1
|
Friend P, Ploeg R, Cranston D. In Memoriam-Professor Sir Peter Morris. Clin Transplant 2023; 37:e15145. [PMID: 37776267 DOI: 10.1111/ctr.15145] [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] [Received: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Peter Friend
- Professor of Transplantation, Consultant Surgeon, University of Oxford
| | - Rutger Ploeg
- Professor of Transplant Biology, Consultant Surgeon, University of Oxford, Oxford, UK
| | - David Cranston
- Associate Professor of Surgery, Consultant Urologist, University of Oxford, Oxford, UK
| |
Collapse
|
2
|
Cranston D. Godfrey Fowler. BMJ 2022. [DOI: 10.1136/bmj.o2114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
3
|
Abstract
High Intensity Focused Ultrasound (HIFU) capably bridges the disciplines of surgery, oncology and biomedical engineering science. It provides the precision associated with a surgical tool whilst remaining a truly non-invasive technique. Oxford has been a centre for both clinical and preclinical research in HIFU over the last twenty years. Research into this technology in the UK has a longer history, with much of the early research being carried out by Professor Gail ter Haar and her team at the Institute of Cancer Research at Sutton in Surrey. A broad range of potential applications have been explored extending from tissue ablation to novel drug delivery. This review presents Oxford's clinical studies and applications for the development of this non-invasive therapy. This includes treatment of solid abdominal tumours comprising those of the liver, kidney, uterus, pancreas, pelvis and prostate. It also briefly introduces preclinical and translational works that are currently being undertaken at the Institute of Biomedical Engineering, University of Oxford. The safety, wide tolerability and effectiveness of this technology is comprehensively demonstrated across these studies. These results can facilitate the incorporation of HIFU as a key clinical management strategy.
Collapse
Affiliation(s)
- Ishika Prachee
- Green Templeton College, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Feng Wu
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.,State Key Laboratory of Ultrasound Engineering in Medicine, Chongqing, China
| | - David Cranston
- Green Templeton College, University of Oxford, Oxford, UK.,Oxford University Hospitals NHS Foundation Trust, Oxford, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
4
|
Mount C, Cranston D. A historical view of orchidopexy - past to present. BJU Int 2021; 128:155-157. [PMID: 33961318 DOI: 10.1111/bju.15440] [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: 11/28/2022]
Affiliation(s)
- Chloe Mount
- Oxford University Hospital NHS Foundation Trust, Oxford, UK
| | - David Cranston
- Oxford University Hospital NHS Foundation Trust, Oxford, UK.,Nuffield Department of Surgery, Oxford University Hospital NHS Foundation Trust, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Lyon PC, Mannaris C, Gray M, Carlisle R, Gleeson FV, Cranston D, Wu F, Coussios CC. Large-Volume Hyperthermia for Safe and Cost-Effective Targeted Drug Delivery Using a Clinical Ultrasound-Guided Focused Ultrasound Device. Ultrasound Med Biol 2021; 47:982-997. [PMID: 33451816 DOI: 10.1016/j.ultrasmedbio.2020.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 06/12/2023]
Abstract
Lyso-thermosensitive liposomes (LTSLs) are specifically designed to release chemotherapy agents under conditions of mild hyperthermia. Preclinical studies have indicated that magnetic resonance (MR)-guided focused ultrasound (FUS) systems can generate well-controlled volumetric hyperthermia using real-time thermometry. However, high-throughput clinical translation of these approaches for drug delivery is challenging, not least because of the significant cost overhead of MR guidance and the much larger volumes that need to be heated clinically. Using an ultrasound-guided extracorporeal clinical FUS device (Chongqing HAIFU, JC200) with thermistors in a non-perfused ex vivo bovine liver tissue model with ribs, we present an optimised strategy for rapidly inducing (5-15 min) and sustaining (>30 min) mild hyperthermia (ΔT <+4°C) in large tissue volumes (≤92 cm3). We describe successful clinical translation in a first-in-human clinical trial of targeted drug delivery of LTSLs (TARDOX: a phase I study to investigate drug release from thermosensitive liposomes in liver tumours), in which targeted tumour hyperthermia resulted in localised chemo-ablation. The heating strategy is potentially applicable to other indications and ultrasound-guided FUS devices.
Collapse
Affiliation(s)
- Paul Christopher Lyon
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, Oxford, UK; Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | | | - Michael Gray
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Robert Carlisle
- Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - Fergus V Gleeson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Feng Wu
- Nuffield Department of Surgical Sciences, Oxford, UK
| | | |
Collapse
|
6
|
Lyon PC, Rai V, Price N, Shah A, Wu F, Cranston D. Ultrasound-Guided High Intensity Focused Ultrasound Ablation for Symptomatic Uterine Fibroids: Preliminary Clinical Experience. Ultraschall Med 2020; 41:550-556. [PMID: 31238385 DOI: 10.1055/a-0891-0729] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To evaluate the middle-term efficacy and complications of ultrasound-guided high intensity focused ultrasound (USgHIFU) for the treatment of symptomatic uterine fibroids in an NHS population. METHODS A prospective observational single-center study at a single university hospital in Oxford, UK. Patients with symptomatic uterine fibroids who declined standard surgical/radiological intervention and were referred to the HIFU unit were considered for USgHIFU treatment. Clinical evaluation, adverse event monitoring, uterine fibroid symptoms and health-related quality of life questionnaire (UFS-QOL) and contrast-enhanced pelvic magnetic resonance imaging (MRI) were performed before and at regular intervals after treatment to assess patient outcome. RESULTS 12 of 22 referred patients underwent one session of USgHIFU ablation of 14 fibroids overall and received a two-year follow-up. No serious adverse events were reported, but a second-degree skin burn was observed in one patient who had a surgical scar from a previous caesarean section. Mean symptom severity scores (SSS-QOL) improved significantly from 56.5 ± 29.1 (SD) at baseline to 33.4 ± 23.3 (p < 0.01) at three months, 45.0 ± 35.4 (p < 0.05) at one year and 40.6 ± 32.7 (p < 0.01) at two years post-treatment. The mean non-perfused volume ratio was 67.7 ± 39.0 % (SD) in the treated fibroids (n = 14) within three months of treatment. The mean volume reduction rates of the treated fibroids were 23.3 ± 25.5 % (SD) at 3 months post-treatment (p < 0.01, n = 14), 49.3 ± 23.7 % at 12 months (p < 0.05, n = 8), and 51.9 ± 11.1 % at 24 months (p < 0.005, n = 8). CONCLUSION This study demonstrates the clinical efficacy of USgHIFU ablation of uterine fibroids and the low risk of complications. We believe that this noninvasive approach may offer an alternative therapy for women with symptomatic uterine fibroids. While HIFU is fast becoming the standard of care for fibroid ablation in other countries, to our knowledge, this study is the first to present clinical experience of US-guided HIFU ablation of symptomatic uterine fibroids in an NHS population. PLAIN LANGUAGE SUMMARY High intensity focused ultrasound (HIFU) can be used for the noninvasive ablation of symptomatic uterine fibroids, and MR-guided treatment has already gained FDA approval. Ultrasound-guided HIFU has the advantage of offering practicalities in anesthesia and considerable cost-savings over MR-guided treatments. In this prospective study we have demonstrated the middle-term efficacy and favorable safety profile of ultrasound-guided HIFU for the treatment of symptomatic uterine fibroids for the first time in an NHS population.
Collapse
Affiliation(s)
- Paul Christopher Lyon
- Clinical HIFU Unit, Oxford-University-Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
- Department of Radiology, Oxford-University-Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Vic Rai
- Department of Obstetrics and Gynaecology, Oxford-University-Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Natalia Price
- Department of Obstetrics and Gynaecology, Oxford-University-Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Aarti Shah
- Department of Radiology, Oxford-University-Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - Feng Wu
- Clinical HIFU Unit, Oxford-University-Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| | - David Cranston
- Clinical HIFU Unit, Oxford-University-Hospitals NHS Foundation Trust, Oxford, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
7
|
Sullivan M, Patel N, Brown S, Blick C, Leiblich A, Protheroe A, Cranston D, Bryant R. Active surveillance of small renal masses in an older population offers long-term oncological efficacy equivalent to partial or radical nephrectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33211-0] [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: 11/26/2022] Open
|
8
|
Chetan MR, Lyon PC, Wu F, Phillips R, Cranston D, Gillies MJ, Bojanic S. Role of diffusion-weighted imaging in monitoring treatment response following high-intensity focused ultrasound ablation of recurrent sacral chordoma. Radiol Case Rep 2019; 14:1197-1201. [PMID: 31428215 PMCID: PMC6698304 DOI: 10.1016/j.radcr.2019.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 06/15/2019] [Accepted: 07/12/2019] [Indexed: 11/25/2022] Open
Abstract
Chordoma is the most common malignant tumor of the sacrum and is associated with significant neurologic morbidity. Local recurrence is very common, and the long-term prognosis is poor. High-intensity focused ultrasound (HIFU) is a noninvasive and nonionising ablative therapy that has been successful in treating other tumor types and is being evaluated as a new therapy for sacral chordoma. Contrast-enhanced magnetic resonance imaging is typically used to evaluate tumor perfusion following HIFU; however, its utility is limited in poorly perfused tumors. Diffusion-weighted imaging (DWI) provides tissue contrast based on differences in the diffusion of extracellular water without using gadolinium-based contrast agents. We present novel DWI findings following a planned partial HIFU ablation of a large sacral chordoma which had recurred after radiotherapy. Following HIFU, the treated tumor volume demonstrated loss of restriction on DWI correlating with photopenia on positron emission tomography. This suggests successful ablation and tumor necrosis. This novel finding may provide guidance for sequence selection when evaluating HIFU therapy for sacral chordoma and other tumor types for which contrast-enhanced magnetic resonance imaging may have limited utility.
Collapse
Affiliation(s)
- Madhurima R Chetan
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Department of Radiology, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Paul C Lyon
- HIFU Unit, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK.,Department of Radiology, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Feng Wu
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,HIFU Unit, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - Rachel Phillips
- Department of Radiology, Churchill Hospital, Old Road, Oxford, OX3 7LE, UK
| | - David Cranston
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK
| | - Martin J Gillies
- Nuffield Department of Surgical Sciences, University of Oxford, Room 6607, Level 6, John Radcliffe Hospital, Headley Way, Oxford, OX3 9DU, UK.,Department of Neurosurgery, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Stana Bojanic
- Department of Neurosurgery, John Radcliffe Hospital, Headley Way, Oxford, UK
| |
Collapse
|
9
|
Dholakia S, Sinha S, Vrakas G, Sullivan M, Vaidya A, Cranston D, Friend PJ. Urological Nephrectomies for Benign Disease: A Possible Missed Resource in Organ Donation. EXP CLIN TRANSPLANT 2018; 16:515-521. [PMID: 30084762 DOI: 10.6002/ect.2018.0158] [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: 11/05/2022]
Abstract
OBJECTIVES The deficit of organs for renal transplant is a global issue. The United Kingdom Hospital Episode Statistics indicates there that were 8168 nephrectomies undertaken in 2014. Furthermore, according to the British Association of Urological Surgeons 2014 nephrectomy report, 71.8% of patients undergoing a nephrectomy had creatinine levels of less than 120 IU/L and roughly 20% had the procedure for benign and functional causes. MATERIALS AND METHODS We report a prospective case series from March 2014 to March 2016 involving 6 patients showing 3 successful transplants performed following 3 native nephrectomies. RESULTS All recipients had normal creatinine levels with good function at 12 months, and all nephrectomy patients, in addition to maintaining normal renal function, had definitive resolution of symptoms. The main limitation of this series was the small sample size. CONCLUSIONS There is no doubt that all should be done to save native organ function, and all salvage procedures and psychological testing must be robust before considering this route. However, within the group that proceeds to nephrectomy, some cases may have the potential to generate a new pool of donor organs suitable for transplant, helping to tackle the organ deficit in renal transplantation.
Collapse
Affiliation(s)
- Shamik Dholakia
- From the Nuffield Department of Surgical Science, Oxford Transplant Unit, University of Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
10
|
Gillies MJ, Lyon PC, Wu F, Leslie T, Chung DY, Gleeson F, Cranston D, Bojanic S. High-intensity focused ultrasonic ablation of sacral chordoma is feasible: a series of four cases and details of a national clinical trial. Br J Neurosurg 2016; 31:446-451. [PMID: 27936948 DOI: 10.1080/02688697.2016.1267330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
High-intensity focused ultrasound describes the use of high-intensity focused ultrasound (HIFU) to ablate tumours without requiring an incision or other invasive procedure. This technique has been trialled on a range of tumours including uterine fibroids, prostate, liver and renal cancer. We describe our experience of using HIFU to ablate sacral chordoma in four patients with advanced tumours. Patients were treated under general anaesthetic or sedation using an ultrasound-guided HIFU device. HIFU therapy was associated with a reduction in tumour volume over time in three patients for whom follow up scans were available. Tumour necrosis was reliably demonstrated in two of the three patients. We have established a national trial to assess if HIFU may improve long-term outcome from sacral chordoma, details are given.
Collapse
Affiliation(s)
- Martin J Gillies
- a Department of Neurosurgery , West Wing, John Radcliffe Hospital , Oxford , UK.,b Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK
| | - Paul C Lyon
- b Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK
| | - Feng Wu
- b Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK.,c HIFU Unit , Churchill Hospital , Headington, Oxford , UK
| | - Tom Leslie
- b Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK
| | - Daniel Y Chung
- d Department of Radiology , Churchill Hospital , Oxford , UK
| | - Fergus Gleeson
- d Department of Radiology , Churchill Hospital , Oxford , UK
| | - David Cranston
- b Nuffield Department of Surgical Sciences , University of Oxford , Oxford , UK.,c HIFU Unit , Churchill Hospital , Headington, Oxford , UK
| | - Stana Bojanic
- a Department of Neurosurgery , West Wing, John Radcliffe Hospital , Oxford , UK
| |
Collapse
|
11
|
Ayers J, Cranston D. “One man's trash is another man's treasure”: Nephrectomy patients as altruistic transplant donors. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.135] [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]
|
12
|
Cranston D. A review of high intensity focused ultrasound in relation to the treatment of renal tumours and other malignancies. Ultrason Sonochem 2015; 27:654-658. [PMID: 26070919 DOI: 10.1016/j.ultsonch.2015.05.035] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/12/2015] [Indexed: 05/27/2023]
Abstract
For 60 years, high-intensity focused ultrasound (HIFU) has been the subject of interest for medical research. HIFU causes tissue necrosis in a very well defined area, at a variable distance from the transducer, through heating or cavitation. Over the past two decades, the use of high-intensity focused ultrasound has been investigated in many clinical settings. This review summarises recent advances made in the field of renal cancer in particular, and gives an overview on the use of the extracorporeal machines in the treatment of other malignant tumours.
Collapse
|
13
|
Blick C, Ramachandran A, McCormick R, Wigfield S, Cranston D, Catto J, Harris AL. Identification of a hypoxia-regulated miRNA signature in bladder cancer and a role for miR-145 in hypoxia-dependent apoptosis. Br J Cancer 2015; 113:634-44. [PMID: 26196183 PMCID: PMC4647685 DOI: 10.1038/bjc.2015.203] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [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] [Revised: 04/27/2015] [Accepted: 05/06/2015] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hypoxia leads to the stabilisation of the hypoxia-inducible factor (HIF) transcription factor that drives the expression of target genes including microRNAs (miRNAs). MicroRNAs are known to regulate many genes involved in tumourigenesis. The aim of this study was to identify hypoxia-regulated miRNAs (HRMs) in bladder cancer and investigate their functional significance. METHODS Bladder cancer cell lines were exposed to normoxic and hypoxic conditions and interrogated for the expression of 384 miRNAs by qPCR. Functional studies were carried out using siRNA-mediated gene knockdown and chromatin immunoprecipitations. Apoptosis was quantified by annexin V staining and flow cytometry. RESULTS The HRM signature for NMI bladder cancer lines includes miR-210, miR-193b, miR-145, miR-125-3p, miR-708 and miR-517a. The most hypoxia-upregulated miRNA was miR-145. The miR-145 was a direct target of HIF-1α and two hypoxia response elements were identified within the promoter region of the gene. Finally, the hypoxic upregulation of miR-145 contributed to increased apoptosis in RT4 cells. CONCLUSIONS We have demonstrated the hypoxic regulation of a number of miRNAs in bladder cancer. We have shown that miR-145 is a novel, robust and direct HIF target gene that in turn leads to increased cell death in NMI bladder cancer cell lines.
Collapse
Affiliation(s)
- C Blick
- Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
- Department of Urology, Churchill Hospital, Oxford OX3 7LE, UK
| | - A Ramachandran
- Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
- Cancer Research UK London Research Institute, Lincoln's Inn Fields Laboratories, London WC2A 3LY, UK
| | - R McCormick
- Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - S Wigfield
- Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - D Cranston
- Department of Urology, Churchill Hospital, Oxford OX3 7LE, UK
| | - J Catto
- The Academic Department of Urology and Institute for Cancer Studies, University of Sheffield, Sheffield S10 2RX, UK
| | - A L Harris
- Molecular Oncology Laboratories, Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DS, UK
| |
Collapse
|
14
|
Abstract
A 49-year-old man presented with a 15-year history of problematic pelviureteric junction obstruction of his left kidney. Surgical management had failed to sufficiently control his symptoms and he was keen to have the kidney removed. Following preoperative discussion, the patient consented to his kidney being used for transplant. Following a total nephrectomy, the kidney was successfully transplanted into a 61-year-old woman, with a cold ischaemic time of 3 h and 22 min. There was primary function in the transplanted kidney and creatinine at 6 weeks was 60. This case highlights the potential for using organs with pelviureteric junction obstruction for living donor transplant and thereby expanding the donor pool.
Collapse
Affiliation(s)
- Benjamin Soukup
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Anil Vaidya
- Department of Transplant, Churchill Hospital, Oxford, Oxfordshire, UK
| | - David Cranston
- Department of Urology, Churchill Hospital, Oxford, Oxfordshire, UK
| |
Collapse
|
15
|
George J, Grebenik K, Patel N, Cranston D, Westaby S. The importance of intraoperative transoesophageal monitoring when operating on renal cancers that involve the right atrium. Ann R Coll Surg Engl 2014; 96:e18-9. [PMID: 25198964 DOI: 10.1308/003588414x13946184903207] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The surgical treatment of advanced renal cancers is challenging. Renal cell carcinoma is interesting in that it invades the vasculature and can extend up as far as the right atrium. Extension of tumour thrombus into the right atrium represents level IV disease, according to Robson staging. Transoesophageal echocardiography is useful for diagnostic purposes. It is also of great value for intraoperative cardiac monitoring and to confirm the extent of vascular involvement.
Collapse
Affiliation(s)
- J George
- Oxford University Hospitals NHS Trust, UK
| | | | | | | | | |
Collapse
|
16
|
|
17
|
Charlesworth PJS, Sullivan ME, Protheroe A, Turner GDH, Roberts ISD, Kilbey N, Harris AL, Cranston D. Changing prognosis of renal cell carcinoma: a single-centre experience over 25 years. Journal of Clinical Urology 2013. [DOI: 10.1177/2051415812473912] [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: 11/17/2022]
Abstract
Objective: The objective of this research is to examine renal cancer nephrectomies over 25 years in our centre and the factors underlying changes in disease-specific survival. Patients and methods: Retrospective data analysis was performed on all patients undergoing nephrectomies at our institution for renal cell carcinoma (RCC) from 1983 to 2007. Data extracted from the Cancer Research Uro-Oncology Database (CRUD©) provided survival, clinical and prognostic information including tumour diameter, Fuhrman grade, WHO staging and age. Results: Analysis of 664 RCCs demonstrated a clear change in kidney cancer-specific survival over the past 25 years, with five-year survival improving from 42% (1983–1986) to 73% (1999–2002). The number of RCC nephrectomies has increased 10 fold. There was no significant change in operative mortality, age, grade, stage or mean tumour size. However, there was a five-fold increase in tumours <6 cm, corresponding to an equal-fold decrease in tumours 6–8 cm, but no change in tumours >8 cm. Tumour size >8 cm was a significant adverse prognostic marker. Conclusions: A 30% improvement in RCC cancer-specific survival has been seen in our centre over the last 25 years. This change relates to a shift to smaller tumours, lower histological grades and a higher volume of cases.
Collapse
Affiliation(s)
| | | | - Andrew Protheroe
- The Department of Medical Oncology, Oxford Radcliffe Hospitals, UK
| | | | - Ian SD Roberts
- The Department of Pathology, Oxford Radcliffe Hospitals, UK
| | - Neviana Kilbey
- The Department of Medical Oncology, Oxford Radcliffe Hospitals, UK
| | - Adrian L Harris
- The Department of Medical Oncology, Oxford Radcliffe Hospitals, UK
| | - David Cranston
- The Department of Urology, Oxford Radcliffe Hospitals, UK
| |
Collapse
|
18
|
Biswas S, Charlesworth PJS, Turner GDH, Leek R, Thamboo PT, Campo L, Turley H, Dildey P, Protheroe A, Cranston D, Gatter KC, Pezzella F, Harris AL. CD31 angiogenesis and combined expression of HIF-1α and HIF-2α are prognostic in primary clear-cell renal cell carcinoma (CC-RCC), but HIFα transcriptional products are not: implications for antiangiogenic trials and HIFα biomarker studies in primary CC-RCC. Carcinogenesis 2012; 33:1717-25. [PMID: 22777959 DOI: 10.1093/carcin/bgs222] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Hypoxia-inducible factors, HIF-1α and HIF-2α, are expressed in the majority of clear-cell renal cell carcinoma (CC-RCC). In vitro, HIFα isoforms regulate a differential set of genes, and their effects in vivo within CC-RCC tumours may affect outcome. The role of angiogenesis and HIFα transcriptional products, including those involved in cell metabolism and morphological dedifferentiation have not been extensively investigated and might have relevance to the development of antiangiogenic or anti-HIFα trials in primary CC-RCC, either before or after radical nephrectomy. We analysed 168 consecutive clear-cell renal tumours from 1983 to 1999 within tissue microarrays and assessed expression of HIF-1α and HIF-2α together with the protein expression of seven of their target genes (BNIP3, CA9, Cyclin D1, GLUT-1, LDH5, Oct-4 and VEGF). The expression of these factors was compared with patient overall survival and CD31 angiogenesis. We found that HIFα antigenicity deteriorated with the age of the paraffin block (P < 0.0001) and in tumours from 1983 to 1992 was deemed not to be reliable. Similar findings were found in aged archival osteosarcoma samples. This might have important implications for retrospective biomarker studies that rely on archival tissue material. HIF-1α(HIGH)/HIF-2α(LOW) tumours had a worse overall survival compared with HIF-1α(LOW)/HIF-2α(LOW) tumours (P = 0.04). Surprisingly, on multivariate analysis, high levels of CD31(+) angiogenesis was shown to be an independent prognostic marker of increased overall survival (P = 0.003). We propose that better differentiation of vascular endothelium may be a reflection of a greater production of vessel stabilization factors versus pro-angiogenic factors, and therefore a less aggressive phenotype.
Collapse
Affiliation(s)
- Swethajit Biswas
- Northern Institute for Cancer Research, Paul O'Gorman Building, Newcastle University, Framlington Place, Newcastle-Upon-Tyne, NE2 4HH, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Leslie T, Ritchie R, Illing R, Ter Haar G, Phillips R, Middleton M, Bch B, Wu F, Cranston D. High-intensity focused ultrasound treatment of liver tumours: post-treatment MRI correlates well with intra-operative estimates of treatment volume. Br J Radiol 2012; 85:1363-70. [PMID: 22700259 DOI: 10.1259/bjr/56737365] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To assess the safety and feasibility of high-intensity focused ultrasound (HIFU) ablation of liver tumours and to determine whether post-operative MRI correlates with intra-operative imaging. METHODS 31 patients were recruited into two ethically approved clinical trials (median age 64; mean BMI 26 kg m(-2)). Patients with liver tumours (primary or metastatic) underwent a single HIFU treatment monitored using intra-operative B-mode ultrasound. Follow-up consisted of radiology and histology (surgical trial) or radiology alone (radiology trial). Radiological follow-up was digital subtraction contrast-enhanced MRI. RESULTS Treatment according to protocol was possible in 30 of 31 patients. One treatment was abandoned because of equipment failure. Transient pain and superficial skin burns were seen in 81% (25/31) and 39% (12/31) of patients, respectively. One moderate skin burn occurred. One patient died prior to radiological follow-up. Radiological evidence of ablation was seen in 93% (27/29) of patients. Ablation accuracy was good in 89% (24/27) of patients. In three patients the zone of ablation lay ≤2 mm outside the tumour. The median cross-sectional area (CSA) of the zone of ablation was 5.0 and 5.1 cm(2) using intra-operative and post-operative imaging, respectively. The mean MRI:B-mode CSA ratio was 1.57 [95% confidence interval (CI)=0.57-2.71]. There was positive correlation between MRI and B-mode CSA (Spearman's r=0.48; 95% CI 0.11-0.73; p=0.011) and the slope of linear regression was significantly non-zero (1.23; 95% CI=0.68-1.77; p<0.0001). CONCLUSIONS HIFU ablation of liver tumours is safe and feasible. HIFU treatment is accurate, and intra-operative assessment of treatment provides an accurate measure of the zone of ablation and correlates well with MRI follow-up.
Collapse
Affiliation(s)
- T Leslie
- Oxford Clinical HIFU Unit, Churchill Hospital, Oxford, UK
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Patel N, Cranston D, Akhtar MZ, George C, Jones A, Leiblich A, Protheroe A, Sullivan M. Active surveillance of small renal masses offers short-term oncological efficacy equivalent to radical and partial nephrectomy. BJU Int 2012; 110:1270-5. [PMID: 22564495 DOI: 10.1111/j.1464-410x.2012.11130.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Study Type - Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Active surveillance of small renal masses has traditionally been reserved for elderly patients deemed unfit for surgery or ablation. There is increasing evidence showing the safety of active surveillance in the management of small renal masses. In this retrospective study we compared outcomes for patients with small renal masses managed with active surveillance, radical nephrectomy and partial nephrectomy. We showed that active surveillance was safe and appeared as effective as immediate surgery in the management of small renal tumours. OBJECTIVE • To compare the oncological outcomes of active surveillance (AS), radical nephrectomy (RN) and partial nephrectomy (PN) in the management of T1a small renal masses (SRMs). PATIENTS AND METHODS • At present AS is used in the treatment of SRMs in elderly patients with multiple co-morbidities or in those who decline surgery. • We identified all patients with T1a SRMs managed with RN, PN or AS. • Retrospective data were collected from patient case records with survival data and cause of death cross-referenced with the Oxford Cancer Intelligence Unit. RESULTS • A total of 202 patients with 234 T1a SRMs (solid or Bosniak IV) were identified; 71 patients were managed with AS, 41 with an RN and 90 by PN. • Over a median follow-up of 34 months the mean growth rate on AS was 0.21 cm/year with 53% of SRMs managed with AS showing negative or zero growth. • No statistically significant difference was observed in overall (OS) and cancer-specific (CSS) survival for AS, RN and PN (AS-CSS 98.6%, AS-OS 83%; RN-CSS 92.6%, RN-OS 80.4%; PN-CSS 96.6%, PN-OS 90.0%). CONCLUSIONS • Active surveillance of SRMs offers oncological efficacy equivalent to surgery in the short/intermediate term. • The results of this study support a multicentre prospective randomized controlled trial designed to compare the oncological efficacy of AS and surgery.
Collapse
Affiliation(s)
- Nilay Patel
- Department of Urology, Churchill Hospital, Headington, Oxford, UK.
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Blick C, Ramachandran A, McCormick R, Cranston D, Harris AL. Abstract 3942: The role of vHL and REDD1 in predicting sensitivity to targeted therapies in renal cell carcinoma. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-3942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
There are currently 6 FDA approved therapies in metastatic renal cell carcinoma and their introduction has improved both time to progression and survival in these patients. Despite treatment with targeted therapies approximately 20% of patients do not respond and the remaining patients will most likely develop resistance during the first 18 months of treatment. The aim of this study was to identify a link between differences in sensitivity to targeted therapies, the vHL status and the expression of genes involved in the mTOR pathway in both historic and primary renal cancer cell lines. Drug sensitivity and gene expression data was analysed in 6 historic and 10 primary renal cancer cell lines obtained from nephrectomy specimens. Gene expression data was also available from an additional 68 renal tumours. We found that cell lines with mutated or absent vHL showed increased sensitivity to rapamycin (p<0.01) but not to other therapies. Gene expression data showed that the expression of REDD1 (regulated in development and DNA damage responses 1), a known HIF1 target gene which inhibits the mTORC1 pathway in response to hypoxic stress correlates with rapamycin sensitivity (R-squared = 0.64, p=0.05). REDD1 expression was also higher in renal tumours when compared with matched normal tissue (p<0.01) and was found to correlate with CAIX expression (R-squared = 0.47, p<0.01). CAIX expression is associated with reduced survival in renal cell carcinoma and so further analysis is being performed to establish a potential role of REDD1 as a prognostic marker. Our findings suggest that vHL status and the levels of REDD1 expression in renal cancer cell lines can predict sensitivity to rapamycin.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3942. doi:1538-7445.AM2012-3942
Collapse
Affiliation(s)
- Christopher Blick
- 1The Weatherall Institute if Molecular Medicine, Oxford, United Kingdom
| | | | - Robert McCormick
- 1The Weatherall Institute if Molecular Medicine, Oxford, United Kingdom
| | | | - Adrian L. Harris
- 1The Weatherall Institute if Molecular Medicine, Oxford, United Kingdom
| |
Collapse
|
22
|
Tweed EJ, Roberts ISD, Cranston D, Winearls CG. A case of bilateral renal masses: dilemmas in their evaluation and management. NDT Plus 2011; 4:126-9. [PMID: 25984132 PMCID: PMC4421579 DOI: 10.1093/ndtplus/sfr019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 02/08/2011] [Indexed: 11/13/2022] Open
|
23
|
Abstract
Renal cell carcinomas (RCCs) account for 3% of all solid neoplasms, with an increased incidence after renal transplantation. In transplant recipients, RCCs predominantly occur in the patient's native kidneys. Herein is reported a case of a localized RCC of recipient origin that developed in the donor allograft and was detected 8 years after renal transplantation. Treatment with high-intensity focussed ultrasound followed by partial nephrectomy was successful, averting the need for dialysis therapy.
Collapse
Affiliation(s)
- A Chakera
- Oxford Kidney Unit, Churchill Hospital, Headington, Oxford, England.
| | | | | | | | | |
Collapse
|
24
|
Patel N, Sullivan M, Cranston D. Re: nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses: C. J. Weight, B. T. Larson, A. F. Fergany, T. Gao, B. R. Lane, S. C. Campbell, J. H. Kaouk, E. A. Klein and A. C. Novick J Urol 2010; 183: 1317-1323. J Urol 2010; 184:2213-4; author reply 2214. [PMID: 20864134 DOI: 10.1016/j.juro.2010.06.127] [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] [Received: 04/10/2010] [Indexed: 10/19/2022]
|
25
|
Ritchie RW, Leslie T, Phillips R, Wu F, Illing R, ter Haar G, Protheroe A, Cranston D. Extracorporeal high intensity focused ultrasound for renal tumours: a 3-year follow-up. BJU Int 2010; 106:1004-9. [PMID: 20230379 DOI: 10.1111/j.1464-410x.2010.09289.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether primary extracorporeal high-intensity focused ultrasound (HIFU) is safe, feasible and effective for managing small renal tumours. PATIENTS AND METHODS Although surgery currently remains the standard treatment for localized renal cell carcinoma (RCC), the increasing incidence of small renal cancers has led to a shift towards nephron-sparing surgery, with associated morbidity in 20-25% of cases, and minimally invasive ablative therapies present an alternative management. HIFU results in 'trackless' homogenous tissue ablation and when administered via an extracorporeal device, is entirely noninvasive. The study comprised 17 patients (mean tumour size 2.5 cm) with radiologically suspicious renal tumours who underwent extracorporeal HIFU using the Model-JC System (Chongqing HAIFU™, China), under general anaesthesia with one overnight hospital stay. Real-time diagnostic ultrasonography was used for targeting and monitoring. Patients were followed with a clinical review and gadolinium-enhanced magnetic resonance imaging at 12 days and every 6 months for a mean of 36 months. The outcomes measures were patient morbidity and oncological efficacy of HIFU treatment. RESULTS Of the 17 patients, 15 were treated according to protocol; two procedures were abandoned due to intervening bowel. There were no major complications related to HIFU. Radiological evidence of ablation was apparent at 12 days in seven of the 15 patients. Before the 6-month follow-up one patient had surgery due to persisting central enhancement. Fourteen patients were evaluated at the 6-month follow-up; eight tumours had involuted (mean 12% decrease in tumour area). Four patients had irregular enhancement on imaging and had alternative therapies. Ten patients remain on follow-up at a mean (range) of 36 (14-55) months after HIFU (mean 30% decrease in tumour area). There was central loss of enhancement in all. CONCLUSIONS Renal HIFU achieves stable lesions in two-thirds of patients, with minimal morbidity, and might be appropriate in selected cases. Further trials with accurate histological follow-up are essential to fully evaluate this novel technique.
Collapse
Affiliation(s)
- Robert W Ritchie
- Nuffield Department of Surgery, University of Oxford, Oxford, UK.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Charlesworth PJ, Kilbey N, Taylor M, Leek R, Cranston D, Turner G, Crew J, Harris A, Protheroe A. Automated uro-oncology data collection: the Cancer Research Uro-Oncology Database. BJU Int 2009; 105:1663-6. [DOI: 10.1111/j.1464-410x.2009.09058.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Abstract
OBJECTIVE To present three cases of tumour thrombus in the retro-aortic renal vein (RARV) arising from left renal cell carcinomas (RCCs), a very rare event (<1:1000-2000 per case) and to discuss the embryological, radiological and surgical aspects of this anomaly. PATIENTS AND METHODS Three cases of RCC with RARV thrombus presented in a 1-month period at one institution. RESULTS All three cases were identified before surgery by computed tomography (CT) urograms and had a successful nephrectomy. CONCLUSION RCC in the presence of RARVs is rare but can be identified on CT urogram. At nephrectomy, a midline laparotomy or full 'rooftop incision' is recommended, and any attempt to mobilize the kidney before dealing with the renal pedicle should be avoided.
Collapse
Affiliation(s)
- Howard Marsh
- Department of Urology, Medway Maritime Hospital, Gillingham, Kent, UK.
| | | | | |
Collapse
|
28
|
Aslam MZ, Kheradmund F, Patel NS, Turner G, Cranston D. Dermoid cyst of the spermatic cord: a rare cause of benign inguinal lump. Can Urol Assoc J 2009; 3:E29-E30. [PMID: 19672433 DOI: 10.5489/cuaj.1136] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Dermoid cyst of the spermatic cord is an extremely rare pathology seen at the urological clinic. We present the case of a 26-year-old man who presented with a groin lump, thought to be a lipoma or a hydrocoele of the cord. The final histopathological analysis established the diagnosis of a dermoid cyst.
Collapse
|
29
|
Mohammed Ilyas MI, Turner GDH, Cranston D. Human chorionic gonadotropin-secreting clear cell renal cell carcinoma with paraneoplastic gynaecomastia. ACTA ACUST UNITED AC 2009; 42:555-7. [DOI: 10.1080/00365590802468834] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - David Cranston
- Department of Urology, Churchill Hospital, Oxford Radcliffe Hospitals Trust, Oxford, UK
| |
Collapse
|
30
|
Ritchie RW, Leslie TA, Phillips R, Protheroe A, Cranston D. HIGH INTENSITY FOCUSED ULTRASOUND ABLATION OF SMALL RENAL TUMOURS WITH AN EXTRA-CORPOREAL DEVICE: 3 YEAR OUTCOME DATA. J Urol 2009. [DOI: 10.1016/s0022-5347(09)61325-2] [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: 11/24/2022]
|
31
|
Ritchie R, Leslie T, Phillips R, Protheroe A, Cranston D. 815 EXTRACORPOREAL HIGH INTENSITY FOCUSED ULTRASOUND FOR SMALL KIDNEY TUMOURS: 3 YEAR FOLLOW-UP. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s1569-9056(09)60803-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
32
|
Henderson A, Blick C, Shah S, Ray E, Cranston D, O'Brien TS. PARTIAL NEPHRECTOMY FOR RENAL CELL CARCINOMA IN SINGLE KIDNEYS. J Urol 2008. [DOI: 10.1016/s0022-5347(08)61108-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
33
|
|
34
|
Abstract
Immunosuppression in solid-organ recipients is associated with a greater risk of de novo malignancy after transplantation; herein we report the UK transplant registry (UKTR) database of urological cancer after renal transplantation in the UK transplant population. From September 1999 to January 2006 there were 10,847 kidney recipients with at least one period of follow-up reported after a kidney transplant (mean age at transplantation 42.4 years, sd 15.5; 6685 male, 61.6%, and 4162 female, 38.3%). The recipients represent a homogenous group who received different immunosuppression regimens. Skin cancer was excluded from the study. Unfortunately, the UKTR does not collect information about the presence or absence of cancer, either at registration onto the transplant waiting list or at transplantation. In all, 214 (1.9%) patients were reported to have a subsequent urological malignancy diagnosed among the 10,847 recipients. The UKTR was used to identify patients who developed urological malignancies after renal transplantation, which is a challenging event after solid-organ transplantation. Regular surveillance to diagnose early occurrence and adjustment of immunosuppression might be beneficial. In the presence of metastatic disease, chemotherapy treatment with adjustment or cessation of immunosuppressive therapy is required.
Collapse
Affiliation(s)
- Dler Besarani
- Department of Urology, Churchill Hospital, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK.
| | | |
Collapse
|
35
|
Ord JJ, Agrawal S, Thamboo TP, Roberts I, Campo L, Turley H, Han C, Fawcett DW, Kulkarni RP, Cranston D, Harris AL. An investigation into the prognostic significance of necrosis and hypoxia in high grade and invasive bladder cancer. J Urol 2007; 178:677-82. [PMID: 17574616 DOI: 10.1016/j.juro.2007.03.112] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Indexed: 11/23/2022]
Abstract
PURPOSE We investigated hypoxia and necrosis in high grade and invasive bladder cancer, and related this to prognosis. MATERIALS AND METHODS We performed a retrospective observational study of 98 primary cystectomy specimens scored for necrosis, and the hypoxia associated markers carbonic anhydrase IX, hypoxia-inducible factor 1 alpha and 2 alpha, and Bcl2/adenovirus EIB 19 kDa interacting protein 3. Tumor tissue array was used with cores taken from representative and perinecrotic tumor regions. Necrosis was scored on whole sections as absent, less than 5 mm (comedo) or more than 5 mm (gross). RESULTS Of the 98 cases analyzed followup data were available on 91. Median followup was 22 months (IQR 8-35). Stage was T0/1 to T4 in 18, 20, 41 and 12 cases, respectively. The prevalence of necrosis in bladder cancer was high and it increased with stage (17%, 30%, 70% and 71% at stages T0/1 to T4, respectively). Necrosis was significantly associated with stage (p = 0.0001) and nodal status (p = 0.016). Hypoxia-inducible factor 1 alpha showed no association with stage, grade or nodal status. Hypoxia-inducible factor 1 alpha and carbonic anhydrase IX showed a significant association with necrosis, whereas hypoxia-inducible factor 2 alpha and Bcl2/adenovirus EIB 19 kDa interacting protein 3 did not. Stage (p <0.0001), necrosis (p <0.0001) and intense hypoxia-inducible factor 1 positivity (p = 0.048) were the only significant prognostic factors on univariate analysis. Stage (HR 3.29, 95% CI 1.80-6.04, p <0.001) and necrosis (HR 1.92, 95% CI 1.05-3.51, p = 0.04) were independent prognostic factors on multivariate analysis, while hypoxia-inducible factor 1 lost significance (HR 1.36, 95% CI 0.98-1.88, p = 0.07). Node status was only reported in 45% of cases. CONCLUSIONS Necrosis (the presence and amount) in high grade and invasive bladder cancer is an independent prognostic risk factor.
Collapse
Affiliation(s)
- Jonathan J Ord
- Department of Urology, Churchill Hospital, Oxford, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Chong T, Cranston D, Cerundolo V. MP-20.09. Urology 2006. [DOI: 10.1016/j.urology.2006.08.590] [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: 10/24/2022]
|
37
|
Cranston D. Textbook of benign prostatic hyperplasia. R. Kirby, J. D. McConnell, J. M. Fitzpatrick, C. G. Roehrborn and P. Boyle. 282 × 223 mm. Pp. 566. Illustrated. 1996. Oxford: Isis Medical Media. £99.50. Br J Surg 2005. [DOI: 10.1002/bjs.1800840247] [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: 10/24/2022]
Affiliation(s)
- D Cranston
- Churchill Hospital, Headington, Oxford OX3 7LJ, UK
| |
Collapse
|
38
|
Cranston D. Urology. 2nd ed. J. Blandy and C. Fowler. 282 × 220 mm. Pp. 639. Illustrated. 1995. Oxford: Blackwell Science. £99.50. Br J Surg 2005. [DOI: 10.1002/bjs.1800831063] [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: 11/10/2022]
Affiliation(s)
- D Cranston
- Churchill Hospital, Headington, Oxford OX3 7LJ, UK
| |
Collapse
|
39
|
Abstract
Hypoxia-inducible genes have been linked to the aggressive phenotype of cancer. However, nearly all work on hypoxia-regulated genes has been conducted in vitro on cell lines. We investigated the hypoxia transcriptome in primary human bladder cancer using cDNA microarrays to compare genes induced by hypoxia in vitro in bladder cancer cell line EJ28 with genes upregulated in 39 bladder tumour specimens (27 superficial and 12 invasive). We correlated array mRNA fold changes with carbonic anhydrase 9 (CA IX) staining of tumours as a surrogate marker of hypoxia. Of 6000 genes, 32 were hypoxia inducible in vitro more than two-fold, five of which were novel, including lactate transporter SLC16A3 and RNAse 4. Eight of 32 hypoxia-inducible genes in vitro were also upregulated on the vivo array. Vascular endothelial growth factor mRNA was upregulated two-fold by hypoxia and 2–18-fold in 31 out of 39 tumours. Glucose transporter 1 was also upregulated on both arrays mRNA, and fold changes on the in vivo array significantly correlated with CA IX staining of tumours (P=0.008). However, insulin-like growth factor binding protein 3 mRNA was the most strongly differentially expressed gene in both arrays and this confirmed its upregulation in urine of bladder cancer patients (n=157, P<0.01). This study defines genes suitable for an in vivo hypoxia ‘profile’, shows the heterogeneity of the hypoxia response and describes new hypoxia-regulated genes.
Collapse
Affiliation(s)
- J J Ord
- Department of Urology, Churchill Hospital, Oxford, UK
| | - E H Streeter
- Department of Urology, Churchill Hospital, Oxford, UK
| | - I S D Roberts
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK
| | - D Cranston
- Department of Urology, Churchill Hospital, Oxford, UK
| | - A L Harris
- Institute of Molecular Medicine, Cancer Research UK Laboratory, John Radcliffe Hospital, Oxford, UK
- Institute of Molecular Medicine, Cancer Research UK Laboratory, John Radcliffe Hospital, Oxford, UK. E-mail:
| |
Collapse
|
40
|
Ord JJ, Streeter E, Jones A, Le Monnier K, Cranston D, Crew J, Joel SP, Rogers MA, Banks RE, Roberts ISD, Harris AL. Phase I trial of intravesical Suramin in recurrent superficial transitional cell bladder carcinoma. Br J Cancer 2005; 92:2140-7. [PMID: 15928663 PMCID: PMC2361814 DOI: 10.1038/sj.bjc.6602650] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Suramin is an antitrypanosomal agent with antineoplastic activity, but with serious systemic side effects. We administered Suramin intravesically to determine a concentration with low toxicity but with evidence of a pharmacodynamic effect, to recommend a dose level for phase II trials. This was an open-labelled, nonrandomised dose-escalation phase I study. In all, 12 patients with a history of recurrent superficial bladder cancer were grouped into four dose levels (10–150 mg ml−1 in 60 ml saline). Six catheter instillations at weekly intervals were used. Cystoscopy and biopsy were performed before and 3 months after the start of treatment. Suramin was assayed using high-performance liquid chromatography, vascular endothelial growth factor (VEGF) using ELISA (enzyme-linked immunosorbent assay), and urinary protein profile using surface-enhanced laser desorption ionisation mass spectroscopy (SELDI). Minimal systemic absorption of Suramin was found at the highest dose of 150 mg ml−1. Urinary VEGF was affected by Suramin at doses above 50 mg ml−1, corresponding to the estimated threshold of saturation of Suramin binding to urine albumin. SELDI showed a specific disappearance of urinary protein peaks during treatment. Intravesical Suramin shows lack of toxicity and low systemic absorption. The results of this phase I trial support expanded clinical trials of efficacy at a dose of 100 mg ml−1 intravesically.
Collapse
Affiliation(s)
- J J Ord
- Department of Urology, Churchill Hospital, Oxford, UK
| | - E Streeter
- Department of Urology, Churchill Hospital, Oxford, UK
| | - A Jones
- Department of Urology, Churchill Hospital, Oxford, UK
| | - K Le Monnier
- Department of Urology, Churchill Hospital, Oxford, UK
| | - D Cranston
- Department of Urology, Churchill Hospital, Oxford, UK
| | - J Crew
- Department of Urology, Churchill Hospital, Oxford, UK
| | - S P Joel
- Department of Medical Oncology, St Bartholomew's Hospital, London, UK
| | - M A Rogers
- Cancer Research UK Clinical Centre, St James's University Hospital, Leeds, UK
| | - R E Banks
- Cancer Research UK Clinical Centre, St James's University Hospital, Leeds, UK
| | - I S D Roberts
- Department of Cellular Pathology, John Radcliffe Hospital, Oxford, UK
| | - A L Harris
- Growth Factor Group, Cancer Research UK, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK
- Growth Factor Group, Cancer Research UK, Room 405-411, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford OX3 7LJ, UK. E-mail:
| |
Collapse
|
41
|
Affiliation(s)
- Dler Besarani
- Oxford Radcliffe Hospitals NHS Trust, Churchill Hospital, Oxford, UK.
| | | |
Collapse
|
42
|
Affiliation(s)
- Michael Marberger
- Department of Urology, University of Vienna Medical School, Austria.
| | | | | | | |
Collapse
|
43
|
Kennedy JE, ter Haar GR, Wu F, Gleeson FV, Roberts ISD, Middleton MR, Cranston D. Contrast-enhanced ultrasound assessment of tissue response to high-intensity focused ultrasound. Ultrasound Med Biol 2004; 30:851-854. [PMID: 15219964 DOI: 10.1016/j.ultrasmedbio.2004.03.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2003] [Revised: 03/05/2004] [Accepted: 03/16/2004] [Indexed: 05/24/2023]
Abstract
We report the use of contrast-enhanced ultrasonography as an immediate means of assessing the clinical response to high-intensity focused ultrasound (US) or HIFU treatment of liver tumours. HIFU is a noninvasive transcutaneous technique for the ablation of tumours that has been shown to destroy tumour vasculature, as well as to cause coagulative necrosis of tumour cells. As a dynamic indicator of tissue perfusion, microbubble contrast agents have already been reported to increase the diagnostic sensitivity of ultrasonography in the detection of liver tumours. This report documents the ability of one i.v. microbubble contrast agent (SonoVue, Bracco, Italy) to delineate the extent of HIFU ablation by comparison of pre- and immediately posttreatment perfusion within the target tumour. Observed changes were seen to correlate well with the ablated volume on histologic evaluation of the treated volume. This is the first time that this imaging technique has been reported in this setting.
Collapse
|
44
|
Kennedy JE, Wu F, ter Haar GR, Gleeson FV, Phillips RR, Middleton MR, Cranston D. High-intensity focused ultrasound for the treatment of liver tumours. Ultrasonics 2004; 42:931-5. [PMID: 15047409 DOI: 10.1016/j.ultras.2004.01.089] [Citation(s) in RCA: 249] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
High-intensity focused ultrasound (HIFU) has been investigated as a tool for the treatment of cancer for many decades, but is only now beginning to emerge as a potential alternative to conventional therapies. In recent years, clinical trials have evaluated the clinical efficacy of a number of devices worldwide. In Oxford, UK, we have been using the JC HIFU system (HAIFU Technology Company, Chongqing, PR China) in clinical trials since November 2002. This is the first report of its clinical use outside mainland China. The device is non-invasive, and employs an extracorporeal transducer operating at 0.8-1.6 MHz (aperture 12-15 cm, focal length 9-15 cm), operating clinically at Isp (free field) of 5-15 KWcm(-2). The aims of the trials are to evaluate the safety and performance of the device. Performance is being evaluated through two parallel protocols. One employs radiological assessment of response with the use of follow-up magnetic resonance imaging and microbubble-contrast ultrasound. In the other, histological assessment will be made following elective surgical resection of the HIFU treated tumours. Eleven patients with liver tumours have been treated with HIFU to date. Adverse events include transient pain and minor skin burns. Observed response from the various assessment modalities is discussed.
Collapse
Affiliation(s)
- J E Kennedy
- Department of Urology, Churchill Hospital, Oxford OX3 7LJ, UK.
| | | | | | | | | | | | | |
Collapse
|
45
|
Ord J, Potter M, Reynard J, Cranston D. Transitional cell carcinoma of the kidney invading the inferior vena cava, treated by excision and grafting, with a review of vena cava replacement. BJU Int 2003; 92 Suppl 3:e38-e40. [PMID: 19127633 DOI: 10.1111/j.1464-410x.2003.04056.x] [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: 11/30/2022]
Affiliation(s)
- J Ord
- The Churchill Hospital, Oxford, UK.
| | | | | | | |
Collapse
|
46
|
Abstract
For 50 years, high intensity focused ultrasound (HIFU) has been a subject of interest for medical research. HIFU causes selective tissue necrosis in a very well defined volume, at a variable distance from the transducer, through heating or cavitation. Over the past decade, the use of HIFU has been investigated in many clinical settings. This literature review aims to summarize recent advances made in the field. A Medline-based literature search (1965-2002) was conducted using the keywords "HIFU" and "high intensity focused ultrasound". Additional literature was obtained from original papers and published meeting abstracts. The most abundant clinical trial data comes from studies investigating its use in the treatment of prostatic disease, although early research looked at applications in neurosurgery. More recently horizons have been broadened, and the potential of HIFU as a non-invasive surgical tool has been demonstrated in many settings including the treatment of tumours of the liver, kidney, breast, bone, uterus and pancreas, as well as conduction defects in the heart, for surgical haemostasis, and the relief of chronic pain of malignant origin. Further clinical evaluation will follow, but recent technological development suggests that HIFU is likely to play a significant role in future surgical practice.
Collapse
Affiliation(s)
- J E Kennedy
- Department of Urology, Churchill Hospital, Oxford, Head of Therapeutic Ultrasound, Royal Marsden Hospital, Sutton and Consultant Urologist, Churchill Hospital, Oxford, UK
| | | | | |
Collapse
|
47
|
Marsh HP, Haldar NA, Bunce M, Marshall SE, le Monier K, Winsey SL, Christodoulos K, Cranston D, Welsh KI, Harris AL. Polymorphisms in tumour necrosis factor (TNF) are associated with risk of bladder cancer and grade of tumour at presentation. Br J Cancer 2003; 89:1096-101. [PMID: 12966432 PMCID: PMC2376948 DOI: 10.1038/sj.bjc.6601165] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The purpose of this study is to assess the role of tumour necrosis factor (TNF) polymorphisms in the risk of developing bladder cancer and effect on tumour stage, grade and progression. In all, seven single-nucleotide polymorphisms in TNF were studied in 196 bladder cancer patients and 208 controls using a PCR-SSP genotyping technique. It was seen that there was a significant association of two polymorphisms in TNF with bladder cancer: the TNF+488A allele was found in 28.1% of patients compared with 14.9% of controls (P=0.0012). In addition, TNF-859T was found in 26.0% of patients compared with 14.4% of the controls (P=0.0036). The two loci were in tight linkage disequilibrium, that is, almost all the individuals having TNF+488A also had TNF-859T. Patients with the TNF+488A or TNF-859T were more likely to present with a moderately differentiated tumour than those patients without the uncommon allele. In all, 16.7% of patients with TNF+488A and 29.9% of patients without TNF+488A presented with a G1 tumour (P=0.015). A total of 14% of patients with TNF-859T and 30.5% of patients without TNF-859T presented with a G1 tumour (P=0.0043). There was no significant effect on time to first recurrence, stage progression or grade progression. In conclusion, a significant association between TNF polymorphisms TNF+488A and TNF-859T and risk of bladder cancer was detected in this study. Both these polymorphisms were associated with grade of tumour at presentation although there was no significant effect on subsequent tumour behaviour.
Collapse
Affiliation(s)
- H P Marsh
- Transplant Immunology Laboratory, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
- Department of Urology, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
- Imperial Cancer Research Fund Medical Oncology Unit, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
| | - N A Haldar
- Department of Urology, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
| | - M Bunce
- Transplant Immunology Laboratory, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
| | - S E Marshall
- Transplant Immunology Laboratory, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
| | - K le Monier
- Department of Urology, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
| | - S L Winsey
- Transplant Immunology Laboratory, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
| | - K Christodoulos
- Imperial Cancer Research Fund Medical Oncology Unit, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
| | - D Cranston
- Department of Urology, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
| | - K I Welsh
- Transplant Immunology Laboratory, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
- Emanuel Kaye Building, National Heart and Lung Institute, Manresa Road, London SW3 6LR, UK
| | - A L Harris
- Imperial Cancer Research Fund Medical Oncology Unit, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK
- Imperial Cancer Research Fund Medical Oncology Unit, Oxford Radcliffe Hospitals, Oxford OX3 7LJ, UK. E-mail:
| |
Collapse
|
48
|
Aitchison M, Cranston D. Poster Session 6: Basic Science: Renal Cancer/Transplantation. BJU Int 2003. [DOI: 10.1046/j.1464-410x.91.s2.6.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: 11/20/2022]
|
49
|
Jones A, Cranston D. Bladder cancer. Biology, diagnosis and management K. N. Syrigos and D. G. Skinner (eds) 250 × 190 mm. Pp. 469. Illustrated. 1999. Oxford: Oxford University Press. £79.50. Br J Surg 2002. [DOI: 10.1046/j.1365-2168.1999.01310-5.x] [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]
Affiliation(s)
- A Jones
- Oxford Radcliffe Hospital, The Churchill, Headington, Oxford OX3 7LJ, UK
| | - D Cranston
- Oxford Radcliffe Hospital, The Churchill, Headington, Oxford OX3 7LJ, UK
| |
Collapse
|
50
|
Affiliation(s)
- J Ord
- The Churchill Hospital, Oxford, UK.
| | | |
Collapse
|