESIGN Cross sectional analysis within a randomised prospective study. Subjects had a repeat smear, a colposcopic examination, and an excision biopsy of the transformation zone. In addition, women were asked to complete a social questionnaire. SETTING Colposcopy clinic, Aberdeen. SUBJECTS 228 women with a single smear test showing mild or moderate dyskaryosis. MAIN OUTCOME MEASURES Histology, age, sexual and contraceptive history, cigarette smoking. RESULTS 159 (70%) women had cervical intraepithelial neoplasia grades II or III. Among current smokers the prevalence of grade II and III disease was higher in women who smoked greater than or equal to 20 cigarettes a day (84%) than among those who smoked less (66%; p less than 0.04). Women with more than one sexual partner also had a higher prevalence (75%) than women with only one partner (50%; p = 0.0028). Use of oral contraceptives and younger age were not significantly associated. The prevalence of grade II or III disease was up to 66% in the lower risk groups. CONCLUSIONS Because of the high prevalence of cervical intraepithelial neoplasia grades II and III in both the high and the low risk groups social factors are not useful for selecting women with mild or moderate dyskaryosis for either early referral to colposcopy or cytological surveillance.
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Affiliation(s)
- D J Anderson
- Harris Birthright Research Centre, Aberdeen Royal Infirmary, Foresterhill
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Fisher PM. Washington University Medical School: Where's family practice? JAMA 1992; 267:2330. [PMID: 1564772 DOI: 10.1001/jama.1992.03480170056027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Paraskevaidis E, Kitchener HC, Miller ID, Mann E, Jandial L, Fisher PM. A population-based study of microinvasive disease of the cervix--a colposcopic and cytologic analysis. Gynecol Oncol 1992; 45:9-12. [PMID: 1341416 DOI: 10.1016/0090-8258(92)90483-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.2] [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: 12/26/2022]
Abstract
A study of 61 cases of microinvasion of the cervix occurring in our population between 1980 and 1989 is reported. The mean age of the women was 39 years, compared with 30 years for cervical intraepithelial grade 3 (CIN III) and 47 years for frank invasion, respectively. Colposcopic suspicion of microinvasion was present in 31 cases, giving a sensitivity of colposcopic diagnosis of 50% and a specificity of 91%. In 21 cases (34%) there was no suspicion either cytologically or colposcopically of microinvasion. Colposcopy predicted microinvasion more accurately with increasing depth of invasion. In 28 women there had been previous smears within 10 years available for review. The time interval between the first abnormal smear and the histological diagnosis ranged from 1 month to 9.8 years (mean, 4 years).
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Affiliation(s)
- E Paraskevaidis
- Department of Gynaecology, Aberdeen Royal Informary, Scotland, United Kingdom
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Paraskevaidis E, Jandial L, Mann EM, Fisher PM, Kitchener HC. Pattern of treatment failure following laser for cervical intraepithelial neoplasia: implications for follow-up protocol. Obstet Gynecol 1991; 78:80-3. [PMID: 2047073] [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: 12/30/2022]
Abstract
In an effort to devise a rational protocol for the follow-up of patients who have had destructive treatment for cervical intraepithelial neoplasia (CIN), an analysis has been performed of treatment failures following laser therapy in 2130 women treated between 1980-1989. Of this group, 1253 women have been followed up for 3 years or more and 380 for 6 years or more. There have been 119 treatment failures (5.6%), of which 71% of the women had the second lesion detected during the first year of follow-up, 24% during the second year, 3.3% during the third year, and 1.7% during the sixth year. In 18% of these 119, the second lesion was detected colposcopically in the presence of negative cytology. There were two cases of microinvasion and one frankly invasive lesion following laser, all diagnosed during the second year of follow-up. Our data suggest that if the first year of follow-up includes at least one colposcopic examination, some second lesions will be diagnosed in the presence of negative cytology.
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Affiliation(s)
- E Paraskevaidis
- Department of Gynecology, Aberdeen Royal Infirmary, Scotland
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Gordon RD, Tunny TJ, Evans EB, Fisher PM, Jackson RV. Unstimulated renal venous renin ratio predicts improvement in hypertension following nephrectomy for unilateral renal disease. Nephron Clin Pract 1986; 44 Suppl 1:25-8. [PMID: 3528883 DOI: 10.1159/000184041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The ability of renal venous renin ratio (RVRR) to predict the blood pressure response to nephrectomy was studied in 45 hypertensive patients followed for at least 1 year after nephrectomy. Twenty patients had unilateral chronic parenchymal renal disease (UCPR) and 25 patients had unilateral renal artery stenosis (RAS). The RVRR procedure was performed according to a strict protocol which included sodium restricted diet (40 mmol daily) and hospital admission, with one set of unstimulated samples collected after overnight recumbency, and at least one further set collected after sympathetic nervous system stimulation induced by tilting or i.v. diazoxide. In only 3 of 12 patients with serum creatinine 0.15 mmol/l or higher and presumed bilateral renal disease was hypertension improved. If these 12 patients are excluded, RVRR was a good predictor of outcome, but only if the question of unstimulated and stimulated ratios was considered. Whereas inclusion of stimulated ratios increased the predictive accuracy to 81% in RAS, and avoided two false-negatives, in UCPR the stimulated ratio created four false-positives. Since there were no false-negatives and six true-negatives in UCPR, overnight recumbent RVRR was a perfect predictor of outcome in this sub-group. It appears that RVRR without sympathetic stimulation is most reliable in UCPR, and RVRR during sympathetic stimulation in RAS, raising the question that renin regulation may be different in these two conditions.
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Thom H, Campbell AG, Farr V, Fisher PM, Hall MH, Swapp GH, Gray ES. The impact of maternal serum alpha fetoprotein screening on open neural tube defect births in north-east Scotland. Prenat Diagn 1985; 5:15-9. [PMID: 2579374 DOI: 10.1002/pd.1970050104] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Over the three years period 1980-1982, 18 256 pregnancies in the Grampian Region of N-E Scotland including the islands of Orkney and Shetland were screened for raised levels of maternal serum alpha fetoprotein (MSAFP) in the second trimester. Thirty six cases of fetal open neural tube defect in singletons were detected (18 anencephaly and 18 spina bifida). Four additional cases of open spina bifida were associated with normal MSAFP levels although two of these were detected by amniotic fluid AFP measurement when amniocentesis was carried out because of previous NTD history. A further three cases of open spina bifida and two of anencephaly occurred in unscreened pregnancies. The MSAFP screening programme alone was thus instrumental in reducing the birth incidence of open neural tube defects by 36 out of 45 cases (80 per cent) in singletons.
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Gordon RD, Tunny TJ, Evans EB, Fisher PM, Jackson RV. Renal venous renin ratio as a predictor of improvement in hypertension following nephrectomy for unilateral renal disease. Clin Exp Pharmacol Physiol 1984; 11:403-6. [PMID: 6394182 DOI: 10.1111/j.1440-1681.1984.tb00288.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Renal venous renin ratio (RVRR) was measured in twenty hypertensive patients before removal of a kidney for unilateral, parenchymal renal disease. They were then followed for 1.3-9 y. Hypertension was cured or improved in six of eight patients with positive unstimulated and stimulated ratios, in none of five whose ratios became positive only on stimulation, and in one of seven with all ratios negative. Patients improved or cured by surgery had a significantly shorter duration of hypertension and a significantly lower serum creatinine after nephrectomy. Unstimulated RVRR was a reliable predictor of the effect of unilateral nephrectomy on blood pressure level.
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Buckley RH, Sampson HA, Fisher PM, Becker WG, Shirley LR. Abnormalities in the regulation of human IgE synthesis. Ann Allergy 1982; 49:67-72. [PMID: 6980609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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Abstract
To study insulin response and insulin sensitivity a glucose infusion test was devised. Twenty normal non-pregnant and twenty normal pregnant women had an intravenous glucose tolerance test followed by a glucose infusion test. In a normal pregnant group at 38-40 weeks gestation (n = 20) the plasma insulin response was found to be 3.7 times greater than that observed in a normal non-pregnant group (n = 20), while in the normal pregnant group the insulin sensitivity index was only 18 per cent of that observed in the non-pregnant group. Intravenous glucose tolerance in the non-pregnant women was observed to correlate with the insulin sensitivity index (r = 0.61, p less than 0.05) but in the pregnant women it correlated with the insulin response (r = 0.66, p less than 0.01). These findings support the hypothesis that in the non-pregnant state intravenous glucose tolerance may be primarily related to insulin sensitivity while during pregnancy it may be related to the degree of compensatory hyperinsulinism.
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Abstract
Using a glucose infusion test insulin responses and insulin sensitivities were studied in 15 gestational diabetic women at 36-40 weeks gestation. In all women intravenous glucose tolerance had returned to normal at six weeks postpartum. Twelve women had a repeat glucose infusion test done 7-24 weeks (mean 17 weeks) postpartum. The results were compared with previously evaluated normal non-pregnant and normal pregnant standards and insulin responses below the normal 15th percentile were defined as "low". Twelve women had "low insulin responses in late pregnancy, and six had "low" insulin responses postpartum. The mean insulin sensitivity index of 1.34 +/- 1.21 (mean +/- SD) was significantly higher in the gestational diabetic group during pregnancy compared with a control pregnant group at 0.53 +/- 0.21 (p less than 0.01). The findings in this study support the hypothesis that gestational diabetes may arise in women who are unable to achieve adequate insulinogenic compensation to pregnancy. Increased insulin sensitivity in gestational diabetes may be a compensatory mechanism.
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Thom H, Dinwiddie R, Fisher PM, Russell G, Sutherland HW. Palmitic acid concentrations and lecithin/sphingomyelin ratios in amniotic fluid. Clin Chim Acta 1975; 62:143-7. [PMID: 1149269 DOI: 10.1016/0009-8981(75)90291-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Palmitic acid concentrations and L/S ratios have been estimated in amniotic fluid specimens with and without centrifugation and cold acetone precipitation. Although the number of cases was small, both of these measurements in uncentrifuged fluid seemed to reflect only indirectly on lung maturation in normal pregnancy while with centrifuged fluid the L/S value predicted RDS in one infant more reliably than palmitic acid concentration.
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