1
|
Lai TS, Francoeur A, Manrriquez E, Venkat P, Chang A, Douek M, Bahrami S, Raman SS, Memarzadeh S. Percutaneous interstitial brachytherapy ablation for targeting oligometastatic gynecologic cancers. Brachytherapy 2024; 23:266-273. [PMID: 38453533 DOI: 10.1016/j.brachy.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 12/08/2023] [Accepted: 12/30/2023] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Treatment of recurrent oligometastatic gynecologic malignancy may involve targeted surgery, thermal ablation, or CT-guided high-dose-rate interstitial brachytherapy ablation (CT-HDR-IBTA). The purpose of this study was to describe the safety and efficacy of CT-HDR-IBTA for oligometastatic gynecologic malignancies. METHODS With institutional review board approval (IRB) approval and compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliance, we searched our database to assemble a single-arm study cohort of all patients with oligometastatic gynecologic cancers who underwent CT-HDR-IBTA from 2012-2022 with follow-up. The electronic record was reviewed to determine relevant clinicopathological variables including patient demographics, prior treatments, clinical course, local control, and local and distant recurrence with follow-up imaging. RESULTS The study cohort comprised 37 lesions in 34 patients treated with CT-HDR-IBTA for recurrent oligometastatic uterine (n = 17), cervix (n = 1), or ovarian cancer (n = 16) with an average lesion size of 2.5 cm with an average patient age of 61.4 years. Each lesion was treated with an average radiation dose of 23.8 Gy in 1.8 fractions and a median follow-up time of 24.0 months. The primary efficacy of CT HDR ITBA was 73% with a median progression-free survival of 8.0 months (95% CI 3.6-12.8 months) and with 58% of patients still alive at 43 months with median overall survival not reached. The rate of Grade 1 adverse events was 22% without any Grade 2, 3 or 4 events. CONCLUSIONS CT HDR IBTA was safe and effective for treating oligometastatic gynecologic cancers in a heavily pretreated cohort.
Collapse
Affiliation(s)
- Tiffany S Lai
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA.
| | - Alex Francoeur
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA
| | | | - Puja Venkat
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Albert Chang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA
| | - Michael Douek
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Simin Bahrami
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Steven S Raman
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| | - Sanaz Memarzadeh
- Department of Obstetrics and Gynecology, University of California Los Angeles, Los Angeles, CA
| |
Collapse
|
2
|
Gong AJ, Ruchalski K, Kim HJ, Douek M, Gutierrez A, Patel M, Sai V, Coy H, Villegas B, Raman S, Goldin J. RECIST 1.1 Target Lesion Categorical Response in Metastatic Renal Cell Carcinoma: A Comparison of Conventional versus Volumetric Assessment. Radiol Imaging Cancer 2023; 5:e220166. [PMID: 37656041 PMCID: PMC10546365 DOI: 10.1148/rycan.220166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 09/02/2023]
Abstract
Purpose To investigate Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1) approximations of target lesion tumor burden by comparing categorical treatment response according to conventional RECIST versus actual tumor volume measurements of RECIST target lesions. Materials and Methods This is a retrospective cohort study of individuals with metastatic renal cell carcinoma enrolled in a clinical trial (from 2003 to 2017) and includes individuals who underwent baseline and at least one follow-up chest, abdominal, and pelvic CT study and with at least one target lesion. Target lesion volume was assessed by (a) Vmodel, a spherical model of conventional RECIST 1.1, which was extrapolated from RECIST diameter, and (b) Vactual, manually contoured volume. Volumetric responses were determined by the sum of target lesion volumes (Vmodel-sum TL and Vactual-sum TL, respectively). Categorical volumetric thresholds were extrapolated from RECIST. McNemar tests were used to compare categorical volume responses. Results Target lesions were assessed at baseline (638 participants), week 9 (593 participants), and week 17 (508 participants). Vmodel-sum TL classified more participants as having progressive disease (PD), compared with Vactual-sum TL at week 9 (52 vs 31 participants) and week 17 (57 vs 39 participants), with significant overall response discordance (P < .001). At week 9, 25 (48%) of 52 participants labeled with PD by Vmodel-sum TL were classified as having stable disease by Vactual-sum TL. Conclusion A model of RECIST 1.1 based on a single diameter measurement more frequently classified PD compared with response assessment by actual measured tumor volume. Keywords: Urinary, Kidney, Metastases, Oncology, Tumor Response, Volume Analysis, Outcomes Analysis ClinicalTrials.gov registration no. NCT01865747 © RSNA, 2023 Supplemental material is available for this article.
Collapse
Affiliation(s)
- Amanda J. Gong
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Kathleen Ruchalski
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Hyun J. Kim
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Michael Douek
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Antonio Gutierrez
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Maitraya Patel
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Victor Sai
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Heidi Coy
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Bianca Villegas
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Steven Raman
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| | - Jonathan Goldin
- From the David Geffen School of Medicine, University of California,
Los Angeles, Calif (A.J.G., K.R., H.J.K., M.D., A.G., M.P., V.S., H.C., S.R.,
J.G.); Department of Radiological Sciences, UCLA, Los Angeles, Calif (K.R.,
H.J.K., M.D., A.G., M.P., V.S., S.R., J.G.); and UCLA Center for Computer Vision
and Imaging Biomarkers, 924 Westwood Blvd, Ste 615, Los Angeles, CA 90024
(A.J.G., H.J.K., H.C., B.V., J.G.)
| |
Collapse
|
3
|
Jozsa F, Baker R, Kelly P, Ahmed M, Douek M. The Use of Machine Learning to Reduce Overtreatment of the Axilla in Breast Cancer: Retrospective Cohort Study. JMIR Perioper Med 2022; 5:e34600. [DOI: 10.2196/34600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 09/18/2022] [Accepted: 10/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background
Patients with early breast cancer undergoing primary surgery, who have low axillary nodal burden, can safely forego axillary node clearance (ANC). However, routine use of axillary ultrasound (AUS) leads to 43% of patients in this group having ANC unnecessarily, following a positive AUS. The intersection of machine learning with medicine can provide innovative ways to understand specific risks within large patient data sets, but this has not yet been trialed in the arena of axillary node management in breast cancer.
Objective
The objective of this study was to assess if machine learning techniques could be used to improve preoperative identification of patients with low and high axillary metastatic burden.
Methods
A single-center retrospective analysis was performed on patients with breast cancer who had a preoperative AUS, and the specificity and sensitivity of AUS were calculated. Standard statistical methods and machine learning methods, including artificial neural network, naive Bayes, support vector machine, and random forest, were applied to the data to see if they could improve the accuracy of preoperative AUS to better discern high and low axillary burden.
Results
The study included 459 patients; 142 (31%) had a positive AUS; among this group, 88 (62%) had 2 or fewer macrometastatic nodes at ANC. Logistic regression outperformed AUS (specificity 0.950 vs 0.809). Of all the methods, the artificial neural network had the highest accuracy (0.919). Interestingly, AUS had the highest sensitivity of all methods (0.777), underlining its utility in this setting.
Conclusions
We demonstrated that machine learning improves identification of the important subgroup of patients with no palpable axillary disease, positive ultrasound, and more than 2 metastatically involved nodes. A negative ultrasound in patients with no palpable lymphadenopathy is highly indicative of low axillary burden, and it is unclear whether sentinel node biopsy adds value in this situation. Further studies with larger patient numbers focusing on specific breast cancer subgroups are required to refine these techniques in this setting.
Collapse
|
4
|
Hu TX, Nguyen DT, Patel M, Beckett K, Douek M, Masamed R, Rhyu J, Kim J, Tseng CH, Yeh MW, Livhits MJ. The Effect Modification of Ultrasound Risk Classification on Molecular Testing in Predicting the Risk of Malignancy in Cytologically Indeterminate Thyroid Nodules. Thyroid 2022; 32:905-916. [PMID: 35611970 DOI: 10.1089/thy.2021.0659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background: Thyroid nodules with indeterminate cytology are increasingly subjected to molecular testing. We evaluated the diagnostic performances of Afirma Genomic Sequencing Classifier (GSC) and ThyroSeq v3 in thyroid nodules with high versus low/intermediate suspicion ultrasound classification. Methods: In this prospective cohort study, we analyzed all Bethesda III and IV thyroid nodules that underwent fine-needle aspiration biopsies in the University of California Los Angeles Health System from July 2017 to April 2020. All patients underwent molecular testing with Afirma GSC or ThyroSeq v3 as part of an institutional randomized trial (NCT02681328). Nodules were categorized according to the American Thyroid Association (ATA) ultrasound risk classification. The benign call rate and the positive predictive value of molecular testing were compared between ATA high suspicion versus all other categories. Results: A total of 343 patients with 375 indeterminate thyroid nodules were included. The malignancy rate in ATA high suspicion nodules was not significantly increased by a suspicious Afirma GSC result (77.8% for all ATA high suspicion nodules vs. 87.5% for nodules with ATA high suspicion and suspicious Afirma GSC results, positive likelihood ratio [LR] = 2.0, 95% confidence interval [CI 0.5-8.0], p = 1.0) or by a positive ThyroSeq v3 result (80.0% vs. 80.0%, positive LR = 1.0 [CI 1.0-1.0], p = 1.0). The rate of malignancy in ATA low/intermediate suspicion nodules increased from 21.0% to 56.3% with a suspicious Afirma GSC result (positive LR = 4.8 [CI 3.4-6.9], p < 0.0001) and decreased to 3.8% with a benign Afirma GSC result (negative LR = 0.1 [CI 0.07-0.3], p < 0.0001). Similarly, the rate of malignancy in ATA low/intermediate suspicion nodules increased from 24.3% to 66.7% with a positive ThyroSeq v3 result (positive LR = 6.2 [CI 4.0-9.7], p < 0.0001) and decreased to 2.1% with a negative ThyroSeq v3 result (negative LR = 0.07 [CI 0.02-0.3], p < 0.0001). Conclusions: Afirma GSC and ThyroSeq v3 performed well in ruling out malignancy in sonographically low/intermediate suspicion thyroid nodules but has limited diagnostic value in sonographically high suspicion nodules. Molecular testing can prognosticate more aggressive thyroid cancers, which can inform treatment decisions.
Collapse
Affiliation(s)
- Theodore X Hu
- Section of Endocrine Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Dalena T Nguyen
- Section of Endocrine Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Maitraya Patel
- Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Katrina Beckett
- Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Michael Douek
- Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Rinat Masamed
- Department of Radiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Jane Rhyu
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Jiyoon Kim
- Department of Biostatistics, Fielding School of Public Health at University of California Los Angeles, Los Angeles, California, USA
| | - Chi-Hong Tseng
- Department of Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Michael W Yeh
- Section of Endocrine Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| | - Masha J Livhits
- Section of Endocrine Surgery, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California, USA
| |
Collapse
|
5
|
Ruchalski K, Kim HJ, Douek M, Raman S, Patel M, Sai V, Gutierrez A, Levine B, Fischer C, Allen-Auerbach M, Gupta P, Coy H, Villegas B, Brown M, Goldin J. Pretreatment visceral metastases in castration resistant metastatic prostate cancer: role in prediction versus actual site of disease progression. Cancer Imaging 2022; 22:34. [PMID: 35836271 PMCID: PMC9281063 DOI: 10.1186/s40644-022-00469-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 06/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the anatomic site(s) of initial disease progression in patients with castration resistant metastatic prostate cancer (mCRPC) in the presence or absence of pre-treatment visceral metastases while on systemic therapy. METHODS This is a retrospective cohort study of mCRPC patients who have baseline and at least one follow up bone scan and CT chest, abdomen and pelvis (CAP). Disease progression was determined by RECIST and/or ≥ 30% increase in automated bone scan lesion area score. Kaplan-Meier plot was used to estimate the median progression free survival and log-rank tests were used to compare anatomic sites. RESULTS Of 203 patients, 61 (30%) had pre-treatment visceral metastases. Patients with baseline visceral disease were 1.5 times more likely to develop disease progression (HR = 1.53; 95% CI, 1.03-2.26). Disease progression was a result of worsening bone scan disease (42% (16/38)) versus visceral (32% (12/38)) or lymph node disease (3% (1/38)) by CT or a combination thereof (23% (9/38)). Median time to progression (TTP) did not differ by anatomic location of initial progression (p = 0.86). Development of new lesions occurred in 50% of those visceral patients with soft tissue only progression and was associated with a significantly longer TTP (3.1 months (2.8-4.3 months) than those with worsening of pre-existing lesions (1.8 months (1.6-2.7 months); p = 0.04. CONCLUSIONS Patients with pre-treatment visceral metastases in mCRPC are more likely to experience disease progression of bone disease with the initial anatomic site of progression similar to those without baseline visceral involvement.
Collapse
Affiliation(s)
| | - Hyun J Kim
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA.,UCLA Center for Computer Vision and Imaging Biomarkers, Los Angeles, CA, USA
| | - Michael Douek
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
| | - Steven Raman
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
| | - Maitraya Patel
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
| | - Victor Sai
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
| | | | - Benjamin Levine
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
| | - Cheryce Fischer
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA
| | - Martin Allen-Auerbach
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA
| | - Pawan Gupta
- Ahmanson Translational Theranostics Division, Department of Molecular & Medical Pharmacology, University of California Los Angeles, Los Angeles, CA, USA
| | - Heidi Coy
- UCLA Center for Computer Vision and Imaging Biomarkers, Los Angeles, CA, USA
| | - Bianca Villegas
- UCLA Center for Computer Vision and Imaging Biomarkers, Los Angeles, CA, USA
| | - Matthew Brown
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA.,UCLA Center for Computer Vision and Imaging Biomarkers, Los Angeles, CA, USA
| | - Jonathan Goldin
- Department of Radiological Sciences, UCLA, Los Angeles, CA, USA.,UCLA Center for Computer Vision and Imaging Biomarkers, Los Angeles, CA, USA
| |
Collapse
|
6
|
Ruchalski K, Kim HJ, Dewan R, Douek M, Sai V, Villegas B, Wong KP, Lisberg AE, Goldman JW, Goldin J, Garon EB, Aberle DR. Inter-reader reliability of immune-specific response criteria (irRECIST & iRECIST). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21108] [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
e21108 Background: RECIST 1.1 can underestimate treatment benefits of immunotherapy, with irRECIST and iRECIST accounting for atypical responses. Inter-reader discordances are known to occur in a dual reader paradigm. Our objective is to compare inter-reader reliability between RECIST 1.1, irRECIST, and iRECIST. Methods: This is a retrospective analysis of advanced NSCLC patients treated with pembrolizumab at our institution as part of the KEYNOTE-001 study. All trial imaging was interpreted by two radiologists. RECIST 1.1, irRECIST, and iRECIST categorical responses and agreement for progressive disease (PD) was compared by kappa statistic. Time to progression (TTP) or time to censor was compared between readers by paired t test. Relationship to disease progression and overall survival (OS) was assessed by log rank. Results: Of 98 patients, 77 had baseline and subsequent imaging available for 5.8 mean timepoints with 42.9 weeks of follow up. From this group, 45 patients had imaging beyond iUPD for confirmation and were analyzed. PD occurred by reader 1, reader 2 in 34, 33 patients by RECIST 1.1 (k = 0.591, CI = 0.320-0.863), 31, 29 patients by irRECIST (k = 0.501, CI = 0.234-0.768), and 27, 22 patients by iRECIST iCPD (confirmed-PD) (k = 0.690, CI = 0.485-0.896). There was no significant difference in reader agreement by RECIST 1.1, irRECIST, iRECIST (p = 0.38, 0.60, 0.26). There was a significant difference in time to progression between RECIST 1.1, irRECIST and iRECIST, with median PFS 3.4 months (2.6-4.6), 4.7 (3.5-6.8) and 8.7 (6.9-14.5) (p < 0.0001). PD by any criteria was not significantly correlated with OS. Conclusions: PD confirmation by iRECIST resulted in substantial reader agreement compared to moderate reader agreement by RECIST 1.1 and irRECIST. There were significant differences in TTP between the criteria, with iRECIST having the longest TTP. PD by each criteria did not correlate with a significant difference in OS.[Table: see text]
Collapse
Affiliation(s)
| | - Hyun J. Kim
- Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, CA
| | - Rohit Dewan
- UCLA Department of Radiological Sciences, Los Angeles, CA
| | - Michael Douek
- University of California Los Angeles Department of Radiological Sciences, Los Angeles, CA
| | - Victor Sai
- UCLA Department of Radiological Sciences, Los Angeles, CA
| | - Bianca Villegas
- UCLA Center for Computer Vision and Imaging Biomarkers, Los Angeles, CA
| | - Koon-Pong Wong
- UCLA Center for Computer Vision and Imaging Biomarkers, Los Angeles, CA
| | - Aaron E. Lisberg
- Department of Medicine, Division of Hematology/Oncology, UCLA, Los Angeles, CA
| | | | | | | | | |
Collapse
|
7
|
Douek M. Radiofrequency ablation of solid, non-functional thyroid nodules. Tech Vasc Interv Radiol 2022; 25:100821. [DOI: 10.1016/j.tvir.2022.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
8
|
Christenhusz A, Pouw JJ, Simonis FFJ, Douek M, Ahmed M, Klaase JM, Dassen AE, Klazen CAH, van der Schaaf MC, Ten Haken B, Alic L. Breast MRI in patients after breast conserving surgery with sentinel node procedure using a superparamagnetic tracer. Eur Radiol Exp 2022; 6:3. [PMID: 35083595 PMCID: PMC8792114 DOI: 10.1186/s41747-021-00257-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 12/03/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND A procedure for sentinel lymph node biopsy (SLNB) using superparamagnetic iron-oxide (SPIO) nanoparticles and intraoperative sentinel lymph node (SLN) detection was developed to overcome drawbacks associated with the current standard-of-care SLNB. However, residual SPIO nanoparticles can result in void artefacts at follow-up magnetic resonance imaging (MRI) scans. We present a grading protocol to quantitatively assess the severity of these artefacts and offer an option to minimise the impact of SPIO nanoparticles on diagnostic imaging. METHODS Follow-up mammography and MRI of two patient groups after a magnetic SLNB were included in the study. They received a 2-mL subareolar dose of SPIO (high-dose, HD) or a 0.1-mL intratumoural dose of SPIO (low-dose, LD). Follow-up mammography and MRI after magnetic SLNB were acquired within 4 years after breast conserving surgery (BCS). Two radiologists with over 10-year experience in breast imaging assessed the images and analysed the void artefacts and their impact on diagnostic follow-up. RESULTS A total of 19 patients were included (HD, n = 13; LD, n = 6). In the HD group, 9/13 patients displayed an artefact on T1-weighted images up to 3.6 years after the procedure, while no impact of the SPIO remnants was observed in the LD group. CONCLUSIONS SLNB using a 2-mL subareolar dose of magnetic tracer in patients undergoing BCS resulted in residual artefacts in the breast in the majority of patients, which may hamper follow-up MRI. This can be avoided by using a 0.1-mL intratumoural dose.
Collapse
Affiliation(s)
- Anke Christenhusz
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
- Department of Surgery Medisch Spectrum Twente, Enschede, The Netherlands.
| | - Joost J Pouw
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Frank F J Simonis
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Muneer Ahmed
- Division of Surgery and Interventional Science, University College London, Royal Free Hospital, London, UK
| | - Joost M Klaase
- Department of Surgery Medisch Spectrum Twente, Enschede, The Netherlands
| | - Anneriet E Dassen
- Department of Surgery Medisch Spectrum Twente, Enschede, The Netherlands
| | | | | | - Bernard Ten Haken
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Lejla Alic
- Magnetic Detection & Imaging group, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| |
Collapse
|
9
|
Singh AS, Hecht JR, Rosen L, Wainberg ZA, Wang X, Douek M, Hagopian A, Andes R, Sauer L, Brackert SR, Chow W, DeMatteo R, Eilber FC, Glaspy JA, Chmielowski B. A Randomized Phase 2 Study Of Nivolumab Monotherapy Or Nivolumab Combined with Ipilimumab In Patients with Advanced Gastrointestinal Stromal Tumors. Clin Cancer Res 2021; 28:84-94. [PMID: 34407970 DOI: 10.1158/1078-0432.ccr-21-0878] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/27/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
PURPOSE Most GISTs are driven by KIT/PDGFRa mutations. TKI benefit is progressively less after imatinib failure. This phase II trial analyzed the efficacy of nivolumab (N) or nivolumab + ipilimumab (N + I) in refractory GIST patients. PATIENTS AND METHODS Advanced/metastatic GIST patients refractory to at least imatinib were randomized 1:1 in a noncomparative, parallel group, unblinded Phase 2 trial of N (240mg Q2wks) or N + I (240 mg Q2wks + 1mg/kg Q6wks). The primary endpoint was the ORR of N alone or N+I by RECIST 1.1 in the ITT population. RESULTS 36 patients with a median of 3 (1-6) prior lines of therapies were enrolled. 10/19(52.6%) patients had SD for a CBR of 52.6 % in the N arm and the median PFS was 11.7 wks (95% CI, 7.0, 17.4). In the N+I arm, 1/16(6.7%) patients had a CR and 4/16(25.0%) had SD for a CBR of 31.3% and a median PFS of 8.3wks (95% CI, 5.6, 22.2). The 4 and 6 month PFS were 42.1% and 26.3%, respectively for N and 31.3% and 18.8%, respectively for N+I. The most common adverse events (AEs) attributed to N and N+I were fatigue: 13.9% and 22.2%, respectively. There were 9 total attributable grade 3-4 AEs. CONCLUSIONS The primary endpoint of RR>15% was not observed for N or N + I. In a heavily pretreated GIST population, responses and long term disease control with both N and N+I were observed. No new safety signals have been observed.
Collapse
Affiliation(s)
- Arun S Singh
- Department of Hematology/Oncology, University of California, Los Angeles
| | - J Randolph Hecht
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA
| | - Lee Rosen
- Medicine, UCLA Santa Monica Hematology-Oncology
| | - Zev A Wainberg
- Division of Hematology/Oncology, David Geffen School of Medicine at UCLA
| | - Xiaoyan Wang
- Department of General Internal Medicine and Healthy Services Research, University of California, Los Angeles
| | | | - Anahis Hagopian
- Department of Hematology/Oncology, University of California, Los Angeles
| | - Rachel Andes
- Department of Hematology/Oncology, University of California, Los Angeles
| | - Lauren Sauer
- Department of Hematology/Oncology, University of California, Los Angeles
| | - Sandra R Brackert
- Department of Hematology/Oncology, University of California, Los Angeles
| | - Warren Chow
- Medical Oncology, City Of Hope National Medical Center
| | | | | | - John A Glaspy
- Department of Medicine, David Geffen School of Medicine at UCLA
| | | |
Collapse
|
10
|
Vaidya JS, Bulsara M, Baum M, Wenz F, Massarut S, Pigorsch S, Alvarado M, Douek M, Saunders C, Flyger H, Eiermann W, Brew-Graves C, Williams NR, Potyka I, Roberts N, Bernstein M, Brown D, Sperk E, Laws S, Sütterlin M, Corica T, Lundgren S, Holmes D, Vinante L, Bozza F, Pazos M, Blanc-Onfroy ML, Gruber G, Polkowski W, Dedes KJ, Niewald M, Blohmer J, McReady D, Hoefer R, Kelemen P, Petralia G, Falzon M, Joseph D, Tobias JS. New clinical and biological insights from the international TARGIT-A randomised trial of targeted intraoperative radiotherapy during lumpectomy for breast cancer. Br J Cancer 2021; 125:380-389. [PMID: 34035435 PMCID: PMC8329051 DOI: 10.1038/s41416-021-01440-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/26/2021] [Accepted: 05/13/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The TARGIT-A trial reported risk-adapted targeted intraoperative radiotherapy (TARGIT-IORT) during lumpectomy for breast cancer to be as effective as whole-breast external beam radiotherapy (EBRT). Here, we present further detailed analyses. METHODS In total, 2298 women (≥45 years, invasive ductal carcinoma ≤3.5 cm, cN0-N1) were randomised. We investigated the impact of tumour size, grade, ER, PgR, HER2 and lymph node status on local recurrence-free survival, and of local recurrence on distant relapse and mortality. We analysed the predictive factors for recommending supplemental EBRT after TARGIT-IORT as part of the risk-adapted approach, using regression modelling. Non-breast cancer mortality was compared between TARGIT-IORT plus EBRT vs. EBRT. RESULTS Local recurrence-free survival was no different between TARGIT-IORT and EBRT, in every tumour subgroup. Unlike in the EBRT arm, local recurrence in the TARGIT-IORT arm was not a predictor of a higher risk of distant relapse or death. Our new predictive tool for recommending supplemental EBRT after TARGIT-IORT is at https://targit.org.uk/addrt . Non-breast cancer mortality was significantly lower in the TARGIT-IORT arm, even when patients received supplemental EBRT, HR 0.38 (95% CI 0.17-0.88) P = 0.0091. CONCLUSION TARGIT-IORT is as effective as EBRT in all subgroups. Local recurrence after TARGIT-IORT, unlike after EBRT, has a good prognosis. TARGIT-IORT might have a beneficial abscopal effect. TRIAL REGISTRATION ISRCTN34086741 (21/7/2004), NCT00983684 (24/9/2009).
Collapse
Affiliation(s)
- Jayant S Vaidya
- Division of Surgery and Interventional Science, University College London, London, UK.
| | - Max Bulsara
- Department of Biostatistics, University of Notre Dame, Fremantle, WA, Australia
| | - Michael Baum
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Samuele Massarut
- Department of Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Steffi Pigorsch
- Department of Radiation Oncology, Red Cross Hospital, Technical University of Munich, Munich, Germany
| | - Michael Alvarado
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Henrik Flyger
- Department of Breast Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Wolfgang Eiermann
- Department of Gynecology and Obstetrics, Red Cross Hospital, Technical University of Munich, Munich, Germany
| | - Chris Brew-Graves
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Norman R Williams
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Ingrid Potyka
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Nicholas Roberts
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Douglas Brown
- Department of Surgery, Ninewells Hospital, Dundee, UK
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Siobhan Laws
- Department of Surgery, Royal Hampshire County Hospital, Winchester, UK
| | - Marc Sütterlin
- Department of Gynecology and Obstetrics, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Berlin, Germany
| | - Tammy Corica
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Steinar Lundgren
- Department of Oncology, St Olav's University Hospital, & Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Dennis Holmes
- John Wayne Cancer Institute & Helen Rey Breast Cancer Foundation, University of Southern California, Los Angeles, CA, USA
| | - Lorenzo Vinante
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Fernando Bozza
- Department of Surgery, Instituto Oncologico Veneto (IVO) IRCCS, Padoa, Italy
| | - Montserrat Pazos
- Department of Radiation Oncology, University Hospital, Ludwig Maximilians Universitat, Munich, Germany
| | | | | | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | | | - Jens Blohmer
- Sankt Gertrauden-Krankenhaus, and The Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Pond Kelemen
- Ashikari Breast Center, New York Medical College, New York, NY, USA
| | - Gloria Petralia
- Department of Surgery, University College London Hospitals, London, UK
| | - Mary Falzon
- Department of Pathology University College London Hospitals, London, UK
| | - David Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Jeffrey S Tobias
- Department of Clinical Oncology, University College London Hospitals, London, UK
| |
Collapse
|
11
|
Ahmed M, Cook LJ, Douek M, Jozsa F. Preservation of the intercostobrachial nerve during axillary node clearance for breast cancer. Hippokratia 2021. [DOI: 10.1002/14651858.cd011229.pub2] [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: 11/09/2022]
Affiliation(s)
- Muneer Ahmed
- Department of Research Oncology; King's College London; London UK
| | - Lorna J Cook
- Department of Research Oncology; King's College London; London UK
| | - Michael Douek
- Department of Research Oncology; King's College London; London UK
| | - Felix Jozsa
- Surgery; Imperial College Healthcare NHS Trust; London UK
| |
Collapse
|
12
|
Nanda A, Hung I, Kwong A, Man VC, Roy P, Davies L, Douek M. Efficacy of surgical masks or cloth masks in the prevention of viral transmission: Systematic review, meta-analysis, and proposal for future trial. J Evid Based Med 2021; 14:97-111. [PMID: 33565274 PMCID: PMC8014575 DOI: 10.1111/jebm.12424] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/16/2020] [Accepted: 01/04/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Recommendations for widespread use of face mask, including suggested type, should reflect the current published evidence and concurrently be studied. This review evaluates the preclinical and clinical evidence on use of cloth and surgical face masks in SARS-CoV-2 transmission and proposes a trial to gather further evidence. METHODS PubMed, EMbase, and the Cochrane Library were searched. Studies of SARS-CoV-2 and face masks and randomized controlled trials (RCTs) of n ≥ 50 for other respiratory illnesses were included. RESULTS Fourteen studies were included in this study. One preclinical and 1 observational cohort clinical study found significant benefit of masks in limiting SARS-CoV-2 transmission. Eleven RCTs in a meta-analysis studying other respiratory illnesses found no significant benefit of masks (±hand hygiene) for influenza-like-illness symptoms nor laboratory confirmed viruses. One RCT found a significant benefit of surgical masks compared with cloth masks. CONCLUSION There is limited available preclinical and clinical evidence for face mask benefit in SARS-CoV-2. RCT evidence for other respiratory viral illnesses shows no significant benefit of masks in limiting transmission but is of poor quality and not SARS-CoV-2 specific. There is an urgent need for evidence from randomized controlled trials to investigate the efficacy of surgical and cloth masks on transmission of SARS-CoV-2 and user reported outcomes such as comfort and compliance.
Collapse
Affiliation(s)
- Akriti Nanda
- Oxford University Clinical Academic Graduate School, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
| | - Ivan Hung
- Division of Infectious Diseases, Department of Medicine, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Ava Kwong
- Division of Breast Surgery, Department of Surgery, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Vivian Chi‐Mei Man
- Division of Breast Surgery, Department of Surgery, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
| | - Pankaj Roy
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
| | - Lucy Davies
- Surgical Interventional Trials Unit, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| | - Michael Douek
- Department of Breast Surgery, Oxford University Hospitals NHS Foundation TrustUniversity of OxfordOxfordUK
- Surgical Interventional Trials Unit, Nuffield Department of Surgical SciencesUniversity of OxfordOxfordUK
| |
Collapse
|
13
|
Brett B, Savva C, Davies L, Douek M, Copson E, Cutress R. P041. Systematic review of surgical and patient reported outcomes of neoadjuvant endocrine therapy for breast cancer. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2021.03.045] [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: 10/21/2022] Open
|
14
|
Nanda A, Roy P, Douek M. P159. Snapshot of randomised controlled trials in breast surgery. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2021.03.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
15
|
Ruchalski K, Braschi-Amirfarzan M, Douek M, Sai V, Gutierrez A, Dewan R, Goldin J. A Primer on RECIST 1.1 for Oncologic Imaging in Clinical Drug Trials. Radiol Imaging Cancer 2021; 3:e210008. [PMID: 33988475 DOI: 10.1148/rycan.2021210008] [Citation(s) in RCA: 1] [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: 11/11/2022]
Abstract
Drug discovery and approval in oncology is mediated by the use of imaging to evaluate drug efficacy in clinical trials. Imaging is performed while patients receive therapy to evaluate their response to treatment. Response criteria, specifically Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), are standardized and can be used at different time points to classify response into the categories of complete response, partial response, stable disease, or disease progression. At the trial level, categorical responses for all patients are summated into image-based trial endpoints. These outcome measures, including objective response rate (ORR) and progression-free survival (PFS), are characteristics that can be derived from imaging and can be used as surrogates for overall survival (OS). Similar to OS, ORR and PFS describe the efficacy of a drug. U.S. Food and Drug Administration (FDA) regulatory approval requires therapies to demonstrate direct evidence of clinical benefit, such as improved OS. However, multiple programs have been created to expedite drug approval for life-threatening illnesses, including advanced cancer. ORR and PFS have been accepted by the FDA as adequate predictors of OS on which to base drug approval decisions, thus substantially shortening the time and cost of drug development (1). Use of imaging surrogate markers for drug approval has become increasingly common, accounting for more than 90% of approvals through the Accelerated Approval Program and allowing for use of many therapies which have altered the course of cancer. Keywords: Oncology, Tumor Response RSNA, 2021.
Collapse
Affiliation(s)
- Kathleen Ruchalski
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1621, Los Angeles, CA 90095-1721 (K.R., M.D., V.S., A.G., R.D., J.G.); and Department of Radiology, Beth Israel Lahey Health, Burlington, Mass (M.B.A.)
| | - Marta Braschi-Amirfarzan
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1621, Los Angeles, CA 90095-1721 (K.R., M.D., V.S., A.G., R.D., J.G.); and Department of Radiology, Beth Israel Lahey Health, Burlington, Mass (M.B.A.)
| | - Michael Douek
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1621, Los Angeles, CA 90095-1721 (K.R., M.D., V.S., A.G., R.D., J.G.); and Department of Radiology, Beth Israel Lahey Health, Burlington, Mass (M.B.A.)
| | - Victor Sai
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1621, Los Angeles, CA 90095-1721 (K.R., M.D., V.S., A.G., R.D., J.G.); and Department of Radiology, Beth Israel Lahey Health, Burlington, Mass (M.B.A.)
| | - Antonio Gutierrez
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1621, Los Angeles, CA 90095-1721 (K.R., M.D., V.S., A.G., R.D., J.G.); and Department of Radiology, Beth Israel Lahey Health, Burlington, Mass (M.B.A.)
| | - Rohit Dewan
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1621, Los Angeles, CA 90095-1721 (K.R., M.D., V.S., A.G., R.D., J.G.); and Department of Radiology, Beth Israel Lahey Health, Burlington, Mass (M.B.A.)
| | - Jonathan Goldin
- From the Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, Suite 1621, Los Angeles, CA 90095-1721 (K.R., M.D., V.S., A.G., R.D., J.G.); and Department of Radiology, Beth Israel Lahey Health, Burlington, Mass (M.B.A.)
| |
Collapse
|
16
|
Vaidya JS, Bulsara M, Sperk E, Massarut S, Douek M, Alvarado M, Pigorsch S, Holmes D, Bernstein M, Saunders C, Flyger H, Joseph D, Wenz F, Tobias JS. In Regard to Polgar et al. Int J Radiat Oncol Biol Phys 2021; 110:905-907. [PMID: 33640419 DOI: 10.1016/j.ijrobp.2021.01.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Jayant S Vaidya
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Max Bulsara
- Department of Biostatistics, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Samuele Massarut
- Department of Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Michael Alvarado
- Department of Surgery, University of California, San Francisco, San Francisco, California
| | - Steffi Pigorsch
- Department of Gynaecology and Obstetrics, Red Cross Hospital, Technical University of Munich, Munich, Germany
| | - Dennis Holmes
- University of Southern California, John Wayne Cancer Institute & Helen Rey Breast Cancer Foundation, Los Angeles, California
| | | | - Christobel Saunders
- School of Surgery, University of Western Australia, Crawley, Western Australia, Australia
| | - Henrik Flyger
- Department of Breast Surgery, University of Copenhagen, Copenhagen, Denmark
| | - David Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | | | - Jeffrey S Tobias
- Department of Clinical Oncology, University College London Hospitals, London, United Kingdom
| | | |
Collapse
|
17
|
Jozsa F, Ahmed M, Baker R, Douek M. Can machine learning be used to reduce overtreatment of the axilla in breast cancer? Results from a retrospective cohort study. Eur J Surg Oncol 2021. [DOI: 10.1016/j.ejso.2020.11.195] [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
|
18
|
Abstract
Introduction The use of neo-adjuvant radiotherapy (NRT) has been proven effective at improving cancer related outcome measures, including overall-survival (OS) in the management of solid cancers. However, its utilisation in breast cancer has not been explored to the extent of neo-adjuvant chemotherapy (NAC). The evidence for the application of NRT in breast cancer is evaluated. Methods PubMed, Embase and the Cochrane Library databases were searched systematically in August 2020 for studies that addressed the role of NRT in the treatment of breast cancer. Studies were deemed eligible if they reported on objective outcome measurements of OS, disease free-survival (DFS) or pathological complete response (pCR) and attained a satisfactory quality assessment. Findings A total of 23 studies reported upon 3,766 patients who had received NRT of which 3,233 also received NAC concurrently (neo-adjuvant chemo-radiotherapy (NCRT)). The pCR values ranged from 14% to 42%, 5-year DFS 61.4% to 81% and 5-year OS 71.6% to 84.2%. Complications were confined to radiation dermatitis with no cases of implant loss reported during breast reconstruction. The application of NRCT alone showed no significant difference in OS or DFS compared to NCRT followed by surgery. Interpretation Numbers of patients receiving exclusively NRT is small. However, NCRT is oncologically safe with a low side-effect profile including preceding breast reconstruction. Potential benefits include precise cancer volume targeting, chemosensitisation, elimination of delays in adjuvant therapies and alternatives to chemotherapy in oestrogen receptor positive patients. These factors warrant further exploration within randomised controlled-trials.
Collapse
Affiliation(s)
- Muneer Ahmed
- Division of Surgery and interventional Science, University College London, Royal Free Hospital, 9th Floor (East), 2QG, 10 Pond St, London NW3 2PS, UK
| | - Felix Jozsa
- Division of Surgery and interventional Science, University College London, Royal Free Hospital, 9th Floor (East), 2QG, 10 Pond St, London NW3 2PS, UK
| | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Oxford OX3 7LD, UK
| |
Collapse
|
19
|
Affiliation(s)
- Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 7DQ, UK.
| | | | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 7DQ, UK
| | - Bleddyn Jones
- Department of Clinical Radiobiology, University of Oxford, Oxford OX3 7DQ, UK
| |
Collapse
|
20
|
Vaidya JS, Bulsara M, Baum M, Wenz F, Massarut S, Pigorsch S, Alvarado M, Douek M, Saunders C, Flyger HL, Eiermann W, Brew-Graves C, Williams NR, Potyka I, Roberts N, Bernstein M, Brown D, Sperk E, Laws S, Sütterlin M, Corica T, Lundgren S, Holmes D, Vinante L, Bozza F, Pazos M, Le Blanc-Onfroy M, Gruber G, Polkowski W, Dedes KJ, Niewald M, Blohmer J, McCready D, Hoefer R, Kelemen P, Petralia G, Falzon M, Joseph DJ, Tobias JS. Long term survival and local control outcomes from single dose targeted intraoperative radiotherapy during lumpectomy (TARGIT-IORT) for early breast cancer: TARGIT-A randomised clinical trial. BMJ 2020; 370:m2836. [PMID: 32816842 PMCID: PMC7500441 DOI: 10.1136/bmj.m2836] [Citation(s) in RCA: 138] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine whether risk adapted intraoperative radiotherapy, delivered as a single dose during lumpectomy, can effectively replace postoperative whole breast external beam radiotherapy for early breast cancer. DESIGN Prospective, open label, randomised controlled clinical trial. SETTING 32 centres in 10 countries in the United Kingdom, Europe, Australia, the United States, and Canada. PARTICIPANTS 2298 women aged 45 years and older with invasive ductal carcinoma up to 3.5 cm in size, cN0-N1, eligible for breast conservation and randomised before lumpectomy (1:1 ratio, blocks stratified by centre) to either risk adapted targeted intraoperative radiotherapy (TARGIT-IORT) or external beam radiotherapy (EBRT). INTERVENTIONS Random allocation was to the EBRT arm, which consisted of a standard daily fractionated course (three to six weeks) of whole breast radiotherapy, or the TARGIT-IORT arm. TARGIT-IORT was given immediately after lumpectomy under the same anaesthetic and was the only radiotherapy for most patients (around 80%). TARGIT-IORT was supplemented by EBRT when postoperative histopathology found unsuspected higher risk factors (around 20% of patients). MAIN OUTCOME MEASURES Non-inferiority with a margin of 2.5% for the absolute difference between the five year local recurrence rates of the two arms, and long term survival outcomes. RESULTS Between 24 March 2000 and 25 June 2012, 1140 patients were randomised to TARGIT-IORT and 1158 to EBRT. TARGIT-IORT was non-inferior to EBRT: the local recurrence risk at five year complete follow-up was 2.11% for TARGIT-IORT compared with 0.95% for EBRT (difference 1.16%, 90% confidence interval 0.32 to 1.99). In the first five years, 13 additional local recurrences were reported (24/1140 v 11/1158) but 14 fewer deaths (42/1140 v 56/1158) for TARGIT-IORT compared with EBRT. With long term follow-up (median 8.6 years, maximum 18.90 years, interquartile range 7.0-10.6) no statistically significant difference was found for local recurrence-free survival (hazard ratio 1.13, 95% confidence interval 0.91 to 1.41, P=0.28), mastectomy-free survival (0.96, 0.78 to 1.19, P=0.74), distant disease-free survival (0.88, 0.69 to 1.12, P=0.30), overall survival (0.82, 0.63 to 1.05, P=0.13), and breast cancer mortality (1.12, 0.78 to 1.60, P=0.54). Mortality from other causes was significantly lower (0.59, 0.40 to 0.86, P=0.005). CONCLUSION For patients with early breast cancer who met our trial selection criteria, risk adapted immediate single dose TARGIT-IORT during lumpectomy was an effective alternative to EBRT, with comparable long term efficacy for cancer control and lower non-breast cancer mortality. TARGIT-IORT should be discussed with eligible patients when breast conserving surgery is planned. TRIAL REGISTRATION ISRCTN34086741, NCT00983684.
Collapse
Affiliation(s)
- Jayant S Vaidya
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | - Max Bulsara
- Department of Biostatistics, University of Notre Dame, Fremantle, WA, Australia
| | - Michael Baum
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Samuele Massarut
- Department of Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Steffi Pigorsch
- Department of Gynaecology and Obstetrics, Red Cross Hospital, Technical University of Munich, Munich, Germany
| | - Michael Alvarado
- Department of Surgery, University of California, San Francisco, CA, USA
| | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Henrik L Flyger
- Department of Breast Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Wolfgang Eiermann
- Department of Gynaecology and Obstetrics, Red Cross Hospital, Technical University of Munich, Munich, Germany
| | - Chris Brew-Graves
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | - Norman R Williams
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | - Ingrid Potyka
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | - Nicholas Roberts
- Division of Surgery and Interventional Science, University College London, 43-45 Foley Street, London W1W 7JN, UK
| | | | - Douglas Brown
- Department of Surgery, Ninewells Hospital, Dundee, UK
| | - Elena Sperk
- Department of Radiation Oncology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Siobhan Laws
- Department of Surgery, Royal Hampshire County Hospital, Winchester, UK
| | - Marc Sütterlin
- Department of Gynaecology and Obstetrics, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Tammy Corica
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Steinar Lundgren
- Department of Oncology, St Olav's University Hospital, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Dennis Holmes
- University of Southern California, John Wayne Cancer Institute & Helen Rey Breast Cancer Foundation, Los Angeles, CA, USA
| | - Lorenzo Vinante
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Montserrat Pazos
- Department of Radiation Oncology, University Hospital, The Ludwig Maximilian University of Munich, Munich, Germany
| | | | | | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | | | - Jens Blohmer
- Sankt Gertrauden Hospital, Charité, Medical University of Berlin, Berlin, Germany
| | - David McCready
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Pond Kelemen
- Ashikari Breast Center, New York Medical College, New York, NY, USA
| | - Gloria Petralia
- Department of Surgery, University College London Hospitals, London, UK
| | - Mary Falzon
- Department of Pathology, University College London Hospitals, London, UK
| | - David J Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | | |
Collapse
|
21
|
Vaidya JS, Bulsara M, Saunders C, Flyger H, Tobias JS, Corica T, Massarut S, Wenz F, Pigorsch S, Alvarado M, Douek M, Eiermann W, Brew-Graves C, Williams N, Potyka I, Roberts N, Bernstein M, Brown D, Sperk E, Laws S, Sütterlin M, Lundgren S, Holmes D, Vinante L, Bozza F, Pazos M, Le Blanc-Onfroy M, Gruber G, Polkowski W, Dedes KJ, Niewald M, Blohmer J, McCready D, Hoefer R, Kelemen P, Petralia G, Falzon M, Baum M, Joseph D. Effect of Delayed Targeted Intraoperative Radiotherapy vs Whole-Breast Radiotherapy on Local Recurrence and Survival: Long-term Results From the TARGIT-A Randomized Clinical Trial in Early Breast Cancer. JAMA Oncol 2020; 6:e200249. [PMID: 32239210 PMCID: PMC7348682 DOI: 10.1001/jamaoncol.2020.0249] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Importance Conventional adjuvant radiotherapy for breast cancer given daily for several weeks is onerous and expensive. Some patients may be obliged to choose a mastectomy instead, and some may forgo radiotherapy altogether. We proposed a clinical trial to test whether radiotherapy could be safely limited to the tumor bed. Objective To determine whether delayed second-procedure targeted intraoperative radiotherapy (TARGIT-IORT) is noninferior to whole-breast external beam radiotherapy (EBRT) in terms of local control. Design, Setting, and Participants In this prospective, randomized (1:1 ratio) noninferiority trial, 1153 patients aged 45 years or older with invasive ductal breast carcinoma smaller than 3.5 cm treated with breast conservation were enrolled from 28 centers in 9 countries. Data were locked in on July 3, 2019. Interventions The TARGIT-A trial was started in March 2000; patients were randomized after needle biopsy to receive TARGIT-IORT immediately after lumpectomy under the same anesthetic vs EBRT and results have been shown to be noninferior. A parallel study, described in this article, was initiated in 2004; patients who had their cancer excised were randomly allocated using separate randomization tables to receive EBRT or delayed TARGIT-IORT given as a second procedure by reopening the lumpectomy wound. Main Outcomes and Measures A noninferiority margin for local recurrence rate of 2.5% at 5 years, and long-term survival outcomes. Results Overall, 581 women (mean [SD] age, 63 [7] years) were randomized to delayed TARGIT-IORT and 572 patients (mean [SD] age, 63 [8] years) were randomized to EBRT. Sixty patients (5%) had tumors larger than 2 cm, or had positive nodes and only 32 (2.7%) were younger than 50 years. Delayed TARGIT-IORT was not noninferior to EBRT. The local recurrence rates at 5-year complete follow-up were: delayed TARGIT-IORT vs EBRT (23/581 [3.96%] vs 6/572 [1.05%], respectively; difference, 2.91%; upper 90% CI, 4.4%). With long-term follow-up (median [IQR], 9.0 [7.5-10.5] years), there was no statistically significant difference in local recurrence-free survival (HR, 0.75; 95% CI, 0.57-1.003; P = .052), mastectomy-free survival (HR, 0.88; 95% CI, 0.65-1.18; P = .38), distant disease-free survival (HR, 1.00; 95% CI, 0.72-1.39; P = .98), or overall survival (HR, 0.96; 95% CI, 0.68-1.35; P = .80). Conclusions and Relevance These long-term data show that despite an increase in the number of local recurrences with delayed TARGIT-IORT, there was no statistically significant decrease in mastectomy-free survival, distant disease-free survival, or overall survival. Trial Registration ISRCTN34086741, ClinicalTrials.gov Identifier: NCT00983684.
Collapse
Affiliation(s)
- Jayant S Vaidya
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Max Bulsara
- Division of Surgery and Interventional Science, University College London, London, United Kingdom.,Department of Biostatistics, University of Notre Dame, Fremantle, West Australia, Australia
| | - Christobel Saunders
- University of Western Australia School of Surgery, West Australia, Australia
| | - Henrik Flyger
- Department of Breast Surgery, University of Copenhagen, Copenhagen, Denmark
| | - Jeffrey S Tobias
- Department of Clinical Oncology, University College London Hospitals, London, United Kingdom
| | - Tammy Corica
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, West Australia, Australia
| | - Samuele Massarut
- Department of Surgery, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Frederik Wenz
- University Medical Center Mannheim, Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Steffi Pigorsch
- Red Cross Hospital, Department of Gynecology and Obstetrics, Technical University of Munich, Munich, Germany
| | | | - Michael Douek
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Wolfgang Eiermann
- Red Cross Hospital, Department of Gynecology and Obstetrics, Technical University of Munich, Munich, Germany
| | - Chris Brew-Graves
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Norman Williams
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Ingrid Potyka
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - Nicholas Roberts
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | | | - Douglas Brown
- Department of Surgery, Ninewells Hospital, Dundee, United Kingdom
| | - Elena Sperk
- University Medical Center Mannheim, Department of Radiation Oncology, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Siobhan Laws
- Department of Surgery, Royal Hampshire County Hospital, Winchester, United Kingdom
| | - Marc Sütterlin
- University Medical Center Mannheim, Department of Gynecology and Obstetrics, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Steinar Lundgren
- Department of Oncology, St Olav's University Hospital, Trondheim, Norway.,Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Dennis Holmes
- Helen Rey Breast Cancer Foundation, John Wayne Cancer Institute, University of Southern California, Los Angeles
| | - Lorenzo Vinante
- Department of Radiation Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | | | - Montserrat Pazos
- University Hospital, Department of Radiation Oncology, Ludwig Maximilians Universitat, Munich, Germany
| | | | | | - Wojciech Polkowski
- Department of Surgical Oncology, Medical University of Lublin, Lublin, Poland
| | | | | | - Jens Blohmer
- Sankt Gertrauden-Krankenhaus, and The Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - David McCready
- Princess Margaret Cancer Centre Toronto, Toronto, Ontario, Canada
| | | | - Pond Kelemen
- Ashikari Breast Center, New York Medical College, New York, New York
| | - Gloria Petralia
- Department of Surgery, University College London Hospitals, London, United Kingdom
| | - Mary Falzon
- Department of Pathology, University College London Hospitals, London, United Kingdom
| | - Michael Baum
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
| | - David Joseph
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, West Australia, Australia
| |
Collapse
|
22
|
Wang MM, Beckett K, Douek M, Masamed R, Patel M, Tseng CH, Yeh MW, Leung AM, Livhits MJ. Diagnostic Value of Molecular Testing in Sonographically Suspicious Thyroid Nodules. J Endocr Soc 2020; 4:bvaa081. [PMID: 32856009 PMCID: PMC7442277 DOI: 10.1210/jendso/bvaa081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/12/2020] [Indexed: 01/21/2023] Open
Abstract
Objective Molecular testing can refine the diagnosis for the 20% of thyroid fine-needle aspiration biopsies that have indeterminate cytology. We assessed the diagnostic accuracy of molecular testing based on ultrasound risk classification. Methods This retrospective cohort study analyzed all thyroid nodules with indeterminate cytology at an academic US medical center (2012-2016). All indeterminate nodules underwent reflexive molecular testing with the Afirma Gene Expression Classifier (GEC). Radiologists performed blinded reviews to categorize each nodule according to the American Thyroid Association (ATA) ultrasound classification and the American College of Radiology Thyroid Imaging, Reporting and Data System. GEC results and diagnostic performance were compared across ultrasound risk categories. Results Of 297 nodules, histopathology confirmed malignancy in 65 (22%). Nodules by ATA classification were 8% high suspicion, 44% intermediate, and 48% low/very low suspicion. A suspicious GEC result was more likely in ATA high-suspicion nodules (81%) than in nodules of all other ATA categories (57%; P = .04). The positive predictive value (PPV) of GEC remained consistent across ultrasound categories (ATA high suspicion, 64% vs all other ATA categories, 48%; P = .39). The ATA high-suspicion category had higher specificity than a suspicious GEC result (93% vs 51%; P < .01). A suspicious GEC result did not increase specificity for the ATA high-suspicion category. Conclusion The PPV of molecular testing remained consistent across ultrasound risk categories. However, a suspicious GEC result was very likely in ATA high-suspicion nodules and did not improve specificity in this sonographic category.
Collapse
Affiliation(s)
- Maxwell M Wang
- David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Katrina Beckett
- Department of Radiology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Michael Douek
- Department of Radiology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Rinat Masamed
- Department of Radiology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Maitraya Patel
- Department of Radiology, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Chi-Hong Tseng
- Department of Medicine, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Michael W Yeh
- Section of Endocrine Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California.,Division of Endocrinology, Diabetes, and Metabolism; VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Masha J Livhits
- Section of Endocrine Surgery, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| |
Collapse
|
23
|
Ruchalski K, Kim HJ, Douek M, Raman S, Patel M, Gutierrez A, Levine BD, Fischer C, Auerbach MS, Gupta P, Coy H, Villegas B, Goldin J. Pre-therapy visceral metastases in castrate resistant metastatic prostate cancer: Role in tumor progression. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e17586] [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
e17586 Background: Visceral metastases in castrate resistant metastatic prostate cancer (mCRPC) are known to develop late in the course of disease and portend a poor prognosis. As patients with visceral metastases still derive a clinical benefit to treatment, understanding patterns of progressive disease (PD) may help differentiate important disease phenotypes in mCRPC. The aim of our study was to evaluate the differences in anatomic sites of PD in patients with pretreatment visceral or bone metastases on time to progression (TTP). Methods: A retrospective review of anonymized patients enrolled in phase 2 and 3 clinical trials was performed. Patients were excluded if lacked Tc bone scan or CT chest, abdomen and pelvis (CT CAP) at baseline. Bone disease was defined by automated bone scan lesion area (BSLA) criteria. All CT CAPs per clinical trial protocol were assessed by RECIST 1.1. Soft tissue PD was noted as target, non-target lesion growth and/or presence of new lesions by anatomic site. Bone PD was defined by > 20% increase in BSLA score. Results: Of the 169 subjects that met our selection criterion, visceral disease was present at baseline in 90 patients (53%). Baseline BSLA score was 90474 mm² in visceral and 80348 mm² in non-visceral patients (p = 0.395). Disease progression occurred in 93 patients (55%). With baseline visceral disease, PD was a result of BSLA in 26 (51%) and visceral disease only in 11 (22%) of patient. Lacking visceral disease at baseline resulted in PD by BSLA in 26 (62%) and visceral disease only in 3 (7%) of patients. There was no significant difference in PFS for baseline visceral/non-visceral involvement; median PFS = 4.5 months in visceral; median PFS = 4.34 months in non-visceral (HR = 1.28; p = 0.244). Conclusions: Patients with visceral disease may still derive a similar clinical benefit from treatment to those without. While the presence of baseline visceral disease was associated with higher rates of PD by visceral involvement, PD by bone disease remained the most common cause of PD regardless of presence of baseline visceral metastases.
Collapse
Affiliation(s)
| | - Hyun J. Kim
- Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, CA
| | - Michael Douek
- University of California Los Angeles Department of Radiological Sciences, Los Angeles, CA
| | - Steven Raman
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Maitraya Patel
- UCLA Department of Radiological Sciences, Los Angeles, CA
| | | | - Benjamin D. Levine
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Cheryce Fischer
- Department of Radiological Sciences, University of California, Los Angeles, CA
| | - Martin S. Auerbach
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA
| | - Pawan Gupta
- Department of Nuclear Medicine, University of California, Los Angeles, CA
| | - Heidi Coy
- University of California Los Angeles Department of Radiological Sciences, Los Angeles, CA
| | - Bianca Villegas
- UCLA Center for Computer Vision and Imaging Biomarkers, Los Angeles, CA
| | | |
Collapse
|
24
|
Hanley J, Li D, Shah R, Chiang J, McWilliams J, Raman S, Lu D, Padia S, Douek M, Felker E, Masamed R, Bahrami S, Sahagun O. 3:09 PM Abstract No. 200 Comparison of bleeding complications using two techniques for renal transplant biopsy. J Vasc Interv Radiol 2020. [DOI: 10.1016/j.jvir.2019.12.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|
25
|
Ruchalski K, Douek M, Raman S, Patel M, Gutierrez A, Sai V, Levine BD, Allen-Auerbach M, Gupta P, Kim HJ, Villegas B, Goldin J. Role of soft tissue metastases on tumor progression in castrate-resistant metastatic prostate cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.214] [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
214 Background: While visceral metastases in castrate resistant prostate cancer (mCRPC) are a negative prognostic factor, patients may still derive treatment benefits. Given varying anatomic sites of tumor may display differing treatment responses we investigated the role of soft tissue metastases in progressive disease (PD) by anatomic site. Methods: A retrospective review of anonymized patients enrolled in phase 3 clinical trials was performed. Patients were excluded if lacked Tc bone scan or CT chest, abdomen and pelvis (CT CAP) on trial. Subjects were included if they had soft tissue disease per RECIST 1.1. Bone disease was defined by automated BSLA criteria. All CT CAPs per clinical trial protocol were assessed by RECIST 1.1. Soft tissue PD was noted as target|nontarget lesion growth and/or presence of new lesions by anatomic site. Bone PD was defined by >20% increase in BSLA score. Results: Of 322 total patients, 138 met criteria of soft tissue disease at baseline. Baseline anatomic sites of metastases per RECIST included: visceral (74, 53.6%), lymph node only (52, 37.7%) and soft tissue bone (12, 7.1%). PD occurred in 46 patients with baseline soft tissue disease; with PD first detected by BSLA (23, 16.7 %), RECIST (19, 13.8 %) or with PD occurring simultaneously by BSLA and RECIST (4, 2.9%). Of the 138 patients with baseline soft tissue disease, PD occurred by RECIST in 25 patients. This occurred due to worsening visceral (11, 68.8%), lymph node (4, 25.0%) or soft tissue bone (1, 6.3%) disease. PD by new lesions only occurred in 9 patients (36.0%), as a result of 77.8% visceral and 22.2% lymph node. Conclusions: In mCRPC with soft tissue disease at baseline, progression by BSLA bone score still accounts for a large portion of PD. Further analyses must be performed to better differentiate disease phenotypes amongst mCRPC with combined visceral/osseous disease.
Collapse
Affiliation(s)
| | - Michael Douek
- University of California Los Angeles Department of Radiological Sciences, Los Angeles, CA
| | - Steven Raman
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Maitraya Patel
- UCLA Department of Radiological Sciences, Los Angeles, CA
| | | | - Victor Sai
- UCLA Department of Radiological Sciences, Los Angeles, CA
| | - Benjamin D. Levine
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | - Pawan Gupta
- Department of Nuclear Medicine, University of California, Los Angeles, CA
| | - Hyun J. Kim
- Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA
| | - Bianca Villegas
- UCLA Center for Computer Vision and Imaging Biomarkers, Los Angeles, CA
| | | |
Collapse
|
26
|
Barrow-McGee R, Procter J, Owen J, Woodman N, Lombardelli C, Kothari A, Kovacs T, Douek M, George S, Barry PA, Ramsey K, Gibson A, Buus R, Holgersen E, Natrajan R, Haider S, Shattock MJ, Gillett C, Tutt AN, Pinder SE, Naidoo K. Real-time ex vivo perfusion of human lymph nodes invaded by cancer (REPLICANT): a feasibility study. J Pathol 2019; 250:262-274. [PMID: 31755096 PMCID: PMC7065097 DOI: 10.1002/path.5367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 07/26/2019] [Revised: 11/06/2019] [Accepted: 11/18/2019] [Indexed: 01/18/2023]
Abstract
Understanding how breast cancer (BC) grows in axillary lymph nodes (ALNs), and refining how therapies might halt that process, is clinically important. However, modelling the complex ALN microenvironment is difficult, and no human models exist at present. We harvested ALNs from ten BC patients, and perfused them at 37 °C ex vivo for up to 24 h. Controlled autologous testing showed that ALNs remain viable after 24 h of ex vivo perfusion: haematoxylin and eosin-stained histological appearance and proliferation (by Ki67 immunohistochemistry) did not change significantly over time for any perfused ALN compared with a control from time-point zero. Furthermore, targeted gene expression analysis (NanoString PanCancer IO360 panel) showed that only 21/750 genes were differentially expressed between control and perfused ALNs (|log2 FC| > 1 and q < 0.1): none were involved in apoptosis and metabolism, but rather all 21 genes were involved in immune function and angiogenesis. During perfusion, tissue acid-base balance remained stable. Interestingly, the flow rate increased (p < 0.001) in cancer-replaced (i.e. metastasis occupied more than 90% of the surface area on multiple levels) compared to cancer-free nodes (i.e. nodes with no metastasis on multiple sections). CXCL11 transcripts were significantly more abundant in cancer-replaced nodes, while CXCL12 transcripts were significantly more abundant in cancer-free nodes. These cytokines were also detected in the circulating perfusate. Monoclonal antibodies (nivolumab and trastuzumab) were administered into a further three ALNs to confirm perfusion efficacy. These drugs saturated the nodes; nivolumab even induced cancer cell death. Normothermic ALN perfusion is not only feasible but sustains the tumour microenvironment ex vivo for scientific investigation. This model could facilitate the identification of actionable immuno-oncology targets. © 2019 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
Collapse
Affiliation(s)
- Rachel Barrow-McGee
- Toby Robins Breast Cancer Now Research Centre, Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Julia Procter
- Toby Robins Breast Cancer Now Research Centre, Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Julie Owen
- King's Health Partners Cancer Biobank, Guy's Comprehensive Cancer Centre, London, UK
| | - Natalie Woodman
- King's Health Partners Cancer Biobank, Guy's Comprehensive Cancer Centre, London, UK
| | - Cristina Lombardelli
- King's Health Partners Cancer Biobank, Guy's Comprehensive Cancer Centre, London, UK
| | | | - Tibor Kovacs
- Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | - Michael Douek
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Comprehensive Cancer Centre, London, UK
| | - Simi George
- Department of Cellular Pathology, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| | | | | | - Amy Gibson
- Toby Robins Breast Cancer Now Research Centre, Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Richard Buus
- Toby Robins Breast Cancer Now Research Centre, Breast Cancer Research Division, The Institute of Cancer Research, London, UK.,Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Erle Holgersen
- Toby Robins Breast Cancer Now Research Centre, Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Rachael Natrajan
- Toby Robins Breast Cancer Now Research Centre, Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Syed Haider
- Toby Robins Breast Cancer Now Research Centre, Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Michael J Shattock
- British Heart Foundation Centre of Research Excellence, King's College London, St Thomas' Hospital, London, UK
| | - Cheryl Gillett
- King's Health Partners Cancer Biobank, Guy's Comprehensive Cancer Centre, London, UK
| | - Andrew Nj Tutt
- Toby Robins Breast Cancer Now Research Centre, Breast Cancer Research Division, The Institute of Cancer Research, London, UK
| | - Sarah E Pinder
- School of Cancer and Pharmaceutical Sciences, King's College London, Guy's Comprehensive Cancer Centre, London, UK
| | - Kalnisha Naidoo
- Toby Robins Breast Cancer Now Research Centre, Breast Cancer Research Division, The Institute of Cancer Research, London, UK.,Department of Cellular Pathology, Guy's and St. Thomas' Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
27
|
Savolainen H, Volpe A, Phinikaridou A, Douek M, Fruhwirth G, de Rosales RTM. 68Ga-Sienna+ for PET-MRI Guided Sentinel Lymph Node Biopsy: Synthesis and Preclinical Evaluation in a Metastatic Breast Cancer Model. Nanotheranostics 2019; 3:255-265. [PMID: 31263657 PMCID: PMC6584137 DOI: 10.7150/ntno.34727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is commonly performed in cancers that metastasise via the lymphatic system. It involves excision and histology of sentinel lymph nodes (SLNs) and presents two main challenges: (i) sensitive whole-body localisation of SLNs, and (ii) lack of pre-operative knowledge of their metastatic status, resulting in a high number (>70%) of healthy SLN excisions. To improve SLNB, whole-body imaging could improve detection and potentially prevent unnecessary surgery by identifying healthy and metastatic SLNs. In this context, radiolabelled SPIOs and PET-MRI could find applications to locate SLNs with high sensitivity at the whole-body level (using PET) and guide high-resolution MRI to evaluate their metastatic status. Here we evaluate this approach by synthesising a GMP-compatible 68Ga-SPIO (68Ga-Sienna+) followed by PET-MR imaging and histology studies in a metastatic breast cancer mouse model. Methods. A clinically approved SPIO for SLN localisation (Sienna+) was radiolabelled with 68Ga without a chelator. Radiochemical stability was tested in human serum. In vitro cell uptake was compared between 3E.Δ.NT breast cancer cells, expressing the hNIS reporter gene, and macrophage cell lines (J774A.1; RAW264.7.GFP). NSG-mice were inoculated with 3E.Δ.NT cells. Left axillary SLN metastasis was monitored by hNIS/SPECT-CT and compared to the healthy right axillary SLN. 68Ga-Sienna+ was injected into front paws and followed by PET-MRI. Imaging results were confirmed by histology. Results.68Ga-Sienna+ was produced in high radiochemical purity (>93%) without the need for purification and was stable in vitro. In vitro uptake of 68Ga-Sienna+ in macrophage cells (J774A.1) was significantly higher (12 ± 1%) than in cancer cells (2.0 ± 0.1%; P < 0.001). SPECT-CT confirmed metastasis in the left axillary SLNs of tumour mice. In PET, significantly higher 68Ga-Sienna+ uptake was measured in healthy axillary SLNs (2.2 ± 0.9 %ID/mL), than in metastatic SLNs (1.1 ± 0.2 %ID/mL; P = 0.006). In MRI, 68Ga-Sienna+ uptake in healthy SLNs was observed by decreased MR signal in T2/T2*-weighted sequences, whereas fully metastatic SLNs appeared unchanged. Conclusion.68Ga-Sienna+ in combination with PET-MRI can locate and distinguish healthy from metastatic SLNs and could be a useful preoperative imaging tool to guide SLN biopsy and prevent unnecessary excisions.
Collapse
Affiliation(s)
- Heli Savolainen
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Alessia Volpe
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Alkystis Phinikaridou
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Michael Douek
- Department of Research Oncology, School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Gilbert Fruhwirth
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rafael T. M. de Rosales
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- London Centre for Nanotechnology, King's College London, Strand Campus, London, WC2R 2LS, United Kingdom (UK)
| |
Collapse
|
28
|
Jozsa F, Ahmed M, Baker R, Douek M. Is sentinel node biopsy necessary in the radiologically negative axilla in breast cancer? Breast Cancer Res Treat 2019; 177:1-4. [DOI: 10.1007/s10549-019-05299-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/25/2019] [Indexed: 11/27/2022]
|
29
|
Singh AS, Chmielowski B, Hecht JR, Rosen LS, Chow WA, Wang X, Brackert S, Adame C, Bovill J, Schink E, Douek M, Chantharasamee J, Wong K, Eilber FC, Glaspy JA. A randomized phase II study of nivolumab monotherapy versus nivolumab combined with ipilimumab in advanced gastrointestinal stromal tumor (GIST). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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
11017 Background: Most GISTs are driven by mutations in KIT and PDGFRa and secondary mutations are felt to confer resistance to TKIs. In advanced/metastatic GIST, the benefit of second line TKIs and beyond is progressively less after imatinib failure. As such, novel non-TKI approaches are important to explore. Here we report interim analyses of safety and efficacy in advanced GIST patients treated with immunotherapy. Methods: Patients with advanced/metastatic GIST refractory to at least imatinib were enrolled on a randomized, parallel group, unblinded Phase 2 trial of either nivo (240 mg Q2wks) or nivo (240 mg Q2wks) with ipi (1mg/kg Q6wks) for up to 2 years. The primary endpoint was the objective response rate(ORR) of nivo alone or nivo + ipi by RECIST 1.1 criteria. Imaging was assessed by investigator and 3 independent radiologists. Patients were randomized 1:1 and were restaged every 8 weeks. With a sample size of 20 per group, an exact binomial test with a nominal 0.050 one-sided significance level will have 82% power to detect the difference between the null hypothesis response rate 1.5% and the alternative response rate of 15%. Secondary objectives are to ascertain the PFS, CBR, RR by Choi criteria and safety. Blood and biopsies are also being collected. Results: At cutoff, 29 patients (27 evaluable) with a median of 3 (1-7) lines of prior therapies have started on trial. In the nivo only arm, 7/15 pts had a best response of SD for a CBR of 46.7% with the median PFS being 8.57 wks. In the nivo + ipi arm, 1/12 patients had a PR and 2/12 have SD for a CBR of 25.0% (95% exact C.I. 5.5%-57.2%) with a median PFS of 9.1 wks. 8 patients have been on therapy for more than 6 months and two patients with a KIT Exon 17 mutation had radiographic disease shrinkage. Most AEs were grades 1-2 with fatigue (37%) being the most common. 4 Grade 3/4 AEs occurred in the nivo and ipi arm (hyperglycemia, weakness, diarrhea x 2) and 4 grade 3/4AEs occurred in the nivo arm (DKA, hyperglycemia, rash, fatigue). Pretreatment biopsies have been obtained in all patients and blood has been collected on all patients for correlative analysis. Conclusions: In a heavily pretreated GIST population, responses and disease control with both nivo and nivo + ipi were observed. To date, the drugs have been well tolerated and no new safety signals have been observed in this disease state. Clinical trial information: NCT02880020.
Collapse
Affiliation(s)
- Arun S. Singh
- Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Bartosz Chmielowski
- Division of Hematology-Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - J. Randolph Hecht
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Lee S. Rosen
- University of California Los Angeles, Los Angeles, CA
| | | | | | | | | | | | | | - Michael Douek
- University of California Los Angeles Department of Radiological Sciences, Los Angeles, CA
| | | | | | - Frederick C. Eilber
- Division of Surgical Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - John A. Glaspy
- Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, CA
| |
Collapse
|
30
|
Coy H, Young JR, Pantuck AJ, Douek M, Sisk A, Magyar C, Brown MS, Sayre J, Raman S. Radiomic correlates of molecular and clinicopathological characteristics in clear cell renal cell carcinoma. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.7_suppl.625] [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
625 Background: Clear cell renal cell carcinoma (ccRCC) is a highly vascularized tumor and has a heterogeneous molecular profile, but the correlation between its tumor biology and radiomic features have only recently been investigated. As 70% of ccRCCs are detected incidentally at imaging, and tumor phenotypes are only available after surgery, a non-invasive biomarker to predict ccRCC phenotypes and aggressiveness on imaging may be clinically valuable, as low grade lesions may undergo active surveillance. Methods: With IRB approval and HIPAA compliance, our study cohort comprised 92 consecutive patients with 102 ccRCCs (mean age, 62 years (SD ± 14.2) with histopathology and molecular endpoints imaged preoperatively on CT with a four-phase renal protocol [unenhanced (U), corticomedullary (C), nephrographic (N), excretory (E)]. Radiomic data was obtained by contouring the entire ccRCC in each phase to obtain a 3D tumor volume of interest (VOI). The mean enhancement in each phase the and wash-in and wash-out of enhancement was calculated for each ccRCC. Molecular data was obtained through immunohistochemistry of resected ccRCCs to assess carbonic anhydrase-IX (CAIX), microvessel density (MVD), phosphatase and tension homolog (PTEN), and tumor grade (TG). Categorical variables were analyzed with logistic regression and odds ratio (OR) was reported. Continuous variables were analyzed with linear regression and Pearson correlation coefficient (r2) was reported. P-values < .05 were considered significant. Results: Significant radiomic associations included TG and 3D tumor enhancement in the C (OR = 4.72, p = .030), N (OR = 17.71, p < .0001), and E phases (OR = 17.10, p < .0001), and wash-in from U to C (OR = 8.27, p = .004). MVD had a significant positive association with 3D tumor enhancement in the C phase (r2= 0.410, p < .0001), wash-in from U to C (r2= 0.435, p < .0001) and wash-out from the C to N (r2= 0.435, p = .001). There were no significant radiomic correlates with CAIX or PTEN expression. Conclusions: A 3D ccRCC VOI on multiphasic CT had significant correlations with TG and MVD, independent of clinical features, potentially becoming a predictive imaging biomarker of ccRCC aggressiveness and clinical outcome.
Collapse
Affiliation(s)
- Heidi Coy
- University of California Los Angeles Department of Radiological Sciences, Los Angeles, CA
| | - Jonathan R Young
- Department of Radiology, University of California, Davis, Sacramento, CA
| | - Allan J. Pantuck
- Institute of Urologic Oncology (IUO), Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Michael Douek
- University of California Los Angeles Department of Radiological Sciences, Los Angeles, CA
| | - Anthony Sisk
- University of California Los Angeles Department of Pathology, Los Angeles, CA
| | - Clara Magyar
- Institute of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA
| | - Matthew S. Brown
- Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA
| | - James Sayre
- University of California Los Angeles, Los Angeles, CA
| | - Steven Raman
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| |
Collapse
|
31
|
Ahmed M, Douek M. Is axillary ultrasound imaging necessary for all patients with breast cancer? Br J Surg 2019; 105:930-932. [PMID: 29902347 DOI: 10.1002/bjs.10784] [Citation(s) in RCA: 1] [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] [Received: 10/03/2017] [Accepted: 11/09/2017] [Indexed: 11/10/2022]
Abstract
Better use selectively
Collapse
Affiliation(s)
- M Ahmed
- Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK
| | - M Douek
- Research Oncology, Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK
| |
Collapse
|
32
|
Stringfellow T, Douek M. Giant juvenile fibroadenoma in a 12-year-old girl treated with breast conserving surgery: Largest reported case in the UK. Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Winters Z, Afzal M, Rutherford C, Holzner B, Rumpold G, da Costa Vieira RA, Hartup S, Flitcroft K, Bjelic-Radisic V, Oberguggenburger A, Panouilleres M, Mani M, Catanuto G, Douek M, Kokan J, King MT. International validation of the European organisation for research and treatment of cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction. European Journal of Surgical Oncology 2018. [DOI: 10.1016/j.ejso.2018.02.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
34
|
Kuwahata A, Ahmed M, Saeki K, Chikaki S, Kaneko M, Qiu W, Xin Z, Yamaguchi S, Kaneko A, Douek M, Kusakabe M, Sekino M. Combined use of fluorescence with a magnetic tracer and dilution effect upon sentinel node localization in a murine model. Int J Nanomedicine 2018; 13:2427-2433. [PMID: 29719391 PMCID: PMC5914738 DOI: 10.2147/ijn.s153163] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 12/16/2022] Open
Abstract
Background Sentinel node biopsy using radioisotope and blue dye remains a gold standard for axillary staging in breast cancer patients with low axillary burden. However, limitations in the use of radioisotopes have resulted in emergence of novel techniques. This is the first in vivo study to assess the feasibility of combining the two most common novel techniques of using a magnetic tracer and indocyanine green (ICG) fluorescence. Materials and methods A total of 48 mice were divided into eight groups. Groups 1 and 2, the co-localization groups, received an injection of magnetic tracers (Resovist® and Sienna+®, respectively) and ICG fluorescence; distilled water was used as the solvent of ICG. Groups 3 and 4, the diluted injection groups, received an injection of magnetic tracers (Resovist and Sienna+, respectively) and saline for dilution. Groups 5, 6, and 7, the control groups, received magnetic tracer (Resovist, Sienna+) and ICG alone, respectively. Fluorescent intensity assessment and iron quantification of excised popliteal lymph nodes were performed. Group 1', a co-localization group, received an injection of magnetic tracers (Resovist) and ICG' fluorescence: saline was used as the solvent for ICG. Results Lymphatic uptake of all tracers was confined to the popliteal nodes only, with co-localization confirmed in all cases and no significant difference in fluorescent intensity or iron content of ex vivo nodes between the groups (except for Group 1'). There was no impact of dilution on the iron content in the diluted Sienna+ group, but it significantly enhanced Resovist uptake (P=0.005). In addition, there was a significant difference in iron content (P=0.003) in Group 1'. Conclusion The combination of a magnetic tracer (Resovist or Sienna+) and ICG fluorescence is feasible for sentinel node biopsy and will potentially allow for precise transcutaneous node identification, in addition to accurate intraoperative assessment. This radioisotope-free "combined technique" warrants further assessment within a clinical trial.
Collapse
Affiliation(s)
- Akihiro Kuwahata
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Muneer Ahmed
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London, UK
| | - Kohei Saeki
- Graduate School of Agriculture and Life Sciences, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shinichi Chikaki
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Miki Kaneko
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Wenqi Qiu
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Zonghao Xin
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shinji Yamaguchi
- Graduate School of Agriculture and Life Sciences, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Akiko Kaneko
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| | - Michael Douek
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London, UK
| | - Moriaki Kusakabe
- Graduate School of Agriculture and Life Sciences, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan.,Matrix Cell Research Institute Inc., Ibaraki, Japan
| | - Masaki Sekino
- Department of Electrical Engineering and Information Systems, Graduate School of Engineering, The University of Tokyo, Hongo, Bunkyo-ku, Tokyo, Japan
| |
Collapse
|
35
|
Coy H, Young J, Douek M, Sisk A, Magyar C, Brown M, Sayer J, Raman S. MP36-12 CAN A 3D TUMOR VOLUME CONTOUR ON MULTIPHASIC CT PREDICT THE TUMOR MICROENVIRONMENT OF CLEAR CELL RENAL CARCINOMA? J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1146] [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: 10/17/2022]
|
36
|
|
37
|
|
38
|
Abstract
Breast conserving surgery (BCS) is now the standard of care for the majority of women with early stage breast cancer. There is a finite rate of ipsilateral breast tumour recurrence (IBTR) for breast conserving therapy (BCT) with annual rates of less than 1% for specialist breast practices. There has been recent consensus on the definition of an adequate resection margin for both invasive and noninvasive breast cancer treated with BCS, although some variation in margin policy persists with definitions of 'no tumour at ink', 1 and 2 mm margin mandates. Despite the development of methods for intraoperative assessment of margins, up to 20% of patients require further surgery (cavity re-excision or completion mastectomy) to achieve clear surgical margins. In the past decade, several novel technologies for intraoperative margin assessment have been explored with the aim of reducing rates of re-operation and its attendant patient anxiety, inconvenience and additional cost. Ongoing studies are addressing the safety, feasibility and cost-effectiveness of these novel technologies relative to methods in routine clinical usage.
Collapse
Affiliation(s)
- Dorin Dumitru
- The Royal Hampshire Hospitals, NHS Foundation Trust, Winchester SO22 5DG, UK
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | - Michael Douek
- Division of Cancer Studies, King's College, London WC2R 2LS, UK
- Guy's and St Thomas' Hospitals, NHS Foundation Trust, London SE1 9RT, UK
| | - John R Benson
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge CB2 0QQ, UK
- School of medicine, Anglia Ruskin University, Cambridge CB1 1PT, UK
| |
Collapse
|
39
|
Abstract
Intraoperative radiotherapy (IORT) for breast cancer has challenged the standard external beam radiotherapy (EBRT) and has been shown to be non-inferior for treating early breast cancer in the past decade. Several technologies have been tested for IORT and various randomised controlled trials are still ongoing. Different methods of application of IORT have also been evaluated, from early breast cancer to tumour bed boost radiotherapy amongst high risk women. TARGIT-A and ELIOT trials have reported a low incidence of local recurrence and good survival in both arms. Moreover, mortality has been found to be lower amongst women who underwent partial breast radiotherapy compared to those treated with EBRT in a recent meta-analysis. Despite this, IORT has not been introduced in the current clinical practice as yet, and many clinicians do not mention this treatment option to patients awaiting breast cancer surgery. The scientific community does not unanimously support the effectiveness of IORT and still raises concerns about introducing IORT as a standard treatment option for breast cancer. Current evidence demonstrates that IORT is ready for roll-out; it is time to let well-selected and informed patients be offered this treatment option in the current clinical practice.
Collapse
Affiliation(s)
- Emanuela Esposito
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.,Division of Cancer Studies, King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
| | - Michael Douek
- Division of Cancer Studies, King's College London, 3rd Floor Bermondsey Wing, Guy's Hospital, Great Maze Pond, London SE1 9RT, United Kingdom
| |
Collapse
|
40
|
Winters ZE, Afzal M, Rutherford C, Holzner B, Rumpold G, da Costa Vieira RA, Hartup S, Flitcroft K, Bjelic-Radisic V, Oberguggenberger A, Panouilleres M, Mani M, Catanuto G, Douek M, Kokan J, Sinai P, King MT, Spillane A, Snook K, Boyle F, French J, Elder E, Chalmers B, Kabir M, Campbell I, Wong A, Flay H, Scarlet J, Weis J, Giesler J, Bliem B, Nagele E, del Angelo N, Andrade V, Assump¸ão Garcia D, Bonnetain F, Kjelsberg M, William-Jones S, Fleet A, Hathaway S, Elliott J, Galea M, Dodge J, Chaudhy A, Williams R, Cook L, Sethi S, Turton P, Henson A, Gibb J, Bonomi R, Funnell S, Noren C, Ooi J, Cocks S, Dawson L, Patel H, Bailey L, Chatterjee S, Goulden K, Kirk S, Osborne W, Harter L, Sharif MA, Corcoran S, Smith J, Prasad R, Doran A, Power A, Devereux L, Cannon J, Latham S, Arora P, Ridgway S, Coulding M, Roberts R, Absar M, Hodgkiss T, Connolly K, Johnson J, Doyle K, Lunt N, Cooper M, Fuchs I, Peall L, Taylor L, Nicholson A. International validation of the European Organisation for Research and Treatment of Cancer QLQ-BRECON23 quality-of-life questionnaire for women undergoing breast reconstruction. Br J Surg 2017; 105:209-222. [PMID: 29116657 DOI: 10.1002/bjs.10656] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 03/02/2017] [Accepted: 06/23/2017] [Indexed: 11/12/2022]
Abstract
Abstract
Background
The aim was to carry out phase 4 international field-testing of the European Organisation for Research and Treatment of Cancer (EORTC) breast reconstruction (BRECON) module. The primary objective was finalization of its scale structure. Secondary objectives were evaluation of its reliability, validity, responsiveness, acceptability and interpretability in patients with breast cancer undergoing mastectomy and reconstruction.
Methods
The EORTC module development guidelines were followed. Patients were recruited from 28 centres in seven countries. A prospective cohort completed the QLQ-BRECON15 before mastectomy and the QLQ-BRECON24 at 4–8 months after reconstruction. The cross-sectional cohort completed the QLQ-BRECON24 at 1–5 years after reconstruction, and repeated this 2–8 weeks later (test–retest reliability). All participants completed debriefing questionnaires.
Results
A total of 438 patients were recruited, 234 in the prospective cohort and 204 in the cross-sectional cohort. A total of 414 reconstructions were immediate, with a comparable number of implants (176) and donor-site flaps (166). Control groups comprised patients who underwent two-stage implant procedures (72, 75 per cent) or delayed reconstruction (24, 25 per cent). Psychometric scale validity was supported by moderate to high item-own scale and item-total correlations (over 0·5). Questionnaire validity was confirmed by good scale-to-sample targeting, and computable scale scores exceeding 50 per cent, except nipple cosmesis (over 40 per cent). In known-group comparisons, QLQ-BRECON24 scales and items differentiated between patient groups defined by clinical criteria, such as type and timing of reconstruction, postmastectomy radiotherapy and surgical complications, with moderate effect sizes. Prospectively, sexuality and surgical side-effects scales showed significant responsiveness over time (P < 0·001). Scale reliability was supported by high Cronbach's α coefficients (over 0·7) and test–retest (intraclass correlation more than 0·8). One item (finding a well fitting bra) was excluded based on high floor/ceiling effects, poor test–retest and weak correlations in factor analysis (below 0·3), thus generating the QLQ-BRECON23 questionnaire.
Conclusion
The QLQ-BRECON23 is an internationally validated tool to be used alongside the EORTC QLQ-C30 (cancer) and QLQ-BR23 (breast cancer) questionnaires for evaluating quality of life and satisfaction after breast reconstruction.
Collapse
Affiliation(s)
- Z E Winters
- Breast Cancer Surgery Patient-Reported and Clinical Outcomes Research Group, University of Bristol, School of Clinical Sciences, Southmead Hospital, Bristol, UK
- Surgical and Interventional Trials Unit, Division of Surgical Sciences, University College London, London, UK
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - M Afzal
- Breast Cancer Surgery Patient-Reported and Clinical Outcomes Research Group, University of Bristol, School of Clinical Sciences, Southmead Hospital, Bristol, UK
| | - C Rutherford
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
| | - B Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - G Rumpold
- Department of Medical Psychology, Evaluation Software Development, Rum, Austria
| | | | - S Hartup
- St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - K Flitcroft
- Breast and Surgical Oncology, Poche Centre, University of Sydney, New South Wales, Australia
| | - V Bjelic-Radisic
- Department of Breast Surgery and Gynaecology, Medical University Graz, Graz, Austria
| | - A Oberguggenberger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria
| | - M Panouilleres
- Department of Plastic Surgery, Besançon University Hospital, Besançon, France
| | - M Mani
- Department of Surgical Sciences, Plastic and Reconstructive Surgery, Uppsala University, Uppsala, Sweden
| | - G Catanuto
- Multidisciplinary Breast Care, Cannizzaro Hospital, Catania, Italy
| | - M Douek
- Department of Surgical Oncology, Guy's Hospital, London, London, UK
| | - J Kokan
- Cancer Resource Centre, Macclesfield Hospital, Macclesfield, UK
| | - P Sinai
- Breast Cancer Surgery Patient-Reported and Clinical Outcomes Research Group, University of Bristol, School of Clinical Sciences, Southmead Hospital, Bristol, UK
| | - M T King
- Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine, University of Sydney, New South Wales, Australia
| | - A Spillane
- Poche Centre, Sydney, New South Wales, Australia
| | - K Snook
- Poche Centre, Sydney, New South Wales, Australia
| | - F Boyle
- Poche Centre, Sydney, New South Wales, Australia
| | - J French
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | - E Elder
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | - B Chalmers
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | - M Kabir
- The Crown Princess Mary Westmead Breast Cancer Centre and Specialist Services, Sydney, New South Wales, Australia
| | | | - A Wong
- Waikato Hospital, Hamilton, New Zealand
| | - H Flay
- Waikato Hospital, Hamilton, New Zealand
| | - J Scarlet
- Waikato Hospital, Hamilton, New Zealand
| | - J Weis
- University of Freiburg, Freiberg, Germany
| | - J Giesler
- University of Freiburg, Freiberg, Germany
| | - B Bliem
- Medical University Graz, Graz, Austria
| | - E Nagele
- Medical University Graz, Graz, Austria
| | | | - V Andrade
- Barretos Cancer Hospital, Sao Paolo, Brazil
| | | | - F Bonnetain
- Besançon University Hospital, Besançon, France
| | | | - S William-Jones
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - A Fleet
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - S Hathaway
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - J Elliott
- Clinical Research Network, West Midlands, Queen-s Hospital, Burton upon Trent, UK
| | - M Galea
- Cancer Research Unit, Great Western Hospital, Swindon, UK
| | - J Dodge
- Cancer Research Unit, Great Western Hospital, Swindon, UK
| | - A Chaudhy
- Cancer Research Unit, Great Western Hospital, Swindon, UK
| | | | - L Cook
- Guy's Hospital, London, UK
| | | | - P Turton
- Leeds Teaching Hospital, Leeds, UK
| | - A Henson
- Leeds Teaching Hospital, Leeds, UK
| | - J Gibb
- Leeds Teaching Hospital, Leeds, UK
| | - R Bonomi
- Worthing Hospital, Western Sussex Hospitals, Worthing, UK
| | - S Funnell
- Worthing Hospital, Western Sussex Hospitals, Worthing, UK
| | - C Noren
- Worthing Hospital, Western Sussex Hospitals, Worthing, UK
| | - J Ooi
- Royal Bolton Hospital, Bolton, UK
| | - S Cocks
- Royal Bolton Hospital, Bolton, UK
| | - L Dawson
- Royal Bolton Hospital, Bolton, UK
| | - H Patel
- Royal Bolton Hospital, Bolton, UK
| | - L Bailey
- Royal Bolton Hospital, Bolton, UK
| | | | | | - S Kirk
- Salford Royal Hospital, UK
| | | | | | | | | | - J Smith
- Stepping Hill Hospital, Stockport, UK
| | - R Prasad
- Royal AlbertEdward Infirmary, Wigan, UK
| | - A Doran
- Royal AlbertEdward Infirmary, Wigan, UK
| | - A Power
- Royal AlbertEdward Infirmary, Wigan, UK
| | | | - J Cannon
- Royal AlbertEdward Infirmary, Wigan, UK
| | - S Latham
- Royal AlbertEdward Infirmary, Wigan, UK
| | - P Arora
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - S Ridgway
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - M Coulding
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - R Roberts
- Tameside General Hospital, Ashton-under-Lyne, UK
| | - M Absar
- North ManchesterGeneral Hospital, Manchester, UK
| | - T Hodgkiss
- North ManchesterGeneral Hospital, Manchester, UK
| | - K Connolly
- North ManchesterGeneral Hospital, Manchester, UK
| | - J Johnson
- North ManchesterGeneral Hospital, Manchester, UK
| | - K Doyle
- North ManchesterGeneral Hospital, Manchester, UK
| | - N Lunt
- Cancer Resource Centre, Macclesfield Hospital, Macclesfield, UK
| | - M Cooper
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - I Fuchs
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - L Peall
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - L Taylor
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| | - A Nicholson
- Bristol Breast Care Centre, Southmead Hospital, Bristol, UK
| |
Collapse
|
41
|
Ahmed M, Douek M. A systematic review of neo-adjuvant radiotherapy in the treatment of breast cancer. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.10.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
42
|
Peek MCL, Ahmed M, Scudder J, Baker R, Charalampoudis P, Pinder SE, Douek M. High-intensity focused ultrasound in the treatment of breast fibroadenomata (HIFU-F trial). Int J Hyperthermia 2017; 34:1002-1009. [PMID: 28854826 DOI: 10.1080/02656736.2017.1373865] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 10/19/2022] Open
Abstract
BACKGROUND High-intensity focussed ultrasound (HIFU) is a non-invasive ablative technique utilising the application of high frequency ultrasound (US) pressure waves to cause tissue necrosis. This emerging technology is currently limited by prolonged treatment times. The aim of the HIFU-F trial was to perform circumferential HIFU treatment as a means of shortening treatment times. METHODS A prospective trial was set up to treat 50 consecutive patients ≥18 years of age. Eligible patients possessed symptomatic fibroadenomata, visible on US. Patients ≥25 years of age required histological confirmation of the diagnosis. Primary outcome measures were reduction in treatment time, reduction in volume on US after 12 months and complication rates. RESULTS HIFU treatment was performed in 51 patients (53 treatments) with a mean age of 29.8 years (SD 7.2 years) and a diameter of 2.6 cm (SD 1.4 cm). Circumferential ablation reduced treatment times by an estimated 19.9 min (SD 25.1 min), which is a 29.4% (SD 15.2%) reduction compared with whole lesion ablation. Volume reduction of 43.2% (SD 35.4%; p < 0.005, paired t-test) was observed on US at 12 months post-treatment. Local complications completely resolved at 1 month apart from skin hyper-pigmentation, which persisted in nine cases at three months, six cases at 6 months and six at 12 months. CONCLUSION Circumferential HIFU treatment for breast fibroadenomata is feasible to reduce both lesion size and treatment time. HIFU is a non-invasive alternative technique for the treatment of breast fibroadenomata. ISRCTN registration: 76622747.
Collapse
Affiliation(s)
- M C L Peek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - M Ahmed
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - J Scudder
- b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - R Baker
- c School of Business , University of Salford , Salford , Great Britain
| | - P Charalampoudis
- b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - S E Pinder
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | - M Douek
- a Division of Cancer Studies , King's College London, Guy's Hospital Campus , London , Great Britain.,b Guy's and St. Thomas' NHS Foundation Trust , London , Great Britain
| | | |
Collapse
|
43
|
Ahmed M, Jozsa F, Baker R, Rubio IT, Benson J, Douek M. Erratum to: Meta-analysis of tumour burden in pre-operative axillary ultrasound positive and negative breast cancer patients. Breast Cancer Res Treat 2017; 166:337. [PMID: 28856616 DOI: 10.1007/s10549-017-4457-4] [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: 10/19/2022]
Affiliation(s)
- Muneer Ahmed
- Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK
| | - F Jozsa
- Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK
| | - R Baker
- Department of Statistics, School of Business, University of Salford, 612, Maxwell Building, Salford, M5 4WT, UK
| | - I T Rubio
- Breast Surgical Unit, Breast Cancer Centre, Hospital Universitario Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - J Benson
- Breast Surgical Unit, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - M Douek
- Division of Cancer Studies, Research Oncology, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT, UK.
| |
Collapse
|
44
|
Abstract
Minimally invasive techniques like high intensity focused ultrasound, radiofrequency ablation, cryo-ablation, laser ablation and microwave ablation have been used to treat both breast fibroadenomata and breast cancer as an alternative to surgical excision, potentially reducing the complications, improving cosmesis and reducing hospital stay. This review describes the most common minimally invasive techniques available, their history and some of the studies performed with these techniques in both benign and malignant lesions. In addition we described some of the difficulties of using these minimally invasive techniques such as optimization of anaesthesia, imaging and immobilisation in order to increase the complete histopathological ablation rates.
Collapse
Affiliation(s)
- Mirjam C L Peek
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT UK
| | - Michael Douek
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London, SE1 9RT UK
| |
Collapse
|
45
|
Young JR, Coy H, Douek M, Lo P, Sayre J, Pantuck AJ, Raman SS. Type 1 papillary renal cell carcinoma: differentiation from Type 2 papillary RCC on multiphasic MDCT. Abdom Radiol (NY) 2017; 42:1911-1918. [PMID: 28265706 DOI: 10.1007/s00261-017-1091-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To investigate whether multiphasic MDCT enhancement can help differentiate type 1 papillary renal cell carcinoma (RCC) from type 2 papillary RCC. METHODS With IRB approval for this HIPAA-compliant retrospective study, we derived a cohort of 36 type 1 papillary RCCs and 33 type 2 papillary RCCs with preoperative multiphasic MDCT with up to four phases (unenhanced, corticomedullary, nephrographic, and excretory) from 2000 to 2013. Following segmentation, a computer-assisted detection (CAD) algorithm selected a 0.5 cm-diameter region of maximal attenuation within each lesion in each phase; a 0.5 cm-diameter region of interest was manually placed on uninvolved renal cortex in each phase. The relative attenuation of each lesion was calculated as [(Lesion attenuation-cortex attenuation)/cortex attenuation] × 100. Absolute and relative attenuation values were compared using Mann-Whitney tests with Bonferroni correction for multiple comparisons. RESULTS Relative excretory phase attenuation of type 2 papillary RCCs was significantly greater than that of type 1 papillary RCCs (2.0 vs. -18.3, p = 0.005). Relative excretory phase attenuation differentiated type 1 papillary RCCs from type 2 papillary RCCs with an accuracy of 73% (36/49), sensitivity of 87% (26/30), positive predictive value of 74% (26/35), and negative predictive value of 71% (10/14). CONCLUSION Multiphasic MDCT enhancement may assist in differentiating type 1 papillary RCCs from type 2 papillary RCCs, if prospectively validated.
Collapse
Affiliation(s)
- Jonathan R Young
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA.
| | - Heidi Coy
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA
| | - Michael Douek
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA
| | - Pechin Lo
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA
| | - James Sayre
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA
| | - Allan J Pantuck
- Department of Urology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Steven S Raman
- Department of Radiology, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, 757 Westwood Plaza, Suite 1638, Los Angeles, CA, USA
| |
Collapse
|
46
|
Affiliation(s)
- Muneer Ahmed
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK
| | - Mirjam Cl Peek
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK
| | - Michael Douek
- Division of Cancer Studies, King's College London, Guy's Hospital Campus, Great Maze Pond, London SE1 9RT, UK
| |
Collapse
|
47
|
Ahmed M, Jozsa F, Douek M. Is there a role for sentinel node biopsy in the pre-operative ultrasound positive axilla? Breast Cancer Res Treat 2017; 165:225-228. [PMID: 28597050 DOI: 10.1007/s10549-017-4313-6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 05/23/2017] [Indexed: 11/29/2022]
Abstract
Axillary management in breast cancer is becoming increasingly conservative. This approach is based on the identification of low axillary burden on sentinel node biopsy (SNB). The modern practice of routine pre-operative axillary ultrasound has meant that patients are 'fast tracked' to axillary node clearance (ANC) in the presence of a histologically confirmed positive axilla. This practice reduces the number of patients undergoing SNB compared to the original trials, which evaluated the role of SNB, and those assessing safety of omission of ANC in low axillary burden. The risk of depriving patients with low axillary burden the opportunity to avoid ANC as a consequence of pre-operative ultrasound is discussed.
Collapse
Affiliation(s)
- M Ahmed
- Division of Cancer Studies, Research Oncology, King's College London, London, SE1 9RT, UK.
| | - F Jozsa
- Division of Cancer Studies, Research Oncology, King's College London, London, SE1 9RT, UK
| | - M Douek
- Division of Cancer Studies, Research Oncology, King's College London, London, SE1 9RT, UK
| |
Collapse
|
48
|
Grootendorst MR, Cariati M, Pinder SE, Kothari A, Douek M, Kovacs T, Hamed H, Pawa A, Nimmo F, Owen J, Ramalingam V, Sethi S, Mistry S, Vyas K, Tuch DS, Britten A, Van Hemelrijck M, Cook GJ, Sibley-Allen C, Allen S, Purushotham A. Intraoperative Assessment of Tumor Resection Margins in Breast-Conserving Surgery Using 18F-FDG Cerenkov Luminescence Imaging: A First-in-Human Feasibility Study. J Nucl Med 2017; 58:891-898. [PMID: 27932562 DOI: 10.2967/jnumed.116.181032] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/26/2016] [Indexed: 01/27/2023] Open
Abstract
In early-stage breast cancer, the primary treatment option for most women is breast-conserving surgery (BCS). There is a clear need for more accurate techniques to assess resection margins intraoperatively, because on average 20% of patients require further surgery to achieve clear margins. Cerenkov luminescence imaging (CLI) combines optical and molecular imaging by detecting light emitted by 18F-FDG. Its high-resolution and small size imaging equipment make CLI a promising technology for intraoperative margin assessment. A first-in-human study was conducted to evaluate the feasibility of 18F-FDG CLI for intraoperative assessment of tumor margins in BCS. Methods: Twenty-two patients with invasive breast cancer received 18F-FDG (5 MBq/kg) 45-60 min before surgery. Sentinel lymph node biopsy was performed using an increased 99mTc-nanocolloid activity of 150 MBq to facilitate nodal detection against the γ-probe background signal (cross-talk) from 18F-FDG. The cross-talk and 99mTc dose required was evaluated in 2 lead-in studies. Immediately after excision, specimens were imaged intraoperatively in an investigational CLI system. The first 10 patients were used to optimize the imaging protocol; the remaining 12 patients were included in the analysis dataset. Cerenkov luminescence images from incised BCS specimens were analyzed postoperatively by 2 surgeons blinded to the histopathology results, and mean radiance and margin distance were measured. The agreement between margin distance on CLI and histopathology was assessed. Radiation doses to staff were measured. Results: Ten of the 12 patients had an elevated tumor radiance on CLI. Mean radiance and tumor-to-background ratio were 560 ± 160 photons/s/cm2/sr and 2.41 ± 0.54, respectively. All 15 assessable margins were clear on CLI and histopathology. The agreement in margin distance and interrater agreement was good (κ = 0.81 and 0.912, respectively). Sentinel lymph nodes were successfully detected in all patients. The radiation dose to staff was low; surgeons received a mean dose of 34 ± 15 μSv per procedure. Conclusion: Intraoperative 18F-FDG CLI is a promising, low-risk technique for intraoperative assessment of tumor margins in BCS. A randomized controlled trial will evaluate the impact of this technique on reexcision rates.
Collapse
Affiliation(s)
- Maarten R Grootendorst
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Massimiliano Cariati
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sarah E Pinder
- Division of Cancer Studies, King's College London, London, United Kingdom
| | - Ashutosh Kothari
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michael Douek
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Tibor Kovacs
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Hisham Hamed
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amit Pawa
- Anesthetic Department, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Fiona Nimmo
- Day Surgery Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Julie Owen
- Division of Cancer Studies, King's College London, London, United Kingdom
| | - Vernie Ramalingam
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sweta Sethi
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sanjay Mistry
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kunal Vyas
- Sagentia Ltd., Cambridge, United Kingdom
| | - David S Tuch
- Lightpoint Medical Ltd., Chesham, United Kingdom
| | - Alan Britten
- Medical Physics Department, St George's Hospital, London, United Kingdom
| | | | - Gary J Cook
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom; and
| | - Chris Sibley-Allen
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Sarah Allen
- Department of Nuclear Medicine, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Arnie Purushotham
- Division of Cancer Studies, King's College London, London, United Kingdom
- Department of Breast Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
49
|
Coy H, Young J, Douek M, Magyar C, Sisk A, Brown MS, Sayre J, Raman S. Correlation of tumor enhancement and imaging features on multiphasic multidetector CT with microvessel density as a step toward a minimally invasive method to predict Fuhrman nuclear grade in patients with clear cell renal cell carcinoma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e16049] [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
e16049 Background: Clear cell renal cell carcinoma (ccRCC) is the most common tumor of the kidney. Up to 70% are incidentally detected on multiphasic CT. The prognosis for patients with ccRCC is related to Fuhrman grade (FG) and is diagnosed by biopsy or excision. There is a great need for a non-invasive method to assess tumor grade which may help inform clinical decision-making. The purpose of our study is to determine if contrast enhancement on CT predicts FG and microvessel density (MVD) of ccRCC lesions and to assess which combination of quantitative and qualitative radiological features and clinical features predict high FG ccRCC lesions. Methods: With IRB approval for this HIPAA-compliant retrospective study, our pathology and imaging databases were queried to obtain a cohort of ccRCC with a preoperative multiphasic (unenhanced (U), corticomedullary (C), nephrographic (N), and excretory (E)) CT scan. Tumors were stained with CD4 to quantify % MVD. Spearman’s rank correlation was calculated to test the strength of the association between CT enhancement, %MVD and FG. Stepwise logistic regression analysis was performed to determine the quantitative and/or qualitative feature with the highest performance in predicting high FG tumor. The multivariate logistic regression analysis was evaluated using ROC curves and AUCs. Results: Our cohort had 127 patients with 89 low-grade tumors and 43 high-grade tumors. The %wash-in of enhancement from the U to the C phase showed a significant correlation with %MVD of the tumor (R2= 0.181,p < . 001) as did enhancement of the tumor in the early C phase with %MVD (R2= 0.159,p < . 001). There was a significant inverse correlation with %MVD and FG (R2= 0.137,p < . 001). T-stage, tumor size, %MVD and presence of renal vein invasion were determined to be significant independent predictors of high grade lesions with an AUC of .838 (95% CI .748-.927). Conclusions: Lower grade ccRCC tumors have a higher MVD. Therefore, contrast material washes in at a faster rate from the UN to the CM phase, enabling low grade to be discriminated from high-grade tumors on CT.
Collapse
Affiliation(s)
- Heidi Coy
- University of California Los Angeles Department of Radiological Sciences, Los Angeles, CA
| | - Jonathan Young
- University of California Los Angeles Department of Radiological Sciences, Los Angeles, CA
| | - Michael Douek
- University of California Los Angeles Department of Radiological Sciences, Los Angeles, CA
| | - Clara Magyar
- Institute of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, CA
| | - Anthony Sisk
- University of California Los Angeles Department of Pathology, Los Angeles, CA
| | - Matthew S. Brown
- Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, CA
| | - James Sayre
- University of California, Los Angeles, Los Angeles, CA
| | - Steven Raman
- Department of Radiology, University of California Los Angeles, Los Angeles, CA
| |
Collapse
|
50
|
Coy H, Young J, Douek M, Brown M, Sisk A, Sayre J, Raman S. MP22-07 CORRELATION OF CAD PEAK LESION ENHANCEMENT WITH QUANTITATIVE TUMOR ANGIOGENESIS TO NON-INVASIVELY ASSESS FURHMAN GRADES I-IV IN PATIENTS WITH CLEAR CELL RENAL CELL CARCINOMA. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.661] [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: 10/19/2022]
|