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Powles T, Bellmunt J, Comperat E, De Santis M, Huddart R, Loriot Y, Necchi A, Valderrama BP, Ravaud A, Shariat SF, Szabados B, van der Heijden MS, Gillessen S. ESMO Clinical Practice Guideline interim update on first-line therapy in advanced urothelial carcinoma. Ann Oncol 2024:S0923-7534(24)00075-9. [PMID: 38490358 DOI: 10.1016/j.annonc.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/29/2024] [Accepted: 03/01/2024] [Indexed: 03/17/2024] Open
Affiliation(s)
- T Powles
- Barts Cancer Centre, Barts Health NHS Trust, Queen Mary University of London, London, UK
| | - J Bellmunt
- Department of Hematology and Oncology, Dana-Farber Cancer Institute, Harvard Cancer Centre, Boston, USA
| | - E Comperat
- Department of Pathology, Medical University Vienna, Austria
| | - M De Santis
- Department of Urology, Charité Universitätsmedizin, Berlin, Germany; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - R Huddart
- Royal Marsden Hospital, Institute of Cancer Research, London, UK
| | - Y Loriot
- Department of Medical Oncology, Université Paris-Saclay and Gustave Roussy, Villejuif, France
| | - A Necchi
- Vita-Salute San Raffaele University, Milan; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - B P Valderrama
- Department of Medical Oncology, University Hospital Virgen del Rocio, Seville, Spain
| | - A Ravaud
- Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France
| | - S F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York; Department of Urology, University of Texas Southwestern, Dallas, USA; Division of Urology, Department of Special Surgery, University of Jordan, Amman, Jordan
| | - B Szabados
- Barts Cancer Centre, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - M S van der Heijden
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Gillessen
- Oncology Institute of Southern Switzerland (EOC-IOSI), Bellinzona; Università della Svizzera Italina (USI), Lugano, Switzerland
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Huddart R, Hafeez S, Omar A, Alonzi R, Birtle A, Cheung KC, Choudhury A, Foroudi F, Gribble H, Henry A, Hilman S, Hindson B, Lewis R, Muthukumar D, McLaren DB, McNair H, Nikapota A, Olorunfemi A, Parikh O, Philipps L, Rimmer Y, Syndikus I, Tolentino A, Varughese M, Vassallo-Bonner C, Webster A, Griffin C, Hall E. Acute Toxicity of Hypofractionated and Conventionally Fractionated (Chemo)Radiotherapy Regimens for Bladder Cancer: An Exploratory Analysis from the RAIDER Trial. Clin Oncol (R Coll Radiol) 2023; 35:586-597. [PMID: 37225552 DOI: 10.1016/j.clon.2023.05.002] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/24/2023] [Accepted: 05/04/2023] [Indexed: 05/26/2023]
Abstract
AIMS Adding concurrent (chemo)therapy to radiotherapy improves outcomes for muscle-invasive bladder cancer patients. A recent meta-analysis showed superior invasive locoregional disease control for a hypofractionated 55 Gy in 20 fractions schedule compared with 64 Gy in 32 fractions. In the RAIDER clinical trial, patients undergoing 20 or 32 fractions of radical radiotherapy were randomised (1:1:2) to standard radiotherapy or to standard-dose or escalated-dose adaptive radiotherapy. Neoadjuvant chemotherapy and concomitant therapy were permitted. We report exploratory analyses of acute toxicity by concomitant therapy-fractionation schedule combination. MATERIALS AND METHODS Participants had unifocal bladder urothelial carcinoma staged T2-T4a N0 M0. Acute toxicity was assessed (Common Terminology Criteria for Adverse Events) weekly during radiotherapy and at 10 weeks after the start of treatment. Within each fractionation cohort, non-randomised comparisons of the proportion of patients reporting treatment emergent grade 2 or worse genitourinary, gastrointestinal or other adverse events at any point in the acute period were carried out using Fisher's exact tests. RESULTS Between September 2015 and April 2020, 345 (163 receiving 20 fractions; 182 receiving 32 fractions) patients were recruited from 46 centres. The median age was 73 years; 49% received neoadjuvant chemotherapy; 71% received concomitant therapy, with 5-fluorouracil/mitomycin C most commonly used: 44/114 (39%) receiving 20 fractions; 94/130 (72%) receiving 32 fractions. The acute grade 2+ gastrointestinal toxicity rate was higher in those receiving concomitant therapy compared with radiotherapy alone in the 20-fraction cohort [54/111 (49%) versus 7/49 (14%), P < 0.001] but not in the 32-fraction cohort (P = 0.355). Grade 2+ gastrointestinal toxicity was highest for gemcitabine, with evidence of significant differences across therapies in the 32-fraction cohort (P = 0.006), with a similar pattern but no significant differences in the 20-fraction cohort (P = 0.099). There was no evidence of differences in grade 2+ genitourinary toxicity between concomitant therapies in either the 20- or 32-fraction cohorts. CONCLUSION Grade 2+ acute adverse events are common. The toxicity profile varied by type of concomitant therapy; the gastrointestinal toxicity rate seemed to be higher in patients receiving gemcitabine.
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Affiliation(s)
- R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Radiotherapy Department, The Royal Marsden NHS Foundation Trust, London, UK.
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Radiotherapy Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Omar
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - R Alonzi
- Clinical Oncology, Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Middlesex, UK
| | - A Birtle
- Cancer Oncology, Lancashire Teaching Hospitals NHS Trust, Lancashire, UK
| | - K C Cheung
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - A Choudhury
- Translational Radiobiology, The Christie NHS Foundation Trust, Manchester, UK
| | - F Foroudi
- Radiation Oncology, Austin Health, Heidelberg, Australia
| | - H Gribble
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - A Henry
- University of Leeds and the Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - S Hilman
- Clinical Oncology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - B Hindson
- Canterbury Regional Cancer and Haematology Service, Te Whatu Ora, Waitaha Canterbury, Christchurch, New Zealand
| | - R Lewis
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - D Muthukumar
- Oncology, East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - D B McLaren
- Department of Clinical Oncology, Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK
| | - H McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Radiotherapy Department, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Nikapota
- Clinical Oncology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - A Olorunfemi
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - O Parikh
- Lancashire Teaching Hospitals NHS Trust, Burnley, UK
| | - L Philipps
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - Y Rimmer
- Department of Oncology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - I Syndikus
- Department of Radiotherapy, The Clatterbridge Cancer Centre, Liverpool, UK
| | - A Tolentino
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - M Varughese
- Department of Oncology, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
| | - C Vassallo-Bonner
- Patient Representative, The Institute of Cancer Research, London, UK
| | - A Webster
- National Radiotherapy Trials Quality Assurance Group (RTTQA), University College Hospital, London, UK
| | - C Griffin
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
| | - E Hall
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, UK
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Philipps L, Porta N, James N, Huddart R, Hafeez S, Hall E. Correlation of Clinician- and Patient-Reported Outcomes in the BC2001 Trial. Clin Oncol (R Coll Radiol) 2023; 35:331-338. [PMID: 36918330 DOI: 10.1016/j.clon.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 01/04/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
AIMS To evaluate whether there is sufficient correlation between patient-reported outcomes (PROs) and clinician-reported outcomes (CROs) in bladder cancer follow-up post-radiotherapy to streamline data collection and to reduce trial follow-up burden on patients, clinicians and trial programmes. MATERIALS AND METHODS PROs data were collected within the BC2001 trial using the Functional Assessment of Cancer Therapy specific to bladder cancer (FACT-BL) questionnaire. CROs data were collected by clinicians using Late Effects in Normal Tissues Subjective, Objective and Management (LENT/SOM). Data were collected at baseline, post-treatment, at 6 and 12 months post-randomisation and then annually to 5 years. The percentage agreement between CROs and PROs measures was evaluated at 2 and 5 years post-randomisation. Concordance was tested using the weighted Kappa statistic with 95% confidence intervals. RESULTS Correlation was evaluated between six categories of the FACT-BL and LENT/SOM scores. At 2 years the percentage agreement across these domains ranged from 45 to 78%, with the weighted Kappa statistic between 0.07 and 0.35. Results were similar in year 5 with 48-83% agreement and kappa statistics between -0.02 and 0.21. CONCLUSION The correlation between CROs and PROs in patients treated with radiotherapy for bladder cancer were generally poor. PROs appear to be more sensitive, with higher grade events reported. Further work is needed to evaluate whether PROs alone can be used to evaluate toxicity-related outcomes in randomised controlled trials.
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Affiliation(s)
- L Philipps
- Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK; The Institute of Cancer Research, London, UK.
| | - N Porta
- The Institute of Cancer Research, London, UK
| | - N James
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - R Huddart
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - S Hafeez
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - E Hall
- The Institute of Cancer Research, London, UK
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Philipps L, Porta N, James N, Huddart R, Hafeez S, Ballas L, Hall E. Differences in Quality of Life and Toxicity for Male and Female Patients following Chemo(radiotherapy) for Bladder Cancer. Clin Oncol (R Coll Radiol) 2023; 35:e336-e343. [PMID: 36906497 DOI: 10.1016/j.clon.2023.02.005] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 01/12/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023]
Abstract
AIMS BC2001, a randomised trial of treatment for muscle-invasive bladder cancer, demonstrated no difference in health-related quality of life (HRQoL) or late toxicity between patients receiving radical radiotherapy with and without chemotherapy. This secondary analysis explored sex-based differences in HRQoL and toxicity. MATERIALS AND METHODS Participants completed the Functional Assessment of Cancer Therapy Bladder (FACT-BL) HRQoL questionnaires at baseline, end of treatment, 6 months and annually until 5 years. Clinicians assessed toxicity with the Radiation Therapy Oncology Group (RTOG) and Late Effects in Normal Tissues Subjective, Objective and Management (LENT/SOM) scoring systems at the same timepoints. The impact of sex on patient-reported HRQoL was evaluated using multivariate analyses of change in FACT-BL subscores from baseline to the timepoints of interest. For clinician-reported toxicity, differences were compared by calculating the proportion of patients with grade 3-4 toxicities occurring over the follow-up period. RESULTS For both males and females, all FACT-BL subscores had a reduction in HRQoL at the end of treatment. For males, the mean bladder cancer subscale (BLCS) score remained stable through to year 5. For females, there was a decline in BLCS from baseline at years 2 and 3 with a return to baseline at year 5. At year 3, females had a statistically significant and clinically meaningful worsening of mean BLCS score (-5.18; 95% confidence interval -8.37 to -1.99), which was not seen in males (0.24; -0.76 to 1.23). RTOG toxicity was more frequent in females than males (27% versus 16%, P = 0.027). CONCLUSION Results suggest that female patients treated with radiotherapy ± chemotherapy for localised bladder cancer report worse treatment-related toxicity in post-treatment years 2 and 3 than males.
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Affiliation(s)
- L Philipps
- The Institute of Cancer Research, London, UK.
| | - N Porta
- The Institute of Cancer Research, London, UK
| | - N James
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - R Huddart
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - S Hafeez
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - L Ballas
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - E Hall
- The Institute of Cancer Research, London, UK
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Sherman E, Lee JL, Debruyne PR, Keam B, Shin SJ, Gramza A, Caro I, Amin R, Shah K, Yan Y, Huddart R, Powles T. Safety and efficacy of cobimetinib plus atezolizumab in patients with solid tumors: a phase II, open-label, multicenter, multicohort study. ESMO Open 2023; 8:100877. [PMID: 36947985 PMCID: PMC10163002 DOI: 10.1016/j.esmoop.2023.100877] [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: 09/08/2022] [Revised: 12/21/2022] [Accepted: 01/16/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Although introduction of immune checkpoint inhibitors has revolutionized the treatment of cancer, their response rates are generally low. Preclinical and early phase clinical data suggest that MEK inhibition may sensitize tumors to immune checkpoint inhibitors by upregulating tumor antigen expression, programmed death-ligand 1 (PD-L1) expression, and tumor T-cell infiltration. We evaluated the efficacy and safety of cobimetinib plus atezolizumab in patients with advanced solid tumors in the open-label, multicohort phase II COTEST study. PATIENTS AND METHODS This analysis of the COTEST trial included patients from cohorts 1-4 [1-3: anti-programmed cell death protein 1 (PD-1)/PD-L1 treatment-naive patients; 4: patients with disease progression on anti-PD-1/anti-PD-L1 treatment] who received cobimetinib 60 mg once daily for the first 21 days and intravenous infusions of atezolizumab 840 mg on days 1 and 15 of each 28-day cycle. Efficacy endpoints included objective response rate, overall survival, progression-free survival (PFS), and disease control rate. RESULTS Overall, 77 patients were enrolled in cohorts 1-4 (78% male; median age 62.8 years). Objective response rate was 20% in cohort 1 [squamous cell carcinoma of the head and neck (SCCHN)], 30% in cohort 2 (urothelial carcinoma), and 18% in cohort 3 (renal cell carcinoma); there were no responders among 20 patients in cohort 4 (SCCHN). The disease control rates in cohorts 1-4 were 50%, 40%, 24%, and 25%, respectively. The median PFS was 5.5, 3.4, 3.4, and 3.6 months in cohorts 1-4, respectively, and the median overall survival was 16.8, 18.7, 21.7, and 7.7 months, respectively. Most adverse events were of grade 1/2 and were manageable. CONCLUSIONS Cobimetinib plus atezolizumab had moderate activity in patients with anti-PD-1/PD-L1 treatment-naive SCCHN and urothelial carcinoma, and weak activity in anti-PD-1/PD-L1 treatment-naive renal cell carcinoma, and no activity in checkpoint inhibitor-treated patients.
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Affiliation(s)
- E Sherman
- Memorial Sloan Kettering Cancer Center, Head and Neck Oncology Service, New York, USA.
| | - J L Lee
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - P R Debruyne
- Kortrijk Cancer Centre, AZ Groeninge, Kortrijk, Belgium; Anglia Ruskin University, School of Life Sciences, Cambridge, UK
| | - B Keam
- Seoul National University Hospital, Department of Internal Medicine, Seoul
| | - S J Shin
- Yonsei Cancer Center, Department of Internal Medicine, Seoul, South Korea
| | - A Gramza
- Georgetown University Medical Center, Division of Hematology and Oncology, Washington DC
| | - I Caro
- Genentech, Inc, South San Francisco, USA
| | - R Amin
- Genentech, Inc, South San Francisco, USA
| | - K Shah
- Genentech, Inc, South San Francisco, USA
| | - Y Yan
- Genentech, Inc, South San Francisco, USA
| | - R Huddart
- The Royal Marsden, Royal Marsden Hospital Fulham, Urology Unit, Chelsea, London. https://twitter.com/robert_huddart
| | - T Powles
- Barts & London School of Medicine, Garrod Building, London, UK. https://twitter.com/tompowles1
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Cazzaniga W, Kinsella N, Reid A, Huddart R, Mayer E, Nicol D. Outcomes of minimally invasive retroperitoneal lymph node dissection (Primary MI- RPLND) followed by adjuvant carboplatin (AUC7) for clinical stage IIa/b seminoma. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00794-7] [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: 02/12/2023]
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Ingle M, White I, Chick J, Stankiewicz H, Mitchell A, Barnes H, Herbert T, Nill S, Oelfke U, Huddart R, Ng-Cheng-Hin B, Hafeez S, Lalondrelle S, Dunlop A, Bhide S. Understanding the Benefit of Magnetic Resonance-guided Adaptive Radiotherapy in Rectal Cancer Patients: a Single-centre Study. Clin Oncol (R Coll Radiol) 2023; 35:e135-e142. [PMID: 36336579 DOI: 10.1016/j.clon.2022.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022]
Abstract
AIMS Neoadjuvant chemoradiotherapy followed by surgery is the mainstay of treatment for patients with rectal cancer. Standard clinical target volume (CTV) to planning target volume (PTV) margins of 10 mm are used to accommodate inter- and intrafraction motion of target. Treating on magnetic resonance-integrated linear accelerators (MR-linacs) allows for online manual recontouring and adaptation (MRgART) enabling the reduction of PTV margins. The aim of this study was to investigate motion of the primary CTV (CTVA; gross tumour volume and macroscopic nodes with 10 mm expansion to cover microscopic disease) in order to develop a simultaneous integrated boost protocol for use on MR-linacs. MATERIALS AND METHODS Patients suitable for neoadjuvant chemoradiotherapy were recruited for treatment on MR-linac using a two-phase technique; only the five phase 1 fractions on MR-linac were used for analysis. Intrafraction motion of CTVA was measured between pre-treatment and post-treatment MRI scans. In MRgART, isotropically expanded pre-treatment PTV margins from 1 to 10 mm were rigidly propagated to post-treatment MRI to determine overlap with 95% of CTVA. The PTV margin was considered acceptable if overlap was >95% in 90% of fractions. To understand the benefit of MRgART, the same methodology was repeated using a reference computed tomography planning scan for pre-treatment imaging. RESULTS In total, nine patients were recruited between January 2018 and December 2020 with T3a-T4, N0-N2, M0 disease. Forty-five fractions were analysed in total. The median motion across all planes was 0 mm, demonstrating minimal intrafraction motion. A PTV margin of 3 and 5mm was found to be acceptable in 96 and 98% of fractions, respectively. When comparing to the computed tomography reference scan, the analysis found that PTV margins to 5 and 10 mm only acceptably covered 51 and 76% of fractions, respectively. CONCLUSION PTV margins can be reduced to 3-5 mm in MRgART for rectal cancer treatment on MR-linac within an simultaneous integrated boost protocol.
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Affiliation(s)
- M Ingle
- The Royal Marsden Hospital NHS Trust, London, UK; The Institute of Cancer Research, London, UK.
| | - I White
- Guys and St Thomas NHS Trust, London, UK
| | - J Chick
- The Royal Marsden Hospital NHS Trust, London, UK
| | | | - A Mitchell
- The Royal Marsden Hospital NHS Trust, London, UK
| | - H Barnes
- The Royal Marsden Hospital NHS Trust, London, UK
| | - T Herbert
- The Royal Marsden Hospital NHS Trust, London, UK
| | - S Nill
- The Institute of Cancer Research, London, UK
| | - U Oelfke
- The Institute of Cancer Research, London, UK
| | - R Huddart
- The Royal Marsden Hospital NHS Trust, London, UK; The Institute of Cancer Research, London, UK
| | | | - S Hafeez
- The Royal Marsden Hospital NHS Trust, London, UK; The Institute of Cancer Research, London, UK
| | - S Lalondrelle
- The Royal Marsden Hospital NHS Trust, London, UK; The Institute of Cancer Research, London, UK
| | - A Dunlop
- The Royal Marsden Hospital NHS Trust, London, UK
| | - S Bhide
- The Royal Marsden Hospital NHS Trust, London, UK; The Institute of Cancer Research, London, UK
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Hafeez S, Koh M, Jones K, El Ghzal A, D'Arcy J, Kumar P, Khoo V, Lalondrelle S, McDonald F, Thompson A, Scurr E, Sohaib A, Huddart R. Assessing Bladder Radiotherapy Response With Quantitative Diffusion-Weighted Magnetic Resonance Imaging Analysis. Clin Oncol (R Coll Radiol) 2022; 34:630-641. [PMID: 35534398 DOI: 10.1016/j.clon.2022.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/13/2022] [Accepted: 04/01/2022] [Indexed: 11/28/2022]
Abstract
AIMS Radiotherapy with radiosensitisation offers opportunity for cure with organ preservation in muscle-invasive bladder cancer (MIBC). Treatment response assessment and follow-up are reliant on regular endoscopic evaluation of the retained bladder. In this study we aim to determine the role of diffusion-weighted magnetic resonance imaging (DWI) and apparent diffusion coefficient (ADC) analysis to assess bladder radiotherapy response. MATERIALS AND METHODS Patients with T2-T4aN0-3M0 MIBC suitable for radical radiotherapy were recruited prospectively to an ethics approved protocol. Following transurethral resection of the bladder tumour and prior to any treatment, magnetic resonance imaging including DWI was performed on a 1.5T system using b values of 0, 100, 150, 250, 500, 750 s/mm2. DWI was repeated 3 months after completing radiotherapy. Cystoscopy and tumour site biopsy were undertaken following this. The response was dichotomised into response ( RESULTS Thirty-four patients were evaluated. Response was associated with a significant increase in ΔADC mean compared with poor response at ΔADCall (0.57 × 10-3 mm2/s versus -0.01 × 10-3 mm2/s; P < 0.0001) and ΔADCb100 (0.58 × 10-3 mm2/s versus -0.10 x 10-3 mm2/s; P = 0.007). A 48.50% increase in %ΔADCall mean was seen in response compared with a 1.37% decrease in poor response (P < 0.0001). This corresponded to a %ΔADCb100 mean increase of 50.34% in response versus a 7.36% decrease for poor response (P < 0.0001). Significant area under the curve (AUC) values predictive of radiotherapy response were identified at ΔADC and %ΔADC for ADCall and ADCb100 mean, 10th, 25th, 50th, 75th and 90th percentiles (AUC >0.9, P < 0.01). ΔADCall mean of 0.16 × 10-3 mm2/s and ΔADCb100 mean 0.12 × 10-3 mm2/s predicted radiotherapy response with sensitivity/specificity/positive predictive value/negative predictive value of 92.9%/100.0%/100.0%/75.0% and 89.3%/100.0%/100.0%/66.7%, respectively. CONCLUSIONS Quantitative DWI analysis can successfully provide non-invasive assessment of bladder radiotherapy response. Multicentre validation is required before prospective testing to inform MIBC radiotherapy follow-up schedules and decision making.
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Affiliation(s)
- S Hafeez
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | - M Koh
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - K Jones
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - A El Ghzal
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - J D'Arcy
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - P Kumar
- The Royal Marsden NHS Foundation Trust, London, UK
| | - V Khoo
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S Lalondrelle
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - F McDonald
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - A Thompson
- The Royal Marsden NHS Foundation Trust, London, UK
| | - E Scurr
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A Sohaib
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R Huddart
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
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Abdel-Aty H, Warren-Oseni K, Bagherzadeh-Akbari S, Hansen VN, Jones K, Harris V, Tan MP, Mcquaid D, McNair HA, Huddart R, Dunlop A, Hafeez S. Mapping Local Failure Following Bladder Radiotherapy According to Dose. Clin Oncol (R Coll Radiol) 2022; 34:e421-e429. [PMID: 35691760 PMCID: PMC9515812 DOI: 10.1016/j.clon.2022.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/06/2022] [Accepted: 05/05/2022] [Indexed: 11/27/2022]
Abstract
AIMS To determine the relationship between local relapse following radical radiotherapy for muscle-invasive bladder cancer (MIBC) and radiation dose. MATERIALS AND METHODS Patients with T2-4N0-3M0 MIBC were recruited to a phase II study assessing the feasibility of intensity-modulated radiotherapy to the bladder and pelvic lymph nodes. Patients were planned to receive 64 Gy/32 fractions to the bladder tumour, 60 Gy/32 fractions to the involved pelvic nodes and 52 Gy/32 fractions to the uninvolved bladder and pelvic nodes. Pre-treatment set-up was informed by cone-beam CT. For patients who experienced local relapse, cystoscopy and imaging (CT/MRI) was used to reconstruct the relapse gross tumour volume (GTVrelapse) on the original planning CT . GTVrelapse D98% and D95% was determined by co-registering the relapse image to the planning CT utilising deformable image registration (DIR) and rigid image registration (RIR). Failure was classified into five types based on spatial and dosimetric criteria as follows: A (central high-dose failure), B (peripheral high-dose failure), C (central elective dose failure), D (peripheral elective dose failure) and E (extraneous dose failure). RESULTS Between June 2009 and November 2012, 38 patients were recruited. Following treatment, 18/38 (47%) patients experienced local relapse within the bladder. The median time to local relapse was 9.0 months (95% confidence interval 6.3-11.7). Seventeen of 18 patients were evaluable based on the availability of cross-sectional relapse imaging. A significant difference between DIR and RIR methods was seen. With the DIR approach, the median GTVrelapse D98% and D95% was 97% and 98% of prescribed dose, respectively. Eleven of 17 (65%) patients experienced type A failure and 6/17 (35%) patients type B failure. No patients had type C, D or E failure. MIBC failure occurred in 10/17 (59%) relapsed patients; of those, 7/11 (64%) had type A failure and 3/6 (50%) had type B failure. Non-MIBC failure occurred in 7/17 (41%) patients; 4/11 (36%) with type A failure and 3/6 (50%) with type B failure. CONCLUSION Relapse following radiotherapy occurred within close proximity to the original bladder tumour volume and within the planned high-dose region, suggesting possible biological causes for failure. We advise caution when considering margin reduction for future reduced high-dose radiation volume or partial bladder radiotherapy protocols.
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Affiliation(s)
- H Abdel-Aty
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - K Warren-Oseni
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S Bagherzadeh-Akbari
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - V N Hansen
- Department of Oncology, Section of Radiotherapy, Rigshospitalet, Copenhagen, Denmark
| | - K Jones
- Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - V Harris
- Department of Radiotherapy, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - M P Tan
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - D Mcquaid
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - H A McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
| | - A Dunlop
- Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
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10
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Alexander SE, McNair HA, Oelfke U, Huddart R, Murray J, Pathmanathan A, Patel P, Sritharan K, van As N, Tree AC. Prostate Volume Changes during Extreme and Moderately Hypofractionated Magnetic Resonance Image-guided Radiotherapy. Clin Oncol (R Coll Radiol) 2022; 34:e383-e391. [PMID: 35469741 DOI: 10.1016/j.clon.2022.03.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/04/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
AIMS Prostate morphological changes during external beam radiotherapy are poorly understood. Excellent soft-tissue visualisation offered by magnetic resonance image-guided radiotherapy (MRIgRT) provides an opportunity to better understand such changes. The aim of this study was to quantify prostate volume and dimension changes occurring during extreme and moderately hypofractionated schedules. MATERIALS AND METHODS Forty prostate cancer patients treated on the Unity 1.5 Tesla magnetic resonance linear accelerator (MRL) were retrospectively reviewed. The cohort comprised patients treated with 36.25 Gy in five fractions (n = 20) and 60 Gy in 20 fractions (n = 20). The volume of the delineated prostates on reference planning computed tomography (fused with MRI) and daily T2-weighted 2-min session images acquired on Unity were charted. Forty planning computed tomography and 500 MRL prostate volumes were evaluated. The mean absolute and relative change in prostate volume during radiotherapy was compared using a paired t-test (P value <0.01 considered significant to control for multiple comparisons). The maximum dimension of the delineated prostate was measured in three isocentric planes. RESULTS Significant prostate volume changes, relative to MRL imaging fraction 1 (MRL#1), were seen at all time points for the five-fraction group. The peak mean relative volume increase was 21% (P < 0.001), occurring at MRL#3 and MRL#4 after 14.5 and 21.75 Gy, respectively. Prostate expansion was greatest in the superior-inferior direction; the peak mean maximal extension was 5.9 mm. The maximal extension in the left-right and anterior-posterior directions measured 1.1 and 2.2 mm, respectively. For the 20-fraction group, prostate volume increased relative to MRL#1, for all treatment time points. The mean relative volume increase was 11% (P < 0.001) at MRL#5 after 12 Gy, it then fluctuated between 8 and 13%. From MRL#5 to MRL#20, the volume increase was significant (P < 0.01) for 12 of 16 time points calculated. The peak mean maximal extension in the superior-inferior direction was 3.1 mm. The maximal extension in the left-right and anterior-posterior directions measured 1.7 and 3.7 mm, respectively. CONCLUSION Significant prostate volume and dimension changes occur during extreme and moderately hypofractionated radiotherapy. The extent of change was greater during extreme hypofractionation. MRIgRT offers the opportunity to reveal, quantify and correct for this deformation.
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Affiliation(s)
- S E Alexander
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK.
| | - H A McNair
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - U Oelfke
- The Joint Department of Physics, The Royal Marsden Hospital and the Institute of Cancer Research, London, UK
| | - R Huddart
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - J Murray
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - A Pathmanathan
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - P Patel
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - K Sritharan
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - N van As
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - A C Tree
- The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
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11
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Mitchell A, Ingle M, Smith G, Chick J, Diamantopoulos S, Goodwin E, Herbert T, Huddart R, McNair H, Oelfke U, Nill S, Dunlop A, Hafeez S. Feasibility of tumour-focused adaptive radiotherapy for bladder cancer on the MR-linac. Clin Transl Radiat Oncol 2022; 35:27-32. [PMID: 35571274 PMCID: PMC9092067 DOI: 10.1016/j.ctro.2022.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 11/23/2022] Open
Abstract
Bladder tumour-focused magnetic resonance image-guided adaptive radiotherapy using a 1.5 Tesla MR-linac is feasible. A full online workflow adapting to anatomy at each fraction is achievable in approximately 30 min. Intra-fraction bladder filling did not compromise target coverage with the class solution employed.
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Affiliation(s)
- A. Mitchell
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - M. Ingle
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - G. Smith
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J. Chick
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Diamantopoulos
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - E. Goodwin
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - T. Herbert
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R. Huddart
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - H. McNair
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U. Oelfke
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Nill
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - A. Dunlop
- The Joint Department of Physics, The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Hafeez
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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12
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Wilkins A, Hall E, Lewis R, Gribble H, Melcher A, Huddart R. RE-ARMing the Immune Response to Bladder Cancer with Radiotherapy. Clin Oncol (R Coll Radiol) 2022; 34:421-425. [PMID: 34998656 DOI: 10.1016/j.clon.2021.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/07/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022]
Affiliation(s)
- A Wilkins
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Royal Marsden Hospital, London, UK.
| | - E Hall
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - R Lewis
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - H Gribble
- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - A Melcher
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Royal Marsden Hospital, London, UK
| | - R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Royal Marsden Hospital, London, UK
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13
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Ingle M, Blackledge M, Wetscherek A, Huddart R, Lalondrelle S, Bhide S, Hafeez S. PO-1749 Evaluating diffusion weighted signal change on the MR-Linac during bladder cancer radiotherapy. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03713-6] [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: 10/18/2022]
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14
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Alexander S, Chick J, Herbert T, Huddart R, Ingle M, Mitchell A, Nill S, Oelfke U, Dunlop A, Hafeez S. MO-0312 Systematic multi-disciplinary sequence evaluation for integration into the MR-linac workflow. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)02344-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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15
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Powles T, Bellmunt J, Comperat E, De Santis M, Huddart R, Loriot Y, Necchi A, Valderrama BP, Ravaud A, Shariat SF, Szabados B, van der Heijden MS, Gillessen S. Bladder cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2022; 33:244-258. [PMID: 34861372 DOI: 10.1016/j.annonc.2021.11.012] [Citation(s) in RCA: 179] [Impact Index Per Article: 89.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- T Powles
- Barts Cancer Centre, Barts Health NHS Trust, Queen Mary University of London, London, UK
| | - J Bellmunt
- Beth Israel Deaconess Medical Centre-IMIM Lab, Harvard Medical School, Boston, USA
| | - E Comperat
- L'Assistance Publique-Hôpitaux de Paris, Hôpital Tenon, Paris, France
| | - M De Santis
- Department of Urology, Charité Universitätsmedizin, Berlin, Germany
| | - R Huddart
- Royal Marsden Hospital, Institute of Cancer Research, London, UK
| | - Y Loriot
- Département de Médecine Oncologique, Université Paris-Saclay and Gustave Roussy, Villejuif, France
| | - A Necchi
- Vita-Salute San Raffaele University, Department of Medical Oncology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - A Ravaud
- Hôpital Saint-André CHU, Bordeaux, France; Department of Medical Oncology, Bordeaux University Hospital, Bordeaux, France
| | - S F Shariat
- Department of Urology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - B Szabados
- Barts Cancer Centre, Barts Health NHS Trust, Queen Mary University of London, London, UK; Department of Urology, University College London Hospital, London, UK
| | - M S van der Heijden
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - S Gillessen
- Oncology Institute of Southern Switzerland (IOSI), EOC, Lugano, Switzerland
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16
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Cazzaniga W, Pearce A, Tanabalan C, Rajan P, Kinsella N, Reid A, Huddart R, Nicol D. Medium to long term health-related quality of life and treatment-related side-effects in patients treated with a single dose of adjuvant carboplatin for high-risk seminoma – results from a pilot study. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00648-0] [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: 11/04/2022]
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17
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Cazzaniga W, Pearce A, Tanabalan C, Rajan P, Kinsella N, Reid A, Huddart R, Nicol D. Health-related quality of life and treatment-related side-effects in patients who have been in remission from testicular cancer for 12-24 months. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00649-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Portner R, Bajaj A, Elumalai T, Huddart R, Murthy V, Nightingale H, Patel K, Sargos P, Song Y, Hoskin P, Choudhury A. A practical approach to bladder preservation with hypofractionated radiotherapy for localised muscle-invasive bladder cancer. Clin Transl Radiat Oncol 2021; 31:1-7. [PMID: 34466667 PMCID: PMC8385113 DOI: 10.1016/j.ctro.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
Bladder preservation with trimodality treatment (TMT) is an alternative strategy to radical cystectomy (RC) for the management of localised muscle invasive bladder cancer (MIBC). TMT comprises of transurethral resection of the bladder tumour (TURBT) followed by radiotherapy with concurrent radiosensitisation. TMT studies have shown neo-adjuvant chemotherapy with cisplatin-based regimens is often given to further improve survival outcomes. A hypofractionated radiotherapy regimen is preferable due to its non-inferiority in local control and late toxicities. Radiosensitisation can comprise concurrent chemotherapy (with gemcitabine, cisplatin or combination fluorouracil and mitomycin), CON (carbogen and nicotinomide) or hyperthermic treatment. Radiotherapy techniques are continuously improving and becoming more personalised. As the bladder is a mobile structure subject to volumetric changes from filling, an adaptive approach can optimise bladder coverage and reduce dose to normal tissue. Adaptive radiotherapy (ART) is an evolving field that aims to overcome this. Improved knowledge of tumour biology and advances in imaging techniques aims to further optimise and personalise treatment.
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Affiliation(s)
- R. Portner
- The Christie NHS Foundation Trust, Manchester, UK
| | - A. Bajaj
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
| | - T. Elumalai
- The Christie NHS Foundation Trust, Manchester, UK
| | - R. Huddart
- Royal Marsden NHS Foundation Trust, London, UK
- Institute of Cancer Research, UK
| | - V. Murthy
- Department of Radiation Oncology, ACTREC and Tata Memorial Hospital, Homi Bhabha National University, Mumbai, India
| | | | - K. Patel
- The Christie NHS Foundation Trust, Manchester, UK
| | - P. Sargos
- Department of Radiation Oncology, Institut Bergonié, F-33076 Bordeaux Cedex, France
| | - Y. Song
- The Christie NHS Foundation Trust, Manchester, UK
| | - P. Hoskin
- Mount Vernon Cancer Centre, Northwood, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
| | - A. Choudhury
- The Christie NHS Foundation Trust, Manchester, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
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19
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Huddart R, Hafeez S, Omar A, Choudhury A, Birtle A, Syndikus I, Hindson B, Varughese M, Henry A, McLaren D, Foroud F, Webster A, McNair H, Tolentino A, Webster L, Gribble H, Philipps L, Nikapota A, Parikh O, Alonzi R, Mahmood R, Hilman S, Rimmer Y, Griffin C, Hall E. OC-0513 Acute toxicity of hypo- and conventionally-fractionated radiosensitised bladder radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06939-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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20
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Alexander S, Lawes R, Adair Smith G, Barnes H, Hanson I, Herbert T, Huddart R, Lacey C, McNair H, Mitchell A, Nill S, Ockwell C, Oelfke U, Taylor H, Wetscherek A, Aitken K, Hunt A. PH-0164 Abdominal compression; development of a non-gated pancreas MRIgRT workflow. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07256-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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21
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Webster A, Hafeez S, Lewis R, Griffins C, Warren-Oseni K, Patel E, Hansen VN, Hall E, Huddart R, Miles E, McNair HA. The Development of Therapeutic Radiographers in Imaging and Adaptive Radiotherapy Through Clinical Trial Quality Assurance. Clin Oncol (R Coll Radiol) 2021; 33:461-467. [PMID: 33766503 DOI: 10.1016/j.clon.2021.02.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/29/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023]
Abstract
AIMS Adaptive radiotherapy (ART) is an emerging advanced treatment option for bladder cancer patients. Therapeutic radiographers (RTTs) are central to the successful delivery of this treatment. The purpose of this work was to evaluate the image-guided radiotherapy (IGRT) and ART experience of RTTs before participating in the RAIDER trial. A plan of the day (PoD) quality assurance programme was then implemented. Finally, the post-trial experience of RTTs was evaluated, together with the impact of trial quality assurance participation on their routine practice. MATERIALS AND METHODS A pre-trial questionnaire to assess the experience of the RTT staff group in IGRT and ART in bladder cancer was sent to each centre. Responses were grouped according to experience. The PoD quality assurance programme was implemented, and the RAIDER trial commenced. During stage 1 of the trial, RTTs reported difficulties in delivering PoD and the quality assurance programme was updated accordingly. A follow-up questionnaire was sent assessing experience in IGRT and ART post-trial. Any changes in routine practice were also recorded. RESULTS The experience of RTTs in IGRT and ART pre-trial varied. For centres deemed to have RTTs with more experience, the initial PoD quality assurance programme was streamlined. For RTTs without ART experience, the full quality assurance programme was implemented, of which 508 RTTs completed. The quality assurance programme was updated (as the trial recruited) and it was mandated that at least one representative RTT (regardless of pre-trial experience) participated in the update in real-time. The purpose of the updated quality assurance programme was to provide further support to RTTs in delivering a complex treatment. Engagement with the updated quality assurance programme was high, with RTTs in 24/33 centres participating in the real-time online workshop. All 33 UK centres reported all RTTs reviewed the updated training offline. Post-trial, the RTTs' experience in IGRT and ART was increased. CONCLUSION Overall, 508 RTTs undertook the PoD quality assurance programme. There was a high engagement of RTTs in the PoD quality assurance programme and trial. RTTs increased their experience in IGRT and ART and subsequently updated their practice for bladder cancer and other treatment sites.
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Affiliation(s)
- A Webster
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, London, UK.
| | - S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - R Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - C Griffins
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - E Patel
- University College Hospital, London, UK
| | - V N Hansen
- Odense University Hospital, Odense, Denmark
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
| | - E Miles
- National Radiotherapy Trials Quality Assurance Group, Mount Vernon Cancer Centre, London, UK
| | - H A McNair
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
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22
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Hafeez S, Lewis R, Hall E, Huddart R. Advancing Radiotherapy for Bladder Cancer: Randomised Phase II Trial of Adaptive Image-guided Standard or Dose-escalated Tumour Boost Radiotherapy (RAIDER). Clin Oncol (R Coll Radiol) 2021; 33:e251-e256. [PMID: 33766502 DOI: 10.1016/j.clon.2021.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/18/2021] [Accepted: 02/19/2021] [Indexed: 11/21/2022]
Affiliation(s)
- S Hafeez
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK.
| | - R Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UKS
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UKS
| | - R Huddart
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; Department of Radiotherapy, The Royal Marsden NHS Foundation Trust, London, UK
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23
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Hafeez S, Lewis R, Griffin C, Hall E, Huddart R. Failing to Close the Gap Between Evidence and Clinical Practice in Radical Bladder Cancer Radiotherapy. Clin Oncol (R Coll Radiol) 2021; 33:46-49. [PMID: 32762980 DOI: 10.1016/j.clon.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/12/2020] [Accepted: 07/01/2020] [Indexed: 12/18/2022]
Affiliation(s)
- S Hafeez
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK.
| | - R Lewis
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - C Griffin
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, London, UK
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24
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Hunt A, Hanson I, Dunlop A, Bower L, Barnes H, Chick J, Herbert T, Lawes R, McNair H, Mitchell A, Mohajer J, Morgan T, Smith G, Nill S, Oelfke U, Huddart R, Hafeez S. OC-0469: MR-guided online adaptive radiotherapy for muscle invasive bladder cancer: First UK experience. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00491-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Tan M, Nyamundanda G, Fontana E, Hazell S, Ragulan C, Jones K, Abah B, Jacobs T, Bowes J, Sadanandam A, Huddart R. PO-1207: Exploring molecular subtype as a biomarker of radiation response in muscle-invasive bladder cancer. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hunt A, Hanson I, Dunlop A, Barnes H, Bower L, Chick J, Cruickshank C, Hall E, Herbert T, Lawes R, McQuaid D, McNair H, Mitchell A, Mohajer J, Morgan T, Oelfke U, Smith G, Nill S, Huddart R, Hafeez S. Feasibility of magnetic resonance guided radiotherapy for the treatment of bladder cancer. Clin Transl Radiat Oncol 2020; 25:46-51. [PMID: 33015380 PMCID: PMC7522378 DOI: 10.1016/j.ctro.2020.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/03/2020] [Accepted: 09/06/2020] [Indexed: 12/15/2022] Open
Abstract
Whole bladder magnetic resonance image-guided radiotherapy using the 1.5 Telsa MR-linac is feasible. Full online adaptive planning workflow based on the anatomy seen at each fraction was performed. This was delivered within 45 min. Intra-fraction bladder filling did not compromise target coverage. Patients reported acceptable tolerance of treatment.
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Affiliation(s)
- A. Hunt
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - I. Hanson
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - A. Dunlop
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - H. Barnes
- The Royal Marsden NHS Foundation Trust, London, UK
| | - L. Bower
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - J. Chick
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - C. Cruickshank
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - E. Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - T. Herbert
- The Royal Marsden NHS Foundation Trust, London, UK
| | - R. Lawes
- The Royal Marsden NHS Foundation Trust, London, UK
| | - D. McQuaid
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - H. McNair
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - A. Mitchell
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - J. Mohajer
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - T. Morgan
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - U. Oelfke
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - G. Smith
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Nill
- The Joint Department of Physics at The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, UK
| | - R. Huddart
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - S. Hafeez
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
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Webster A, McNair H, Hansen V, Hafeez S, Lewis R, Griffin C, Hall E, Huddart R. OC-0590: Multicentre dual-trial implementation of plan of the day (PoD) adaptive radiotherapy: lessons learnt. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00612-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Patel K, Choudhury A, Hoskin P, Varughese M, James N, Huddart R, Birtle A. Clinical Guidance for the Management of Patients with Urothelial Cancers During the COVID-19 Pandemic - Rapid Review. Clin Oncol (R Coll Radiol) 2020; 32:347-353. [PMID: 32389318 PMCID: PMC7180390 DOI: 10.1016/j.clon.2020.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 12/12/2022]
Abstract
The current COVID-19 pandemic presents a substantial obstacle to cancer patient care. Data from China as well as risk models suppose that cancer patients, particularly those on active, immunosuppressive therapies are at higher risks of severe infection from the illness. In addition, staff illness and restructuring of services to deal with the crisis will inevitably place treatment capacities under significant strain. These guidelines aim to expand on those provided by NHS England regarding cancer care during the coronavirus pandemic by examining the known literature and provide guidance in managing patients with urothelial and rarer urinary tract cancers. In particular, they address the estimated risk and benefits of standard treatments and consider the alternatives in the current situation. As a result, it is recommended that this guidance will help form a framework for shared decision making with patients. Moreover, they do not advise a one-size-fits-all approach but recommend continual assessment of the situation with discussion within and between centres.
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Affiliation(s)
- K Patel
- The Rosemere Cancer Centre, Preston, Lancashire Teaching Hospitals, NHS Foundation, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - A Choudhury
- Division of Cancer Sciences, University of Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK
| | - P Hoskin
- Mount Vernon Cancer Centre, Northwood, UK; Division of Cancer Sciences, University of Manchester, UK
| | - M Varughese
- The Beacon Centre, Musgrove Park Hospital, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - N James
- Institute of Cancer Research, London, UK; Royal Marsden Hospital, London, UK
| | - R Huddart
- Institute of Cancer Research, London, UK; Royal Marsden Hospital, London, UK
| | - A Birtle
- The Rosemere Cancer Centre, Preston, Lancashire Teaching Hospitals, NHS Foundation, UK; Division of Cancer Science, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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Loriot Y, Sternberg C, Castellano Gauna D, Dumez H, Huddart R, Vianna K, Alonso Gordoa T, Skoneczna I, Fay A, Sacco C, Nole F, Massari F, Brasiuniene B, Maroto P, Oosting S, Fear S, Di Nucci F, De Ducla S, Choy E. Safety and efficacy of atezolizumab (atezo) in patients (pts) with autoimmune disease (AID): Subgroup analysis of the SAUL study in locally advanced/metastatic urinary tract carcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz249.021] [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: 11/14/2022] Open
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Pathmanathan A, Bower L, Creasey H, Dunlop A, Hall E, Hanson I, Herbert T, Lawes R, McQuaid D, McNair H, Mitchell A, Smith G, Huddart R, Oelfke U, Nill S, Tree A. EP-1566 MR-guided online adaptive radiotherapy: First experience in the UK. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31986-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Chan K, Warren-Oseni K, Abdel-Aty H, Dunlop A, McQuaid D, Koh M, Sohaib A, Huddart R, Hafeez S. PO-0864 Normal tissue sparing with diffusion weighted MRI informed tumour boost in bladder radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31284-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hunt A, Chan A, Delacroix L, Dysager L, Edwards A, Frew J, Gordon A, Henry A, Huddart R, Koh M, Kong V, Nagar Y, Parikh O, Pearson R, Rimmer Y, Schytte T, Serra M, Sidhom M, Sohaib A, Syndikus I, Tan A, Treece S, Varughese M, Hafeez S. EP-1589 Establishing international variation in target delineation using MRI for bladder radiotherapy. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32009-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Smith GA, Herbert T, Lawes R, Creasey H, Dunlop A, Mitchell A, Pathmanathan A, Bower L, Hanson I, McQuaid D, Huddart R, Oelfke U, Nill S, Tree A, McNair H. EP-2173 Bladder filling in patients undergoing prostate radiotherapy on the MR-linac. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)32593-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Pathmanathan A, Kieselmann J, Brand D, Christodouleas J, Nill S, Huddart R. Varying Atlas Numbers and Imaging Modality for Auto-contouring in Prostate Radiotherapy. Clin Oncol (R Coll Radiol) 2019. [DOI: 10.1016/j.clon.2018.11.015] [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: 10/27/2022]
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Tree AC, Huddart R, Choudhury A. Magnetic Resonance-guided Radiotherapy - Can We Justify More Expensive Technology? Clin Oncol (R Coll Radiol) 2018; 30:677-679. [PMID: 30217480 DOI: 10.1016/j.clon.2018.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/05/2018] [Accepted: 06/10/2018] [Indexed: 11/18/2022]
Affiliation(s)
- A C Tree
- Royal Marsden NHS Foundation Trust, Institute of Cancer Research, London, UK
| | - R Huddart
- Royal Marsden NHS Foundation Trust, Institute of Cancer Research, London, UK
| | - A Choudhury
- Manchester Cancer Research Centre, Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK; Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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Kumar R, Walder D, Pejanaute A, Gunapala R, Bhosle J, Yousef N, Popat S, McDonald F, Locke I, Harrington K, Tree A, Lalondrelle S, Huddart R, O’Brien M, Ahmed M. Phase I dose escalation of pembrolizumab given concurrently with palliative thoracic radiotherapy (RT) for NSCLC. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Crabb S, Danson S, Dunkley D, Kalevras M, Whitehead A, Hill S, Fines K, Robb C, Bennett J, Ksiazek L, Brown S, Evans L, Serra M, Jones K, McDowell C, Catto J, Huddart R, Griffths G. SPIRE: A phase Ib/ randomised IIa open label clinical trial combining guadecitabine with cisplatin and gemcitabine chemotherapy for solid malignancies including bladder cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy279.412] [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
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39
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Pathmanathan A, Schmidt M, Brand D, Delacroix L, Eccles C, Gordon A, Herbert T, McNair H, Van As N, Huddart R, Tree A. EP-1613: Comparison of prostate delineation on multi-modality imaging for MR-guided radiotherapy. Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)31922-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Huddart R, Henry A, Staffurth J, Syndikus I, Mitra A, Venkitraman R, McNair H, Khoo V, Lewis E, Vassallo-Bonner C, Baker A, Horan G, Parsons E, Moinuddin S, Hansen V, Birtle A, Hafeez S, Goubar A, Hall E. OC-0058: Clinical outcomes of the first rct of adaptive radiotherapy in bladder cancer (HYBRID CRUK/12/055). Radiother Oncol 2018. [DOI: 10.1016/s0167-8140(18)30368-2] [Citation(s) in RCA: 3] [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] [Indexed: 11/16/2022]
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41
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Venkitaraman R, Thomas K, Grace P, Dearnaley D, Horwich A, Huddart R, Parker C. Baseline Urinary Phytoestrogen Levels and the Natural History of Untreated, Localised Prostate Cancer in a British Population. Int J Biol Markers 2018; 23:192-7. [DOI: 10.1177/172460080802300310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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
Aim To determine whether urinary concentrations of phytoestrogens are associated with the rate of disease progression in men with untreated, localised prostate cancer. Patients and methods Patients with untreated, localised prostatic adenocarcinoma on a prospective clinical study of active surveillance had urine samples collected at baseline. Patients underwent monitoring with serial PSA levels and repeat octant prostate biopsies. Disease progression was defined as either adverse histology on repeat biopsy (primary Gleason grade ≥4, or >50% positive cores) or radical treatment for PSA velocity >1 ng/mL/year. Time to disease progression was analysed with respect to baseline urinary levels of genistein, enterolactone, daidzein and equol, assayed using liquid chromatography/tandem mass spectrometry. Results 191 patients were evaluable, with a median follow-up of 2.5 years. 71 patients experienced disease progression. No significant association was seen between time to disease progression and baseline urinary levels of daidzein (p=0.85), genistein (p=0.81), enterolactone (p=0.085) or equol (p=0.33). No significant association was seen between adverse histology on repeat biopsy and urinary levels of either daidzein (p=0.85), genistein (p=0.58), enterolactone (p=0.88) or equol (p=0.71). There was no significant correlation between PSA velocity and urinary levels of daidzein (p=0.90), genistein (p=0.98), enterolactone (p=0.10) or equol (p=0.60). Conclusion These data do not support the hypothesis that phytoestrogens prevent disease progression in men with localised prostate cancer.
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Affiliation(s)
- R. Venkitaraman
- Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research, Sutton, Surrey
| | - K. Thomas
- Computing Department, Royal Marsden NHS Foundation Trust, Sutton, Surrey
| | - P. Grace
- HFL limited, Fordham, Cambridge - UK
| | - D. Dearnaley
- Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research, Sutton, Surrey
| | - A. Horwich
- Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research, Sutton, Surrey
| | - R. Huddart
- Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research, Sutton, Surrey
| | - C.C. Parker
- Academic Unit of Radiotherapy and Oncology, Institute of Cancer Research, Sutton, Surrey
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Patrikidou A, Uccello M, Tree A, Parker C, Attard G, Eeles R, Khoo V, van As N, Huddart R, Dearnaley D, Reid A. Upfront Docetaxel in the Post-STAMPEDE World: Lessons from an Early Evaluation of Non-trial Usage in Hormone-Sensitive Prostate Cancer. Clin Oncol (R Coll Radiol) 2017; 29:e174-e175. [PMID: 28652092 DOI: 10.1016/j.clon.2017.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 05/24/2017] [Accepted: 06/06/2017] [Indexed: 10/19/2022]
Affiliation(s)
- A Patrikidou
- Academic Uro-Oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - M Uccello
- Academic Uro-Oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - A Tree
- Academic Uro-Oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - C Parker
- Academic Uro-Oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - G Attard
- Academic Uro-Oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - R Eeles
- The Institute of Cancer Research, London, UK; Urology Oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - V Khoo
- The Institute of Cancer Research, London, UK; Urology Oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - N van As
- Urology Oncology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - R Huddart
- Academic Uro-Oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - D Dearnaley
- Academic Uro-Oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK; The Institute of Cancer Research, London, UK
| | - A Reid
- Academic Uro-Oncology Unit, The Royal Marsden NHS Foundation Trust, Sutton, UK
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Trainor S, Choudhury A, Huddart R, Kiltie AE, Kockelbergh R, Turner W, Birtle A, Crabb SJ. The National Institute for Health and Care Excellence (NICE) Guidance on Bladder Cancer; a Step in the Right Direction? Clin Oncol (R Coll Radiol) 2017; 29:344-347. [PMID: 28190637 DOI: 10.1016/j.clon.2017.01.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/19/2017] [Indexed: 01/08/2023]
Affiliation(s)
- S Trainor
- Department of Medical Oncology, St James's Institute of Oncology, Leeds, UK
| | - A Choudhury
- The Christie NHS Foundation Trust and Manchester Cancer Research Centre, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
| | - R Huddart
- Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, UK
| | - A E Kiltie
- CRUK/MRC Oxford Institute for Radiation Oncology, University of Oxford, Oxford, UK
| | - R Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - W Turner
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - A Birtle
- Rosemere Cancer Centre, Royal Preston Hospital, Preston, UK
| | - S J Crabb
- Cancer Sciences Unit, University of Southampton, Southampton, UK.
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Shamash J, Sarker SJ, Huddart R, Harland S, Joffe J, Mazhar D, Birtle A, White J, Chowdhury K, Wilson P, Marshall M, Vinnicombe S. A randomized phase III study of 72 h infusional versus bolus bleomycin in BEP (bleomycin, etoposide and cisplatin) chemotherapy to treat IGCCCG good prognosis metastatic germ cell tumours (TE-3). Ann Oncol 2017; 28:1333-1338. [DOI: 10.1093/annonc/mdx071] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Parsons E, Megias D, Baker A, Hafeez S, Hall E, McNair H, Tsang Y, Huddart R. OC-0351: Analysis of concordance in multicentre adaptive bladder trials quality assurance. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30793-4] [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: 10/19/2022]
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Eccles C, McNair H, McQuaid D, Warren-Oseni K, Hansen V, Sohaib A, Koh M, Huddart R, Hafeez S. PV-0461: Integrating diagnostic MRI in radical bladder cancer radiotherapy: Challenges in image registration. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)30902-7] [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: 12/01/2022]
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Hafeez S, Warren-Oseni K, McNair H, Hansen V, Huddart R. EP-1370: Simultaneous integrated tumour boost planning in bladder cancer: a comparison of strategies. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31805-4] [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: 10/19/2022]
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Pathmanathan A, Mitchell A, Thomas K, Henderson D, Nill S, Oelfke U, Huddart R, Van As N, Tree A. PO-0828: Stereotactic body radiotherapy (SBRT) for localised prostate cancer on the MR-Linac. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31265-3] [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: 10/19/2022]
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Khan A, Thomas K, Truelove L, Ferreira M, Gulliford S, McNair H, Parker C, Huddart R, Dearnaley D. EP-1363: Clinical efficacy of a dose escalated and hypofractionated pelvic IMRT study in prostate cancer. Radiother Oncol 2017. [DOI: 10.1016/s0167-8140(17)31798-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]
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Huddart R, Hall E, Miranda M, Crundwell M, Jenkins P, Rawlings C, Tremlett J, Hendron C, Lewis R, Porta N, Hussain S, James N. Quality of life (QL) of muscle invasive bladder cancer (MIBC) patients (pts) receiving radiotherapy (RT) +/- chemotherapy (CT) in the BC2001 trial (CRUK/01/004). Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30676-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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