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Karpes JB, Lansom JD, Alshahrani M, Parikh R, Shamavonian R, Alzahrani NA, Liauw W, Morris DL. Repeat cytoreductive surgery with or without intraperitoneal chemotherapy for recurrent epithelial appendiceal neoplasms. BJS Open 2020; 4:478-485. [PMID: 32020757 PMCID: PMC7260401 DOI: 10.1002/bjs5.50262] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/19/2019] [Indexed: 12/30/2022] Open
Abstract
Background With recurrence rates after primary cytoreductive surgery (CRS) in excess of 50 per cent, repeat CRS is being performed increasingly, but survival outcomes have not been reported widely. This study examined the outcomes following repeat CRS for appendiceal cancer with peritoneal surface malignancy (PSM), and evaluated its feasibility and safety. Methods A retrospective cohort of patients who had surgery between 1996 and 2018 were analysed. Patients who underwent a single CRS procedure with or without heated intraperitoneal chemotherapy (HIPEC) were compared with those who had multiple procedures with or without HIPEC. Perioperative morbidity and survival outcomes were analysed. Results Some 462 patients were reviewed, 102 of whom had repeat procedures. For high‐grade tumours, patients who had a single CRS procedure had significantly reduced overall survival (OS) compared with those who had repeat CRS (55·6 versus 90·7 months respectively; P = 0·016). For low‐grade tumours, there was no difference in OS (P = 0·153). When patients who had a single procedure were compared with those who had multiple procedures, there was no significant difference in major morbidity (P = 0·441) or in‐hospital mortality (P = 0·080). For multiple procedures, no differences were found in major morbidity (P = 0·262) or in‐hospital mortality (P = 0·502) when the first procedure was compared with the second. For low‐grade cancers, the peritoneal carcinomatosis index was a significant prognostic factor for OS (hazard ratio (HR) 1·11, 95 per cent c.i. 1·05 to 1·17; P < 0·001), whereas for high‐grade cancers repeat CRS (HR 0·57, 0·33 to 0·95; P = 0·033), complete cytoreduction score (HR 1·55, 1·01 to 2·40; P = 0·046) and presence of signet ring cells (HR 2·77, 1·78 to 4·30; P < 0·001) were all significant indicators of long‐term survival. Conclusion In selected patients presenting with PSM from epithelial appendiceal neoplasms, repeat CRS performed in high‐volume centres could provide survival benefits.
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Affiliation(s)
- J B Karpes
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - J D Lansom
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia
| | - M Alshahrani
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia
| | - R Parikh
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia
| | - R Shamavonian
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - N A Alzahrani
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - W Liauw
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,Cancer Care Clinic, St George Hospital, Sydney, New South Wales, Australia
| | - D L Morris
- Liver and Peritonectomy Unit, St George Hospital, Sydney, New South Wales, Australia.,St George and Sutherland Clinical School, University of New South Wales, Sydney, New South Wales, Australia
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Valle S, Akhter J, Glenn D, Power M, Lodh S, Liauw W. 03:00 PM Abstract No. 393 A phase I/II study of direct injection of Bromelain and Acetylcysteine in patients with inoperable mucinous peritoneal tumours. J Vasc Interv Radiol 2019. [DOI: 10.1016/j.jvir.2018.12.469] [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] Open
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Michael M, Liauw W, McLachlan SA, Link E, Matera A, Thompson M, Jefford M, Hicks R, Cullinane C, Campbell I, Beale P, Karapetis C, Price T, Burge M. Hepatic functional imaging and genomics to predict irinotecan pharmacokinetics and pharmacodynamics: The PREDICT IR study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx367.038] [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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Leung V, Huo YR, Liauw W, Morris DL. Oxaliplatin versus Mitomycin C for HIPEC in colorectal cancer peritoneal carcinomatosis. Eur J Surg Oncol 2016; 43:144-149. [PMID: 27780675 DOI: 10.1016/j.ejso.2016.09.015] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [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: 04/24/2016] [Revised: 07/17/2016] [Accepted: 09/21/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Compare long-term outcomes in colorectal cancer (CRC) patients with peritoneal carcinomatosis (PC) treated with peritonectomy/HIPEC using oxaliplatin versus MMC. BACKGROUND Peritonectomy and heated intraperitoneal chemotherapy (HIPEC) greatly improves patient survival in CRC PC. This procedure is not uniform across centres and the optimal choice of HIPEC chemotherapeutic is unclear. Oxaliplatin and Mitomycin C (MMC) are the most commonly used agents and comparative studies have reported varying results. METHOD 201 patients were retrospectively selected from the St George Hospital database, all of which had undergone peritonectomy/HIPEC for CRC PC. Oxaliplatin and MMC were used in 106 and 96 patients, respectively. Each patient's baseline characteristics, operative details, choice of chemotherapeutic agent and survival were noted. RESULTS The two groups did not differ significantly at baseline. Patients receiving oxaliplatin had significantly greater unadjusted median survival compared to MMC (56.0 ± 8.1 vs. 29.0 ± 3.4 months) which translated into a hazards ratio of 0.59 (95% CI 0.37-0.91, p = 0.017). Subgroup analysis further confirmed an advantage with oxaliplatin in females, moderate-well differentiated tumours, tumours without signet ring pathology and PCI 10-15. CONCLUSION Our study suggests oxaliplatin offers a survival advantage over MMC when used for HIPEC in CRC PC. Further studies to understand its efficacy, complications and ideal preparation are required. A Phase III randomised control trial comparing oxaliplatin and MMC would enhance decision-making.
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Affiliation(s)
- V Leung
- University of New South Wales, Kensington, Sydney, NSW, 2052, Australia.
| | - Y R Huo
- University of New South Wales, Kensington, Sydney, NSW, 2052, Australia.
| | - W Liauw
- Department of Surgery, St George Hospital, Gray St Kogarah, Sydney, NSW, 2217, Australia.
| | - D L Morris
- University of New South Wales, Kensington, Sydney, NSW, 2052, Australia; Department of Surgery, St George Hospital, Gray St Kogarah, Sydney, NSW, 2217, Australia.
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Huo Y, Glenn D, Power M, Zhao J, Liauw W, Morris D. Incidence of and risk factors for pneumothorax and other complications following percutaneous ablation of lung metastases: a single-centre experience of 312 sessions. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.217] [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] Open
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Huo Y, Glenn D, Power M, Zhao J, Liauw W, Morris D. CEA failure as a prognostic factor for percutaneous ablation of pulmonary colorectal metastases. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.218] [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] Open
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Huo Y, Richards A, Liauw W, Morris D. Hyperthermic intraperitoneal chemotherapy (HIPEC) and cytoreductive surgery (CRS) in ovarian cancer: A systematic review and meta-analysis. Eur J Surg Oncol 2015; 41:1578-89. [DOI: 10.1016/j.ejso.2015.08.172] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/17/2015] [Accepted: 08/24/2015] [Indexed: 01/27/2023] Open
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Valle SJ, Alzahrani NA, Alzahrani SE, Liauw W, Morris DL. Laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) for refractory malignant ascites in patients unsuitable for cytoreductive surgery. Int J Surg 2015; 23:176-80. [PMID: 26475090 DOI: 10.1016/j.ijsu.2015.09.074] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 09/29/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Malignant ascites (MA) is the abnormal accumulation of fluid in the peritoneal cavity of patients with intraperitoneal dissemination of their disease and is associated with a short life expectancy. The most common clinical feature is a progressive increase of abdominal distention resulting in pain, discomfort, anorexia and dyspnoea. Currently, no treatment is established standard of care due to limited efficacy or considerable toxicity. The objective was to examine the efficacy of laparoscopic hyperthermic intraperitoneal chemotherapy (HIPEC) in the palliation of refractory MA in patients who were unsuitable for cytoreductive surgery. METHODS From May 2009 to June 2015, 12 patients with MA due to their peritoneal malignancy were treated with laparoscopic HIPEC. The time between operation and repeat paracentesis, in-hospital data, and the proportion of patients that did not require repeat paracentesis was analyzed. RESULTS One patient (8%) was admitted to ICU for 1 day. The mean operating time and hospital stay was 149.3 min (range 79-185) and 4.6 days (range 2-11) respectively. Neither high-grade morbidity nor mortality was observed. The median OS was 57 days. In our experience, a complete and definitive disappearance of MA was observed in 83% of patients. Two patients (17%) developed recurrent MA 124 days and 283 days post-HIPEC. CONCLUSION Laparoscopic HIPEC is a beneficial treatment for the management and palliation of refractory MA and results in an excellent clinical and radiological resolution in patients with a complete resolution observed in selected patients.
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Affiliation(s)
- S J Valle
- University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia
| | - N A Alzahrani
- University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia; College of Medicine, Al-Iman Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia.
| | - S E Alzahrani
- University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia
| | - W Liauw
- University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia; Cancer Care Centre, St George Hospital, Kogarah, Australia
| | - D L Morris
- University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia
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Leung V, Huang N, Liauw W, Morris DL. High risk features of primary colorectal carcinomas which subsequently undergo peritonectomy. Eur J Surg Oncol 2015; 42:836-40. [PMID: 26995114 DOI: 10.1016/j.ejso.2015.08.161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/12/2015] [Revised: 07/28/2015] [Accepted: 08/11/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Determine what portion of colorectal cancer (CRC) patients with peritoneal metastases (PM) undergoing peritonectomy would have been identified/treated if second-look surgery protocol existed for high-risk primary tumours. BACKGROUND The prognosis of CRC PM greatly improves following peritonectomy/HIPEC. Survival remains dependent upon stage of PM and there is some knowledge of high-risk factors for its development. Subsequently, there is interest in routine second-look laparotomy to follow-up high-risk CRC patients so to 'prevent' PM. METHODS Patients were retrospectively selected from the St George database, all of whom had had PM recurrence after primary CRC resection thus underwent peritonectomy/HIPEC. Each patient's primary tumour pathology was obtained with incidence of high-risk stage (T4), macroscopic (peritoneal involvement, ovarian metastases, perforated primary) and microscopic (mucinous, signet ring) features noted. RESULTS 125 patients were included. At primary diagnosis, 34.4%, 46.4% and 19.2% were of T3, T4a and T4b stage. Primary tumour macroscopic features included 41.1%, 12.6% and 23.7% with synchronous peritoneal involvement, perforated primary and ovarian metastases. Primary tumour microscopic features included 8.1%, 44.0% and 5.6% with signet ring, mucinous and both pathologies. Individually T4 status, macroscopic and microscopic features would have identified 65.6%, 56.8% and 46.5% of patients. Any high-risk factor would have identified 85.6%. CONCLUSION Our study suggests that T4 stage, high-risk macroscopic and high-risk microscopic features at time of primary diagnosis identifies the majority of CRC patients who later develop PM. This provides support for a selective second-look protocol in such patients to enable early identification and, potentially, 'prevention' of CRC PM.
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Affiliation(s)
- V Leung
- University of New South Wales, Kensington, Sydney, NSW 2052, Australia.
| | - N Huang
- University of New South Wales, Kensington, Sydney, NSW 2052, Australia.
| | - W Liauw
- St George Hospital Department of Surgery, Gray St Kogarah, NSW 2217, Australia.
| | - D L Morris
- University of New South Wales, Kensington, Sydney, NSW 2052, Australia; St George Hospital Department of Surgery, Gray St Kogarah, NSW 2217, Australia.
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Huang Y, Alzahrani NA, Liauw W, Morris DL. Repeat cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for recurrent diffuse malignant peritoneal mesothelioma. Eur J Surg Oncol 2015; 41:1373-8. [PMID: 26227745 DOI: 10.1016/j.ejso.2015.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/10/2015] [Accepted: 07/07/2015] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown to improve survival outcomes for patients with diffuse malignant peritoneal mesothelioma (DMPM). PATIENTS AND METHODS This is a retrospective study of prospectively collected data of 44 consecutive patients with DMPM who underwent CRS and HIPEC by the same surgical team at St George Hospital in Sydney, Australia. A total of 58 operations were performed. Clinical data were divided according to the number of operation and HIPEC the patient had undergone (Group 1 = initial CRS and HIPEC; Group 2 = 2nd CRS and HIPEC; Group 3 included 3rd CRS and HIPEC; Group 4 = 4th CRS and HIPEC). A significant difference was defined as p < 0.05. RESULTS There were no significant differences in mortality and morbidity results among the four groups. The median survival for those who only had one operation was 22 months (95% confidence interval (CI) = 0-47.2), whereas the median survival for those who had a second operation was 62 months (95% CI = 22.9-101.1). However, such a difference did not translate into a statistical significance (p = 0.141). CONCLUSION We report an encouraging median survival of 62 months in patients who had recurrence of disease and had repeat CRS and HIPEC with similar morbidity and mortality with the initial operation. Due to the learning curve of this technique, patients with recurrent mesothelioma should be referred to specialised tertiary care centres for evaluation. Selected patients may experience prolonged survival after repeat CRS and HIPEC.
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Affiliation(s)
- Y Huang
- St George Clinical School, University of New South Wales, New South Wales, Australia
| | - N A Alzahrani
- Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia; College of Medicine, Imam Muhammad ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - W Liauw
- Department of Medical Oncology, University of New South Wales, St George Hospital, Sydney, New South Wales, Australia
| | - D L Morris
- Department of Surgery, University of New South Wales, St George Hospital, New South Wales, Australia.
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Ferguson J, Alzahrani N, Zhao J, Glenn D, Power M, Liauw W, Morris D. Long term results of RFA to lung metastases from colorectal cancer in 157 patients. Eur J Surg Oncol 2015; 41:690-5. [DOI: 10.1016/j.ejso.2015.01.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 01/07/2015] [Accepted: 01/15/2015] [Indexed: 12/27/2022] Open
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Huang Y, Alzahrani N, Liauw W, Morris D. Case of intraperitoneal sepsis secondary to rupture of the appendix on the background of pseudomyxoma peritonei. Ann Med Surg (Lond) 2014; 4:1-4. [PMID: 25685336 PMCID: PMC4323747 DOI: 10.1016/j.amsu.2014.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/24/2014] [Accepted: 07/27/2014] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Pseudomyxoma peritonei (PMP) is characterised by gelatinous ascites and pools of mucin associated with neoplastic mucinous epithelium within the peritoneal cavity. It can rarely present as acute intraperitoneal sepsis, requiring urgent medical attention. PRESENTATION OF CASE A 59-year old male was referred to our centre in February 2014 following a diagnostic laparotomy, which showed jelly-like material with occasional epithelial cells. He was listed for peritonectomy in a month's time at our centre. Three weeks later, he was admitted urgently to our hospital due to generalised abdominal pain and watery diarrhoea. Examination at admission was unremarkable. On the following day, he became haemodynamically unstable and was suspected to have intraperitoneal sepsis due to infected PMP. At emergency laparotomy, we found gross intraperitoneal sepsis and did extensive debulking of tumour, appendectomy and extensive division of adhesions. Another laparotomy was done 24 h later for washout. He was discharged three weeks after. DISCUSSION Although we have done 780 peritonectomy procedures, this was the first patient with this presentation of widerspread intraperitoneal sepsis. Continuous mucous production of appendiceal adenoma can lead to appendiceal rupture. The appendix may decompress by perforation and then reseal. However, one episode of appendiceal rupture can cause bacterial contamination of PMP, leading to sepsis. CONCLUSION Intraperitoneal sepsis secondary to appendiceal rupture is rare. Hence surgeons may face an emergency of intraperitoneal sepsis during waiting period of planned CRS or as a primary presentation. With combined therapy of CRS and PIC, the prognosis of mucinous appendiceal adenoma is excellent.
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Affiliation(s)
| | | | | | - D.L. Morris
- Corresponding author. Hepatobiliary and Surgical Oncology Unit, Department of Surgery, St George Hospital, University of New South Wales, Level 3 Pitney Building, Gray Street, Kogarah, Sydney, NSW 2217, Australia. Tel.: +61 (2)91132590.
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Kusamura S, Moran BJ, Sugarbaker PH, Levine EA, Elias D, Baratti D, Morris DL, Sardi A, Glehen O, Deraco M, Gilly FN, Barrios P, Quenet F, Loggie BW, Gómez Portilla A, de Hingh IHJT, Ceelen WP, Pelz JOW, Piso P, González-Moreno S, Van Der Speeten K, Chua TC, Yan TD, Liauw W. Multicentre study of the learning curve and surgical performance of cytoreductive surgery with intraperitoneal chemotherapy for pseudomyxoma peritonei. Br J Surg 2014; 101:1758-65. [DOI: 10.1002/bjs.9674] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Revised: 08/19/2014] [Accepted: 09/17/2014] [Indexed: 12/18/2022]
Abstract
Abstract
Background
The learning curves for cytoreductive surgery with intraperitoneal chemotherapy for treatment of pseudomyxoma peritonei (PMP) were explored between international centres/surgeons to identify institutional or other factors that might affect performance.
Methods
Data from patients with PMP treated with the combined procedure across 33 international centres between 1993 and 2012 were analysed retrospectively. A risk-adjusted sequential probability ratio test was conducted after defining the target outcome as early oncological failure (disease progression within 2 years of treatment), an acceptable risk for the target outcome (odds ratio) of 2, and type I/II error rates of 5 per cent. The risk prediction model was elaborated and patients were evaluated sequentially for each centre/surgeon. The learning curve was considered to be overcome and proficiency achieved when the odds ratio for early oncological failure became smaller than 2.
Results
Rates of optimal cytoreduction, severe postoperative morbidity and early oncological failure were 84·4, 25·7 and 29·0 per cent respectively. The median annual centre volume was 17 (range 6–66) peritoneal malignancies. Only eight of the 33 centres and six of 47 surgeons achieved proficiency after a median of 100 (range 78–284) and 96 (86–284) procedures respectively. The most important institutional factor affecting surgical performance was centre volume.
Conclusion
The learning curve is extremely long, so centralization and/or networking of centres is necessary to assure quality of services. One centre for every 10–15 million inhabitants would be ideal.
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Affiliation(s)
- S Kusamura
- Peritoneal Surface Malignancy Programme, Colorectal Cancer Unit, IRCCS Fondazione Istituto Nazionale Tumori di Milano, Milan, Italy
| | - B J Moran
- Basingstoke and North Hampshire NHS Foundation Trust, Basingstoke, UK
| | - P H Sugarbaker
- Washington Cancer Institute, Washington Hospital Center, Washington, DC
| | - E A Levine
- Surgical Oncology Service, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - D Elias
- Department of Surgical Oncology, Institut Gustave Roussy, Cancer Centre, Villejuif
- RENAPE: Centre Expert National de Référence des Cancers Rares du Péritoine, Unité de Recherche Clinique, Centre Hospitalier Universitaire (CHU) de Lyon Sud, Pierre Bénite, France
| | - D Baratti
- Peritoneal Surface Malignancy Programme, Colorectal Cancer Unit, IRCCS Fondazione Istituto Nazionale Tumori di Milano, Milan, Italy
| | - D L Morris
- Hepatobiliary and Surgical Oncology Unit, University of New South Wales Department of Surgery, St George Hospital, New South Wales, Sydney, Australia
| | - A Sardi
- Division of Surgery, Department of Surgical Oncology, Institute for Cancer Care, Mercy Medical Center, Baltimore, Maryland, USA
| | - O Glehen
- RENAPE: Centre Expert National de Référence des Cancers Rares du Péritoine, Unité de Recherche Clinique, Centre Hospitalier Universitaire (CHU) de Lyon Sud, Pierre Bénite, France
- Department of Digestive Surgery, CHU de Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France
| | - M Deraco
- Peritoneal Surface Malignancy Programme, Colorectal Cancer Unit, IRCCS Fondazione Istituto Nazionale Tumori di Milano, Milan, Italy
| | - F N Gilly
- Department of Digestive Surgery, Centre Hospitalier Universitaire (CHU) de Lyon Sud, Hospices Civils de Lyon, and RENAPE, Unité de Recherche Clinique, CHU de Lyon Sud, Pierre-Benite, France
| | - P Barrios
- Department of Oncological Surgery, Hospital Sant Joan Despí, Moises Broggi, Peritoneal Surface Malignancy Catalonian's Programme, Sant Joan Despí, Barcelona, Spain
| | - F Quenet
- Centre Régional de Lutte du Cancer Val d'Aurell, Montpellier, and RENAPE, CHU de Lyon Sud, Pierre-Benite, France
| | - B W Loggie
- Division of Surgical Oncology, Creighton University Medical Center, Omaha, New England, USA
| | - A Gómez Portilla
- Department of General Surgery and Digestive Diseases, Hospital Santiago Apostol, Vitoria, Spain
| | - I H J T de Hingh
- Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands
| | - W P Ceelen
- Department of Gastrointestinal Surgery, University Hospital, Ghent, Belgium
| | - J O W Pelz
- Department of General, Visceral and Paediatric Surgery, University of Wuerzburg, Wuerzburg, Germany
| | - P Piso
- Department of Surgery, University Medical Centre Regensburg, Regensburg, Germany
| | - S González-Moreno
- Peritoneal Surface Oncology Programme, Department of Surgical Oncology, M. D. Anderson Cancer Center Madrid, Madrid, Spain
| | - K Van Der Speeten
- Department of Surgical Oncology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - T C Chua
- Hepatobiliary and Surgical Oncology Unit, University of New South Wales Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
| | - T D Yan
- Department of Cardiothoracic Surgery, University of Sydney, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - W Liauw
- Hepatobiliary and Surgical Oncology Unit, University of New South Wales Department of Surgery, St George Hospital, Sydney, New South Wales, Australia
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Johnson KR, Liauw W, Lassere MND. Evaluating surrogacy metrics and investigating approval decisions of progression-free survival (PFS) in metastatic renal cell cancer: a systematic review. Ann Oncol 2014; 26:485-96. [PMID: 25057168 DOI: 10.1093/annonc/mdu267] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In metastatic renal cell cancer (mRCC) trials, progression-free survival (PFS) is increasingly used instead of overall survival (OS) as the approval end point. Unlike other solid tumors, there is no published demonstration of what PFS is needed across and by treatment class in mRCC. We determine this and evaluate drug approval decisions in mRCC targeted therapy. METHODS We identified all randomized, controlled trials reporting PFS and OS in mRCC. Surrogacy metrics were the coefficient of determination and surrogate threshold effect (STE)-the PFS difference needed to predict, with 95% confidence, an OS difference. Data from regulatory commentaries, briefing documents and transcripts were extracted. RESULTS No exclusively chemotherapy trial met criteria. Of 30 qualifying trials, 11 trials (13 comparisons) used targeted therapy. The all-trials and immunotherapy-only trials analysis failed to demonstrate a STE. The targeted trials, using the more conservative regression analysis demonstrated an STE of 3.9 months and an R(2) of 0.44. Crossover upon progression, control to active treatment, was common. Regulatory approval, accelerated or regular, labeling, interim analyses, and adjudication were context specific. CONCLUSIONS A new targeted therapy trial showing a PFS difference of 3.9 months can claim an OS benefit in mRCC. PFS surrogacy for OS in metastatic renal cell is not generalizable across all drug classes.
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Affiliation(s)
| | - W Liauw
- Department of Oncology, St George Clinical School-University of New South Wales, Kogarah, Australia
| | - M N D Lassere
- Department of Oncology, St George Clinical School-University of New South Wales, Kogarah, Australia
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Goldstein D, Bell ML, Butow P, Sze M, Vaccaro L, Dong S, Liauw W, Hui R, Tattersall M, Ng W, Asghari R, Steer C, Vardy J, Parente P, Harris M, Karanth NV, King M, Girgis A, Eisenbruch M, Jefford M. Immigrants' perceptions of the quality of their cancer care: an Australian comparative study, identifying potentially modifiable factors. Ann Oncol 2014; 25:1643-9. [PMID: 24827124 DOI: 10.1093/annonc/mdu182] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Recent data show a falling cancer mortality in the general population without a similar shift in immigrant outcomes, leading to a greater cancer burden and mortality for immigrants. Our aims were to compare perceived patterns of care in immigrants and native-born cancer patients. PATIENTS AND METHODS This was a hospital-based sample of first-generation immigrants and Australian-born Anglo patients in the first year following diagnosis. It was restricted to Chinese, Arabic, or Greek speakers. Eligible participants, recruited via 16 oncology clinics, were over 18, with cancer (any type or stage), and having commenced treatment at least 1 month previously. Five hundred and seventy-one CALD patients (comprising 145 Arabic, 248 Chinese, and 178 Greek) and a control group of 274 Anglo-Australian patients participated. RESULTS Immigrants had difficulty communicating with the doctor (73% versus 29%) and understanding the health system (38% versus 10%). Differences were found in 'difficulty knowing who to see' (P = 0.0002), 'length of time to confirm diagnosis' (P = 0.04), wanting more choice about a specialist and hospital (P < 0.0001); being offered the opportunity to see a counselor (P < 0.0001); and actually seeing one (P < 0.0001). There were no significant self-reported differences regarding how cancer was detected, time to see a health professional, or type first seen; however, immigrants reported difficulty knowing who to see. Previous studies showed differences in patterns of care according to socioeconomic status (SES) and educational level. Despite adjusting for age, sex, education, marital status, SES, time since diagnosis, and type of cancer, we did not find significant differences. Instead, we found that understanding of the health system and confidence understanding English were important factors. CONCLUSIONS This study confirmed that immigrants with cancer perceive an inferior quality of cancer care. We highlight potentially modifiable factors including assistance in navigating the health system, translated information, and cultural competency training for health professionals.
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Affiliation(s)
- D Goldstein
- Department of Medical Oncology, Prince of Wales Hospital, Sydney
| | - M L Bell
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - P Butow
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney
| | - M Sze
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - L Vaccaro
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - S Dong
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - W Liauw
- Cancer Care Centre, St George Hospital, Sydney
| | - R Hui
- Department of Medical Oncology, Westmead Hospital and Blacktown Oncology Unit, Blacktown Hospital Sydney, Sydney
| | - M Tattersall
- Department of Cancer Medicine, University of Sydney, Sydney Department of Medical Oncology, Royal Prince Alfred Hospital, Sydney
| | - W Ng
- Department of Medical Oncology, Liverpool Hospital, Sydney
| | - R Asghari
- Bankstown Cancer Care Centre, Bankstown Lidcombe Hospital, Sydney
| | - C Steer
- Border Medical Oncology, Wodonga
| | - J Vardy
- Centre of Medical Psychology and Evidence-based Decision-making (CeMPED), University of Sydney, Sydney
| | - P Parente
- Department of Clinical Haematology and Medical Oncology, Box Hill Hospital, Victoria
| | - M Harris
- Department of Medical Oncology, Monash Medical Centre, Victoria
| | - N V Karanth
- Department of Medical Oncology, Royal Darwin Hospital, Northern Territory
| | - M King
- Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - A Girgis
- Translational Cancer Research Unit, Ingham Institute for Applied Medical Research, and University of NSW, Sydney
| | - M Eisenbruch
- School of Psych, Psychiatry and Psych Medicine, Monash University, Victoria
| | - M Jefford
- Sir Peter MacCallum Department of Oncology and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria Division of Medicine, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
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Liauw W, Chern B, Shafren D. 589 Phase I, Open-Label, Cohort Study of CAVATAK (Coxsackievirus A21) Given Intravenously to Stage IV Patients Bearing ICAM-1 Expressing Solid Tumours. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)72386-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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17
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Cao CQ, Yan TD, Bester L, Liauw W, Morris DL. Radioembolization with yttrium microspheres for neuroendocrine tumour liver metastases. Br J Surg 2010; 97:537-43. [DOI: 10.1002/bjs.6931] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Background
90Y microsphere radioembolization is performed by injecting the microspheres through a hepatic artery catheter placed percutaneously via the femoral or brachial artery. This study assessed the efficacy of 90Y microsphere therapy for patients with unresectable neuroendocrine tumour liver metastases (NETLMs). Potential prognostic factors were analysed for their impact on overall survival.
Methods
A prospectively collected database for patients with NETLMs treated by 90Y microspheres in two centres from 2003 to 2008 was examined retrospectively. Serial radiographic evidence was collected during follow-up to assess response.
Results
Fifty-eight patients were included, 51 of whom had evaluable disease at most recent follow-up. Six patients achieved a complete response, 14 a partial response, 14 had stable disease and 17 had disease progression. Overall survival rates at 1, 2 and 3 years were 86, 58 and 47 per cent respectively; median survival was 36 (range 1–61) months. Extent of tumour involvement, radiographic response to treatment, extrahepatic disease and tumour grade were significant prognostic factors for overall survival.
Conclusion
90Y microsphere radioembolization achieved a radiographic response in a significant proportion of patients with NETLMs.
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Affiliation(s)
- C Q Cao
- Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
| | - T D Yan
- Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
| | - L Bester
- Department of Interventional Radiology, University of New South Wales, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - W Liauw
- Department of Oncology, University of New South Wales, St George Hospital, Sydney, Australia
| | - D L Morris
- Department of Surgery, University of New South Wales, St George Hospital, Sydney, Australia
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Buanes T, Maurel J, Liauw W, Hebbar M, Nemunaitis J. A randomized phase III study of gemcitabine (G) versus GV1001 in sequential combination with G in patients with unresectable and metastatic pancreatic cancer (PC). J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.4601] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4601 Background: A phase I/II study with GV1001, a telomerase peptide vaccine, showed a median overall survival (OS) of 8.6 months in non-resectable PC (Bernhardt SL et al, Br J Cancer. 2006;95:1474–1482). This phase III trial was conducted to determine the impact on overall survival of G monotherapy vs. GV1001 in sequential combination with G in unresectable and metastatic PC. Methods: Eligible patients (pts) had chemotherapy-naive, advanced PC and ECOG performance status 0–1. Pts were randomized 1:1 to receive arm A: G (1,000 mg/m2 30 min i.v.) weekly for 7 weeks (w), 1w off and then 3w during 4-weekly cycles, or arm B: GV1001 0.56 mg s.c. plus GM-CSF as immune adjuvant on days 1, 3, 5, 8, 15, 22, 36, then every 4 weeks. Patients who progressed clinically or radiologically during GV1001 continued on GV1001 and concomitant gemcitabine. CT scans were performed every 8 weeks. The primary end-point was OS. A sample size of 520 patients allowed the detection of a hazard ratio (HR) of 0.73 (B/A), with 2α = 0.05 and 90% power. Results: Between June 2006 and May 2008, 365 pts were enrolled (A / B; 182 / 183). The study was stopped prematurely due to a preliminary analysis with 178 events showing no survival benefit of GV1001. Pts were well balanced for baseline characteristics: male 59.3% / 62.8%; median age 61y / 61y; ECOG PS 0 34.3% / 36.7%; locally advanced 22.4% / 20.7%. As of August 2008, 238 pts (A / B : 114 / 124) had died. Median OS was 7.3 / 5.9 months (HR 0.8; 95% CI 0.6–1.0). Median progression-free survival (PFS) was 3.7 / 1.9 months (HR 0.5; 95%CI 0.4–0.7). Grade 3–4 AEs: gastrointestinal 6% / 8%, infection 5% / 5%, vascular disorders 2% / 3%, neutropenia 6% / 3%. Conclusions: GV1001 did not show efficacy in sequential combination with G in advanced PC. The advantage of G monotherapy over the sequential combination may be due to the delayed treatment with G in arm B. [Table: see text]
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Affiliation(s)
- T. Buanes
- Ullevaal University Hospital, Oslo, Norway; Hospital Clinic, Barcelona, Spain; St George Hospital, Sydney, Australia; Centre Oscar Lambret, Lille, France; Mary Crowley Cancer Research Centers, Dallas, TX
| | - J. Maurel
- Ullevaal University Hospital, Oslo, Norway; Hospital Clinic, Barcelona, Spain; St George Hospital, Sydney, Australia; Centre Oscar Lambret, Lille, France; Mary Crowley Cancer Research Centers, Dallas, TX
| | - W. Liauw
- Ullevaal University Hospital, Oslo, Norway; Hospital Clinic, Barcelona, Spain; St George Hospital, Sydney, Australia; Centre Oscar Lambret, Lille, France; Mary Crowley Cancer Research Centers, Dallas, TX
| | - M. Hebbar
- Ullevaal University Hospital, Oslo, Norway; Hospital Clinic, Barcelona, Spain; St George Hospital, Sydney, Australia; Centre Oscar Lambret, Lille, France; Mary Crowley Cancer Research Centers, Dallas, TX
| | - J. Nemunaitis
- Ullevaal University Hospital, Oslo, Norway; Hospital Clinic, Barcelona, Spain; St George Hospital, Sydney, Australia; Centre Oscar Lambret, Lille, France; Mary Crowley Cancer Research Centers, Dallas, TX
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19
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Chua TC, Robertson G, Farrell R, Liauw W, Yan TD, Morris DL. Systematic review of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for ovarian peritoneal carcinomatosis: A more efficacious way of delivering intraperitoneal chemotherapy. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.5524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5524 Background: Advanced and recurrent ovarian cancer results in extensive dissemination of tumor within the peritoneal cavity. The current evidence suggests that cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) may be a feasible option with potential benefits compared to the current standard of care in the treatment of peritoneal carcinomatosis from ovarian cancer. Methods: A systematic review of relevant studies before August 2008 was undertaken to document and report its efficacy. Each study was appraised using a predetermined protocol. The quality of studies was assessed. The patient characteristics, protocol of treatment, perioperative morbidity and mortality, and treatment outcomes were synthesized through a narrative review with full tabulation of results of all included studies. Results: In total, 15 non-randomized, observational studies were reviewed, comprising of 512 patients. All patients received HIPEC as part of the combined treatment with cytoreductive surgery. Cisplatin was the most common chemoperfusate. The mortality associated with the treatment ranged from 0 to 10%. The rates of severe morbidity ranged from 0 to 40%. The median time of follow up ranged from 14 to 64 months, the median disease-free survival ranged from 10 to 57 months and the overall median survival ranged from 22 to 64 months. In patients who had an optimal cytoreduction, the median survival ranged from 29 to 66 months, with a 3- and 5-year survival rate that ranged from 35 to 63% and 12 to 66%, respectively. Conclusions: The future for cytoreductive surgery and HIPEC in ovarian cancer is promising. More studies are called for to validate the efficacy of this treatment. For it to become generally accepted, the oncology community must commit to a randomized trial. Before this, the current treatment of cytoreductive surgery combined with adjuvant intraperitoneal and intravenous chemotherapy should remain the mainstay of treatment. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | - W. Liauw
- St George Hospital, Sydney, Australia
| | - T. D. Yan
- St George Hospital, Sydney, Australia
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20
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King J, Glenn D, Quinn R, Janssen J, Liauw W, Morris DL. Radioactive microspheres in liver metastases from neuroendocrine cancer (NETLM). J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.15541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Lee CK, Browne L, Bastick P, Liauw W. Women from non-English speaking backgrounds living in Australia present with later stage breast cancer: A population study. J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.17043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17043 Background: Ethnicity may influence both the incidence and prognosis of breast cancer. We have conducted an analysis to determine if women from non-English speaking backgrounds (NESB) living in New South Wales (NSW), Australia, present with later stage breast cancer compared to women from English speaking backgrounds (ESB); and to determine whether there is an impact on their survival. Methods: Data from the NSW Cancer Registry (1980 to 2004) was used to identify women with their first presentation of breast cancer. Stage of breast cancer was classified as early (insitu or localized) versus late (regional nodal or distant metastatic spread) according to registry definitions. Country of birth was used as a surrogate for language status. Stage at diagnosis was compared between ESB versus NESB women. Logistic regression was used to determine the odds of late stage disease and Cox regression to determine survival outcomes Results: 60,676 of 75,583 cases were considered suitable for analysis. Of these 16.64% were NESB. Accounting for potential confounding variables, NESB women were more likely to have late stage disease than ESB women (OR= 1.12; 95% CI, 1.07 to 1.17). Analysis by geographical region of birth revealed women born in Middle Eastern region were most likely to have late stage disease at presentation (OR 1.41; 95% CI, 1.25 to 1.60). In multivariable analysis of all-cause mortality NESB women had a superior overall survival (HR 0.90; 95% CI 0.87 to 0.94) compared to ESB women, however, there was no difference in breast cancer specific survival between these groups by univariate analysis (logrank p=0.46). Conclusions: In New South Wales, Australia, NESB women have a delayed presentation with breast cancer as indicted by more advanced stage. However, stage-adjusted, breast cancer specific survival in NESB women is similar to the ESB women. Further studies are required to determine the reasons for delayed detection for NESB women. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | - W. Liauw
- St George Hospital, NSW, Australia
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22
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King J, Quinn R, Glenn D, Liauw W, Janssen J, Morris D. Pilot study of selective internal radiation therapy (SIRT) for patients with unresectable neuroendocrine liver metastases (NETLM). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.15096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
15096 Background: Few effective treatment options exist for inoperable NETLM. A prospective single-unit study assessed safety and efficacy of radioactive yttrium90 resin (SIR) in 34 patients with unresectable (NETLM). Method: Microspheres were administered via temporary percutaneous hepatic artery catheter with concomitant 7day 5-flurouracil infusion. Patients were monitored prospectively and treatment response measured by CT imaging and chromogranin A (CgA). Results: 34 patients (22 male), mean age 61 years (range 32–79) were treated with SIRT from December 2003 to December 2005. Mean follow-up 28.9 months, (95% CI 23.4 to 32.3). Complications were: post-embolitic pain and lethargy 1 week-1 month; 3 radiation gastritis, 2 of whom developed a duodenal ulcer. RECIST response on CT scan of 34 patients at 1 month: PR 9 (26%); SD 22 (65%); PD 3 (9%); 32 at 6 months, PR 7 (22%); SD 19 (59%); PD 6 (19%); 29 at 12 months CR 2 (7%); PR 3 (10%); SD 16 (55%); PD 8 (28%); 16 at 18 months, CR 4(25%); PR 1 (6%); SD 8 (50%); PD =3 (19%); 8 at 24 months, CR 4 (50%);SD 2 (25%),PD 2 (25%); 6 at 30 months, CR 2 (33%); SD 2 (33%); PD 2 (33%). CgA U/L fall from entry was: 19 (26%) at one month; 15 (43%) at 6 months; 15 (52%) at 9 months; 11 (57%) at 12 months; 8 (38%) at 24 months and 4 (80%) at 30 months. At 36 months from entry 11 (32%) have died; 8 (24%) have PD; 9 (26%) have SD and 6 (18%), (15 to 30 months) have CR on CT scan. Conclusion: SIRT is a promising treatment option for patients with in-operable NETLM. No significant financial relationships to disclose.
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Affiliation(s)
- J. King
- UNSW/St George Hospital, Sydney, Australia
| | - R. Quinn
- UNSW/St George Hospital, Sydney, Australia
| | - D. Glenn
- UNSW/St George Hospital, Sydney, Australia
| | - W. Liauw
- UNSW/St George Hospital, Sydney, Australia
| | - J. Janssen
- UNSW/St George Hospital, Sydney, Australia
| | - D. Morris
- UNSW/St George Hospital, Sydney, Australia
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23
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Liauw W, Segelov E, Lih A, Links M, Dunleavy R, Ward R. Outcomes and utilization patterns of intravenous bisphosphonates for bony metastases in patients with advanced breast cancer: Results in the off-trial setting. J Clin Oncol 2005. [DOI: 10.1200/jco.2005.23.16_suppl.6089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- W. Liauw
- St George Hosp, Kogarah NSW, Australia; St Vincent’s Hosp, Darlinghurst, Australia; Royal Prince Alfred Hosp, Camperdown, Australia
| | - E. Segelov
- St George Hosp, Kogarah NSW, Australia; St Vincent’s Hosp, Darlinghurst, Australia; Royal Prince Alfred Hosp, Camperdown, Australia
| | - A. Lih
- St George Hosp, Kogarah NSW, Australia; St Vincent’s Hosp, Darlinghurst, Australia; Royal Prince Alfred Hosp, Camperdown, Australia
| | - M. Links
- St George Hosp, Kogarah NSW, Australia; St Vincent’s Hosp, Darlinghurst, Australia; Royal Prince Alfred Hosp, Camperdown, Australia
| | - R. Dunleavy
- St George Hosp, Kogarah NSW, Australia; St Vincent’s Hosp, Darlinghurst, Australia; Royal Prince Alfred Hosp, Camperdown, Australia
| | - R. Ward
- St George Hosp, Kogarah NSW, Australia; St Vincent’s Hosp, Darlinghurst, Australia; Royal Prince Alfred Hosp, Camperdown, Australia
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24
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Lomas M, Liauw W, Packham D, Williams K, Kelleher A, Zaunders J, Ward R. Phase I clinical trial of a human idiotypic p53 vaccine in patients with advanced malignancy. Ann Oncol 2004; 15:324-9. [PMID: 14760129 DOI: 10.1093/annonc/mdh053] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The purpose of this study was to induce immunity to p53 by using an idiotypic vaccine, composed of a pool of eight peptides derived from the complimentarity determining regions (CDRs) of human anti-p53 antibodies. PATIENTS AND METHODS Subjects with advanced malignancy received up to four, monthly intradermal injections of pooled peptides (500 microg of each) admixed with granulocyte-macrophage colony-stimulating factor (GM-CSF; 100 microg). In addition, two sheep and two rabbits were also vaccinated with the pooled peptides. RESULTS Fourteen subjects were enrolled into the study and six of these completed the vaccination schedule. The vaccine was well tolerated by all subjects and no major adverse events were attributable to the vaccine. All subjects mounted in vivo delayed type hypersensitivity (DTH) responses to two or more of the individual vaccine peptides. Vaccine-induced antibodies specific for peptides 2, 5 or 8 were detected in four of six subjects, and two of these had vaccine-specific, cell-mediated responses. Increasing titers of p53-specific antibodies were found in one patient. No T-cell response to p53 was observed in any of the subjects. All animals developed humoral immunity to the peptides and one of the sheep developed rising serum titers of anti-p53 antibodies. CONCLUSIONS Vaccination with human antibody CDR regions represents a novel method for inducing human antibodies, which may in turn serve as immunological mimics of p53.
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Affiliation(s)
- M Lomas
- Department of Medical Oncology, St Vincent's Hospital, Darlinghurst, NSW, Australia
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