Citation: International Journal of gynecological cancer. 2020 Apr 21. Online ahead of print.
Author: Rosemary Lord, Jyoti Rauniyar, Tamsin Morris, Orlaith Condon, Rachel Jones, Rowan Miller, Marcia Hall, Fiona Lofts, Rosalind M Glasspool, Emma Hudson
Abstract: Introduction: The introduction of poly-ADP ribose polymerase inhibitors in ovarian cancer has demonstrated significantly improved progression free survival in four randomized controlled clinical trials in patients with platinum sensitive relapsed ovarian cancer. While overall survival data remain immature, this real world evidence study sets a baseline for future evaluation of poly-ADP ribose polymerase inhibitors.
Methods: A retrospective chart review was undertaken to investigate real world survival outcomes across 13 National Health Service Trusts in England, Wales, and Scotland. Patients were included if they had platinum sensitive relapsed high grade serous ovarian cancer and had responded to secondline platinum based chemotherapy. Clinical data were collected retrospectively from electronic prescribing records and chart notes. The index date for overall survival analysis was defined as the later of (1) day 1 of the final secondline platinum based treatment or (2) date of response to secondline treatment. The primary objective was overall survival from the index date. Secondary objectives included progression free survival and overall survival by subsequent line of treatment. BRCA mutation status was collected where available. Quality of life questionnaires were not assessed within this study.
Results: 233 patients were identified who met the study inclusion criteria. Patient characteristics were consistent with other published data, with a median age of 61 years (range 35-85). Sensitivity analysis of the primary objective demonstrated that the earliest point poly-ADP ribose polymerase inhibitors may be initiated (following completion of secondline chemotherapy) is associated with a median overall survival of 19.8 months. Secondline median overall survival and progression free survival from the index date were 19.3±2.4 months and 7.3±1.2 months, respectively. 144 patients were treated with thirdline chemotherapy with median overall survival and progression free survival from the index date (either date of last cycle of thirdline treatment or date of response to thirdline treatment) of 8.3±2.6 and 4.4±1.8 months, respectively.
Conclusion: Overall survival was shown to be shorter in this real world study compared with randomized clinical trials, and underlines the differences in clinical outcomes of patients in a real life setting. This baseline real world study has demonstrated poor survival outcomes in this patient group prior to availability of poly-ADP ribose polymerase inhibitors.
Keywords: fallopian tube neoplasms; ovarian cancer; peritoneal neoplasms.
Link to PubMed record
Friday 29 May 2020
CCC publication: ractice Considerations for Proton Beam Radiotherapy of Uveal Melanoma During the COVID-19 Pandemic: PTCOG Ocular Experience
Citation: Advances in radiation oncology. 2020 Apr 23. Online ahead of print.
Author: K K Mishra, A Afshar, J Thariat, H A Shih, J E Scholey, I K Daftari, A Kacperek, A Pica, J Hrbacek, R Dendale, A Mazal, J Heufelder, D H Char, W Sauerwein, D C Weber, B E Damato
Abstract: Uveal melanoma (UM) is a rare but life-threatening cancer of the eye. In light of the COVID-19 pandemic, hospitals and proton eye therapy facilities must analyze several factors to ensure appropriate treatment protocols for patients and provider teams. Practice considerations to limit COVID-19 transmission in the proton ocular treatment setting for UM are necessary. The Particle Therapy Co-Operative Group (PTCOG) is the largest international community of particle/proton therapy providers. Participating experts are/were affiliated with the member institutions of the PTCOG Ocular subcommittee with long-standing high-volume proton ocular programs. The practices reviewed in this document must be taken in conjunction with local hospital procedures, multidisciplinary recommendations, and regional/national guidelines, as each community may have its unique needs, supplies, and protocols. Importantly, as the pandemic evolves, so will the strategies and recommendations. Given the unique circumstances for UM patients, along with indications of potential ophthalmologic transmission as a result of healthcare providers working in close proximity to patients and intrinsic infectious risk from eyelashes, tears and hair, practice strategies may be adapted to reduce the risk of viral transmission. Certainly, providers and health care systems will continue to examine and provide as safe and effective care as possible for patients in the current environment.
Link to PubMed record
Author: K K Mishra, A Afshar, J Thariat, H A Shih, J E Scholey, I K Daftari, A Kacperek, A Pica, J Hrbacek, R Dendale, A Mazal, J Heufelder, D H Char, W Sauerwein, D C Weber, B E Damato
Abstract: Uveal melanoma (UM) is a rare but life-threatening cancer of the eye. In light of the COVID-19 pandemic, hospitals and proton eye therapy facilities must analyze several factors to ensure appropriate treatment protocols for patients and provider teams. Practice considerations to limit COVID-19 transmission in the proton ocular treatment setting for UM are necessary. The Particle Therapy Co-Operative Group (PTCOG) is the largest international community of particle/proton therapy providers. Participating experts are/were affiliated with the member institutions of the PTCOG Ocular subcommittee with long-standing high-volume proton ocular programs. The practices reviewed in this document must be taken in conjunction with local hospital procedures, multidisciplinary recommendations, and regional/national guidelines, as each community may have its unique needs, supplies, and protocols. Importantly, as the pandemic evolves, so will the strategies and recommendations. Given the unique circumstances for UM patients, along with indications of potential ophthalmologic transmission as a result of healthcare providers working in close proximity to patients and intrinsic infectious risk from eyelashes, tears and hair, practice strategies may be adapted to reduce the risk of viral transmission. Certainly, providers and health care systems will continue to examine and provide as safe and effective care as possible for patients in the current environment.
Link to PubMed record
CCC publication: A Rapid Review of Evidence and Recommendations From the SIOPE Radiation Oncology Working Group to Help Mitigate for Reduced Paediatric Radiotherapy Capacity During the COVID-19 Pandemic or Other Crises
Citation: Radiotherapy and Oncology. 2020, 148, 216-22. Online ahead of print
Author: Geert O Janssens, Henry C Mandeville, Beate Timmermann, John H Maduro, Claire Alapetite, Laetitia Padovani, Gail Horan, Yasmin Lassen-Ramshad, Karin Dieckmann, Christian Ruebe, Nicky Thorp, Lorenza Gandola, Thankamma Ajithkumar, Tom Boterberg
Abstract: Objective: To derive evidence-based recommendations for the optimal utilisation of resources during unexpected shortage of radiotherapy capacity.
Methods and materials: We have undertaken a rapid review of published literature on the role of radiotherapy in the multimodality treatment of paediatric cancers governing the European practise of paediatric radiotherapy. The derived data has been discussed with expert paediatric radiation oncologists to derive a hierarchy of recommendations.
Results: The general recommendations to mitigate the potential detriment of an unexpected shortage of radiotherapy facilities include: (1) maintain current standards of care as long as possible (2) refer to another specialist paediatric radiotherapy department with similar level of expertise (3) prioritise use of existing radiotherapy resources to treat patients with tumours where radiotherapy has the most effect on clinical outcome (4) use chemotherapy to defer the start of radiotherapy where timing of radiotherapy is not expected to be detrimental (5) active surveillance for low-grade tumours if appropriate and (6) consider iso-effective hypofractionated radiotherapy regimens only for selected patients with predicted poor prognosis. The effectiveness of radiotherapy and recommendations for prioritisation of its use for common and challenging paediatric tumours are discussed.
Conclusion: This review provides evidence-based treatment recommendations during unexpected shortage of paediatric radiotherapy facilities. It has wider applications for the optimal utilisation of facilities, to improve clinical outcome in low- and middle-income countries, where limited resources continue to be a challenge.
Keywords: COVID-19; Coronavirus; Paediatric; Radiotherapy; Resources; Treatment.
Link to PubMed record
Author: Geert O Janssens, Henry C Mandeville, Beate Timmermann, John H Maduro, Claire Alapetite, Laetitia Padovani, Gail Horan, Yasmin Lassen-Ramshad, Karin Dieckmann, Christian Ruebe, Nicky Thorp, Lorenza Gandola, Thankamma Ajithkumar, Tom Boterberg
Abstract: Objective: To derive evidence-based recommendations for the optimal utilisation of resources during unexpected shortage of radiotherapy capacity.
Methods and materials: We have undertaken a rapid review of published literature on the role of radiotherapy in the multimodality treatment of paediatric cancers governing the European practise of paediatric radiotherapy. The derived data has been discussed with expert paediatric radiation oncologists to derive a hierarchy of recommendations.
Results: The general recommendations to mitigate the potential detriment of an unexpected shortage of radiotherapy facilities include: (1) maintain current standards of care as long as possible (2) refer to another specialist paediatric radiotherapy department with similar level of expertise (3) prioritise use of existing radiotherapy resources to treat patients with tumours where radiotherapy has the most effect on clinical outcome (4) use chemotherapy to defer the start of radiotherapy where timing of radiotherapy is not expected to be detrimental (5) active surveillance for low-grade tumours if appropriate and (6) consider iso-effective hypofractionated radiotherapy regimens only for selected patients with predicted poor prognosis. The effectiveness of radiotherapy and recommendations for prioritisation of its use for common and challenging paediatric tumours are discussed.
Conclusion: This review provides evidence-based treatment recommendations during unexpected shortage of paediatric radiotherapy facilities. It has wider applications for the optimal utilisation of facilities, to improve clinical outcome in low- and middle-income countries, where limited resources continue to be a challenge.
Keywords: COVID-19; Coronavirus; Paediatric; Radiotherapy; Resources; Treatment.
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CCC publication: Real-world Experience With Doxorubicin and Olaratumab in Soft Tissue Sarcomas in England and Northern Ireland
Citation: Clinical Sarcoma Research. 2020, 10, 9 eCollection 2020.
Author: Spyridon Gennatas, Florence Chamberlain, Thomas Carter, Susanna Slater, Elena Cojocaru, Beth Lambourn, Anna Stansfeld, Radha Todd, Mark Verrill, Nasim Ali, Robin L Jones, Peter Simmonds, Nicola Keay, Heather McCarty, Sandra Strauss, Vassilios Karavasilis, Palma Dileo, Charlotte Benson
Abstract: Background: A randomised phase II trial demonstrated that the addition of olaratumab to doxorubicin significantly increased overall survival (OS) in patients with advanced soft tissue sarcomas (STS) compared to doxorubicin alone. The recently presented phase III study of doxorubicin and olaratumab in advanced soft tissue sarcoma was discordant with this finding.
Methods: We performed a retrospective analysis of adult patients with advanced-/metastatic STS treated with at least two cycles of doxorubicin and olaratumab at eight sarcoma units across England and Northern Ireland between May 2017 and March 2019.
Results: 172 patients were evaluable and 40 patients (23.3%) had died at the time of analysis. Median ECOG performance status (PS) was 1. Median progression free survival (PFS) was 6.8 months (95% CI 5.9-7.7 months). Leiomyosarcoma was the most common histological subtype (75 patients, 43.6%), followed by liposarcomas (19, 11.0%). The mean number of cycles was 5 (doxorubicin range 2-6; olaratumab range 2-23). Two patients (1.2%) had a complete response and 34 (19.8%) had a partial response. 79 (45.9%) had stable and 58 (33.7%) progressive disease. 57 patients (33.1%) experienced grade ≥ 3 neutropenia and 7 patients (4.1%) grade ≥ 3 febrile neutropenia. Grade ≥ 3 anaemia was seen in 21 patients (12.2%). Grade ≥ 3 non-haematological toxicities were seen in 35 patients (20.3%). A clinically significant drop in left ventricular ejection fraction was seen in 6 patients (3.5%). 48 patients (27.9%) required a dose reduction. Overall survival (OS) is pending.
Conclusions: Our results are in keeping with the phase III study findings: response rate, PFS and OS were similar to those reported in the phase III ANNOUNCE trial.
Keywords: Chemotherapy; Doxorubicin; Olaratumab; Soft tissue sarcomas.
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Author: Spyridon Gennatas, Florence Chamberlain, Thomas Carter, Susanna Slater, Elena Cojocaru, Beth Lambourn, Anna Stansfeld, Radha Todd, Mark Verrill, Nasim Ali, Robin L Jones, Peter Simmonds, Nicola Keay, Heather McCarty, Sandra Strauss, Vassilios Karavasilis, Palma Dileo, Charlotte Benson
Abstract: Background: A randomised phase II trial demonstrated that the addition of olaratumab to doxorubicin significantly increased overall survival (OS) in patients with advanced soft tissue sarcomas (STS) compared to doxorubicin alone. The recently presented phase III study of doxorubicin and olaratumab in advanced soft tissue sarcoma was discordant with this finding.
Methods: We performed a retrospective analysis of adult patients with advanced-/metastatic STS treated with at least two cycles of doxorubicin and olaratumab at eight sarcoma units across England and Northern Ireland between May 2017 and March 2019.
Results: 172 patients were evaluable and 40 patients (23.3%) had died at the time of analysis. Median ECOG performance status (PS) was 1. Median progression free survival (PFS) was 6.8 months (95% CI 5.9-7.7 months). Leiomyosarcoma was the most common histological subtype (75 patients, 43.6%), followed by liposarcomas (19, 11.0%). The mean number of cycles was 5 (doxorubicin range 2-6; olaratumab range 2-23). Two patients (1.2%) had a complete response and 34 (19.8%) had a partial response. 79 (45.9%) had stable and 58 (33.7%) progressive disease. 57 patients (33.1%) experienced grade ≥ 3 neutropenia and 7 patients (4.1%) grade ≥ 3 febrile neutropenia. Grade ≥ 3 anaemia was seen in 21 patients (12.2%). Grade ≥ 3 non-haematological toxicities were seen in 35 patients (20.3%). A clinically significant drop in left ventricular ejection fraction was seen in 6 patients (3.5%). 48 patients (27.9%) required a dose reduction. Overall survival (OS) is pending.
Conclusions: Our results are in keeping with the phase III study findings: response rate, PFS and OS were similar to those reported in the phase III ANNOUNCE trial.
Keywords: Chemotherapy; Doxorubicin; Olaratumab; Soft tissue sarcomas.
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CCC publication: Introducing Magnetic Resonance Imaging Into the Lung Cancer Radiotherapy Workflow - An Assessment of Patient Experience
Citation: Radiography. 2021, 27(1), 14-23. 2020 May 22;S1078-8174(20)30072-9. Online ahead of print.
Author: S Bellhouse, S Brown, M Dubec, S Taylor, R Hales, L Whiteside, J Yorke, C Faivre-Finn
Abstract: Introduction: Magnetic resonance imaging (MRI) offers superior soft tissue contrast to computed tomography (CT), the current standard imaging modality for planning radiotherapy treatment. Improved soft tissue contrast could reduce uncertainties in identifying tumour and surrounding healthy tissues, potentially leading to improved outcomes in patients with lung cancer. This study explored patient experience of MR treatment planning scans in addition to a CT scan.
Methods: Participants were recruited to the 'Magnetic Resonance Imaging for the Delineation of Organs At Risk and Target Volumes in Lung Cancer Patients (MR-Lung)' study at a UK specialist cancer centre. Participants completed their standard of care radiotherapy planning CT scan and two additional MRI scans. Baseline and post-scan questionnaires were completed assessing anxiety and claustrophobia. Motion artefact during MRI was assessed by a modified visual grading analysis. Sixteen participants completed semi-structured interviews; transcripts were analysed thematically.
Results: 29 people (66% female; aged 54-89 years) participated. Nineteen participants completed all imaging and 10 participants withdrew before completion. There was minimal adverse impact on state and scan-specific anxiety levels from completing the MRI scans. Completers experienced significantly less scan-specific anxiety during MRI 1 compared to non-completers (U = 33, z = -1.98, p < 0.05). 78% of those who withdrew during or post MRI 1 were positioned 'arms up'. Motion artefact negatively impacted image quality in 34% of scans. Participants commonly reported concerns during MRI; noise, claustrophobia and pain in upper limbs.
Conclusion: Two thirds of participants tolerated two additional MR scans with minimal adverse impact on anxiety levels.
Implications for practice: Patient arm positioning and comfort ought to be considered when introducing MR-Linac systems. A screening tool to identify those at high risk of non-completion should be developed.
Keywords: Lung cancer; MR Linac; MRI; Patient experience; Radiotherapy; Treatment planning.
Link to PubMed record
Author: S Bellhouse, S Brown, M Dubec, S Taylor, R Hales, L Whiteside, J Yorke, C Faivre-Finn
Abstract: Introduction: Magnetic resonance imaging (MRI) offers superior soft tissue contrast to computed tomography (CT), the current standard imaging modality for planning radiotherapy treatment. Improved soft tissue contrast could reduce uncertainties in identifying tumour and surrounding healthy tissues, potentially leading to improved outcomes in patients with lung cancer. This study explored patient experience of MR treatment planning scans in addition to a CT scan.
Methods: Participants were recruited to the 'Magnetic Resonance Imaging for the Delineation of Organs At Risk and Target Volumes in Lung Cancer Patients (MR-Lung)' study at a UK specialist cancer centre. Participants completed their standard of care radiotherapy planning CT scan and two additional MRI scans. Baseline and post-scan questionnaires were completed assessing anxiety and claustrophobia. Motion artefact during MRI was assessed by a modified visual grading analysis. Sixteen participants completed semi-structured interviews; transcripts were analysed thematically.
Results: 29 people (66% female; aged 54-89 years) participated. Nineteen participants completed all imaging and 10 participants withdrew before completion. There was minimal adverse impact on state and scan-specific anxiety levels from completing the MRI scans. Completers experienced significantly less scan-specific anxiety during MRI 1 compared to non-completers (U = 33, z = -1.98, p < 0.05). 78% of those who withdrew during or post MRI 1 were positioned 'arms up'. Motion artefact negatively impacted image quality in 34% of scans. Participants commonly reported concerns during MRI; noise, claustrophobia and pain in upper limbs.
Conclusion: Two thirds of participants tolerated two additional MR scans with minimal adverse impact on anxiety levels.
Implications for practice: Patient arm positioning and comfort ought to be considered when introducing MR-Linac systems. A screening tool to identify those at high risk of non-completion should be developed.
Keywords: Lung cancer; MR Linac; MRI; Patient experience; Radiotherapy; Treatment planning.
Link to PubMed record
CCC publication: Chemotherapy in the workplace is popular with nurses and patients
Citation: Cancer Nursing Practice. 2020, 19(3), 18-9
Author: Bourne
CCC publication: Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial
Citation: The Lancet. 2020, 395(10237), 1613-26
Author: Adrian Murray Brunt, Joanne S Haviland, Duncan A Wheatley, Mark A Sydenham, Abdulla Alhasso, David J Bloomfield, Charlie Chan, Mark Churn, Susan Cleator, Charlotte E Coles, Andrew Goodman, Adrian Harnett, Penelope Hopwood, Anna M Kirby, Cliona C Kirwan, Carolyn Morris, Zohal Nabi, Elinor Sawyer, Navita Somaiah, Liba Stones, Isabel Syndikus, Judith M Bliss, John R Yarnold, Abdulla Alhasso, Anne Armstrong, Judith Bliss, David Bloomfield, Jo Bowen, Murray Brunt, Charlie Chan, Hannah Chantler, Mark Churn, Susan Cleator, Charlotte Coles, Ellen Donovan, Andy Goodman, Susan Griffin, Jo Haviland, Penny Hopwood, Anna Kirby, Julie Kirk, Cliona Kirwan, Marjory MacLennan, Carolyn Morris, Zohal Nabi, Elinor Sawyer, Mark Sculphur, Judith Sinclair, Navita Somaiah, Liba Stones, Mark Sydenham, Isabel Syndikus, Jean Tremlett, Karen Venables, Duncan Wheatley, John Yarnold,
Author: Adrian Murray Brunt, Joanne S Haviland, Duncan A Wheatley, Mark A Sydenham, Abdulla Alhasso, David J Bloomfield, Charlie Chan, Mark Churn, Susan Cleator, Charlotte E Coles, Andrew Goodman, Adrian Harnett, Penelope Hopwood, Anna M Kirby, Cliona C Kirwan, Carolyn Morris, Zohal Nabi, Elinor Sawyer, Navita Somaiah, Liba Stones, Isabel Syndikus, Judith M Bliss, John R Yarnold, Abdulla Alhasso, Anne Armstrong, Judith Bliss, David Bloomfield, Jo Bowen, Murray Brunt, Charlie Chan, Hannah Chantler, Mark Churn, Susan Cleator, Charlotte Coles, Ellen Donovan, Andy Goodman, Susan Griffin, Jo Haviland, Penny Hopwood, Anna Kirby, Julie Kirk, Cliona Kirwan, Marjory MacLennan, Carolyn Morris, Zohal Nabi, Elinor Sawyer, Mark Sculphur, Judith Sinclair, Navita Somaiah, Liba Stones, Mark Sydenham, Isabel Syndikus, Jean Tremlett, Karen Venables, Duncan Wheatley, John Yarnold,
CCC publication: The International Association for the Study of Lung Cancer (IASLC) Global Survey on Molecular Testing in Lung Cancer
Citation: Journal of Throacic Oncology. 2020 May 14;S1556-0864(20)30383-X. Online ahead of print.
Author: Matthew P Smeltzer, Murry W Wynes, Sylvie Lantuejoul, Ross Soo, Suresh S Ramalingam, Marileila Varella-Garcia, Meghan Meadows Taylor, Kristin Richeimer, Kelsey Wood, Kristen E Howell, Mercedes Lilana Dalurzo, Enriqueta Felip, Gina Hollenbeck, Keith Kerr, Edward S Kim, Clarissa Mathias, Jose Pacheco, Pieter Postmus, Charles Powell, Masahiro Tsuboi, Ignacio I Wistuba, Heather A Wakelee, Chandra P Belani, Giorgio V Scagliotti, Fred R Hirsch
Abstract: Introduction: Access to targeted therapies for lung cancer depends on accurate identification of patients' biomarkers through molecular testing. IASLC conducted an international survey to evaluate perceptions on current practice and barriers to implementation of molecular testing.
Methods: We distributed the survey to IASLC members and other healthcare professionals around the world. The survey included a 7-question introduction for all respondents, who then answered according to one of three tracks: requesting tests/treating patients, performing/interpreting assays, or tissue acquisition. Barriers to implementing molecular testing were provided in free-response fields. The Chi-squared test was used for regional comparisons.
Results: 2,537 respondents from 102 countries participated. Most respondents testing/treating patients believe <50% of lung cancer patients in their country receive molecular testing, but report higher rates within their own practice. Although many results varied by region, the five most frequent barriers cited in all regions were cost, quality/standards, access, awareness, and turnaround time. Many respondents expressed dissatisfaction with the current state of molecular testing for lung cancer, including 41% of those performing/interpreting assays. Issues identified included trouble understanding results (37%) and quality of the samples (23% report >10% rejection rate). Despite concerns regarding quality of testing, 47% in the performing/interpreting track stated there is no policy or strategy to improve quality in their country. Additionally, 33% of respondents who request tests/treat patients were unaware of the most recent CAP/IASLC/AMP guidelines for molecular testing.
Conclusions: Adoption of molecular testing for lung cancer is relatively low across the world; barriers include cost, access, quality, turn-around time, and lack of awareness.
Link to PubMed record
Author: Matthew P Smeltzer, Murry W Wynes, Sylvie Lantuejoul, Ross Soo, Suresh S Ramalingam, Marileila Varella-Garcia, Meghan Meadows Taylor, Kristin Richeimer, Kelsey Wood, Kristen E Howell, Mercedes Lilana Dalurzo, Enriqueta Felip, Gina Hollenbeck, Keith Kerr, Edward S Kim, Clarissa Mathias, Jose Pacheco, Pieter Postmus, Charles Powell, Masahiro Tsuboi, Ignacio I Wistuba, Heather A Wakelee, Chandra P Belani, Giorgio V Scagliotti, Fred R Hirsch
Abstract: Introduction: Access to targeted therapies for lung cancer depends on accurate identification of patients' biomarkers through molecular testing. IASLC conducted an international survey to evaluate perceptions on current practice and barriers to implementation of molecular testing.
Methods: We distributed the survey to IASLC members and other healthcare professionals around the world. The survey included a 7-question introduction for all respondents, who then answered according to one of three tracks: requesting tests/treating patients, performing/interpreting assays, or tissue acquisition. Barriers to implementing molecular testing were provided in free-response fields. The Chi-squared test was used for regional comparisons.
Results: 2,537 respondents from 102 countries participated. Most respondents testing/treating patients believe <50% of lung cancer patients in their country receive molecular testing, but report higher rates within their own practice. Although many results varied by region, the five most frequent barriers cited in all regions were cost, quality/standards, access, awareness, and turnaround time. Many respondents expressed dissatisfaction with the current state of molecular testing for lung cancer, including 41% of those performing/interpreting assays. Issues identified included trouble understanding results (37%) and quality of the samples (23% report >10% rejection rate). Despite concerns regarding quality of testing, 47% in the performing/interpreting track stated there is no policy or strategy to improve quality in their country. Additionally, 33% of respondents who request tests/treat patients were unaware of the most recent CAP/IASLC/AMP guidelines for molecular testing.
Conclusions: Adoption of molecular testing for lung cancer is relatively low across the world; barriers include cost, access, quality, turn-around time, and lack of awareness.
Link to PubMed record
CCC publication: Activity and safety of the multi-target tyrosine kinase inhibitor cabozantinib in patients with metastatic gastrointestinal stromal tumour after treatment with imatinib and sunitinib: European Organisation for Research and Treatment of Cancer phase II trial 1317 ‘CaboGIST’
Citation: European Journal of Cancer. 2020, 134, 62-74
Author: Patrick Schöffski, Olivier Mir, Bernd Kasper, Zsuzsanna Papai, Jean-Yves Blay, Antoine Italiano, Charlotte Benson, Katerina Kopeckova, Nasim Ali, Palma Dileo, Axel LeCesne, Franka Menge, Sophie Cousin, Eva Wardelmann, Agnieszka Wozniak, Sandrine Marreaud, Saskia Litiere, Facundo Zaffaroni, Axelle Nzokirantevye, Isabelle Vanden Bempt, Hans Gelderblom
Author: Patrick Schöffski, Olivier Mir, Bernd Kasper, Zsuzsanna Papai, Jean-Yves Blay, Antoine Italiano, Charlotte Benson, Katerina Kopeckova, Nasim Ali, Palma Dileo, Axel LeCesne, Franka Menge, Sophie Cousin, Eva Wardelmann, Agnieszka Wozniak, Sandrine Marreaud, Saskia Litiere, Facundo Zaffaroni, Axelle Nzokirantevye, Isabelle Vanden Bempt, Hans Gelderblom
CCC publication: Radiomics: Quantitative Radiology Transforming Oncology Care
Citation: The British Journal of Radiology. 2020 May 6;20200333. Online ahead of print.
Author: Ian S Boon, Moi H Yap, Tracy P T Au Yong, Cheng S Boon
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Author: Ian S Boon, Moi H Yap, Tracy P T Au Yong, Cheng S Boon
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CCC publication: Scheduling Nab-Paclitaxel Combined With Gemcitabine as First-Line Treatment for Metastatic Pancreatic Adenocarcinoma
Citation: British Journal of Cancer. 2020, 122(12), 1760-68. Epub 2020 Apr 30.
Author: P G Corrie, W Qian, B Basu, J W Valle, S Falk, C Lwuji, H Wasan, D Palmer, M Scott-Brown, J Wadsley, S Arif, J Bridgewater, D Propper, R Gillmore, A Gopinathan, R Skells, P Bundi, R Brais, K Dalchau, L Bax, A Chhabra, A Machin, A Dayim, K McAdam, S Cummins, L Wall, R Ellis, A Anthoney, J Evans, Y T Ma, C Isherwood, A Neesse, D Tuveson, D I Jodrell
Abstract: Background: Nab-paclitaxel plus gemcitabine (nabP+gemcitabine) offers modest survival gains for patients with metastatic pancreatic ductal adenocarcinoma (PDAC). Sequential scheduling of nabP+gemcitabine in a PDAC mouse model improved efficacy; this hypothesis was tested in a clinical trial.
Methods: Patients with previously untreated metastatic PDAC were randomised to receive nabP+gemcitabine administered either concomitantly on the same day, or sequentially, with gemcitabine administered 24 h after nabP. The primary outcome measure was progression-free survival (PFS). Secondary outcome measures were objective response rate (ORR), overall survival (OS), safety, quality of life (QoL) and predictive biomarkers.
Results: In total, 71 patients received sequential (SEQ) and 75 concomitant (CON) treatment. Six-month PFS was 46% with SEQ and 32% with CON scheduling. Median PFS (5.6 versus 4.0 months, hazard ratio [HR] 0.67, 95% confidence interval [95% CI] 0.47-0.95, p = 0.022) and ORR (52% versus 31%, p = 0.023) favoured the SEQ arm; median OS was 10.2 versus 8.2 months (HR 0.93, 95% CI 0.65-1.33, p = 0.70). CTCAE Grade ≥3 neutropaenia incidence doubled with SEQ therapy but was not detrimental to QoL. Strongly positive tumour epithelial cytidine deaminase (CDA) expression favoured benefit from SEQ therapy (PFS HR 0.31, 95% CI 0.13-0.70).
Conclusions: SEQ delivery of nabP+gemcitabine improved PFS and ORR, with manageable toxicity, but did not significantly improve OS.
Clinical trial registration: ISRCTN71070888; ClinialTrials.gov (NCT03529175).
Link to PubMed record
Author: P G Corrie, W Qian, B Basu, J W Valle, S Falk, C Lwuji, H Wasan, D Palmer, M Scott-Brown, J Wadsley, S Arif, J Bridgewater, D Propper, R Gillmore, A Gopinathan, R Skells, P Bundi, R Brais, K Dalchau, L Bax, A Chhabra, A Machin, A Dayim, K McAdam, S Cummins, L Wall, R Ellis, A Anthoney, J Evans, Y T Ma, C Isherwood, A Neesse, D Tuveson, D I Jodrell
Abstract: Background: Nab-paclitaxel plus gemcitabine (nabP+gemcitabine) offers modest survival gains for patients with metastatic pancreatic ductal adenocarcinoma (PDAC). Sequential scheduling of nabP+gemcitabine in a PDAC mouse model improved efficacy; this hypothesis was tested in a clinical trial.
Methods: Patients with previously untreated metastatic PDAC were randomised to receive nabP+gemcitabine administered either concomitantly on the same day, or sequentially, with gemcitabine administered 24 h after nabP. The primary outcome measure was progression-free survival (PFS). Secondary outcome measures were objective response rate (ORR), overall survival (OS), safety, quality of life (QoL) and predictive biomarkers.
Results: In total, 71 patients received sequential (SEQ) and 75 concomitant (CON) treatment. Six-month PFS was 46% with SEQ and 32% with CON scheduling. Median PFS (5.6 versus 4.0 months, hazard ratio [HR] 0.67, 95% confidence interval [95% CI] 0.47-0.95, p = 0.022) and ORR (52% versus 31%, p = 0.023) favoured the SEQ arm; median OS was 10.2 versus 8.2 months (HR 0.93, 95% CI 0.65-1.33, p = 0.70). CTCAE Grade ≥3 neutropaenia incidence doubled with SEQ therapy but was not detrimental to QoL. Strongly positive tumour epithelial cytidine deaminase (CDA) expression favoured benefit from SEQ therapy (PFS HR 0.31, 95% CI 0.13-0.70).
Conclusions: SEQ delivery of nabP+gemcitabine improved PFS and ORR, with manageable toxicity, but did not significantly improve OS.
Clinical trial registration: ISRCTN71070888; ClinialTrials.gov (NCT03529175).
Link to PubMed record
CCC publication: Cancer Datasets and the SARS-CoV-2 Pandemic: Establishing Principles for Collaboration
Citation: ESMO Open. 2020, 5(3), e000825
Author: Carlo Palmieri, Daniel Palmer, Peter Jm Openshaw, J Kenneth Baille, Malcolm G Semple, Lance Turtle
Abstract: Keywords: COVID-19; cancer; principles.
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Author: Carlo Palmieri, Daniel Palmer, Peter Jm Openshaw, J Kenneth Baille, Malcolm G Semple, Lance Turtle
Abstract: Keywords: COVID-19; cancer; principles.
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CCC publication: Density Compensated Diodes for Small Field Dosimetry: Comprehensive Testing and Implications for Design
Citation: Physics in medicine and biology. 2020, 65(15), 155011. Online ahead of print (2020 May 11)
Author: Georgios Georgiou, Sudhir Kumar, Jan Wuerfel, Tracy S A Underwood, James Thompson, Mark A Hill, Carl Graham Rowbottom, John D Fenwick
Abstract: Purpose.In small megavoltage photon fields, the accuracies of an unmodified PTW 60017-type diode dosimeter and six diodes modified by adding airgaps of thickness 0.6-1.6 mm and diameter 3.6 mm have been comprehensively characterized experimentally and computationally. The optimally thick airgap for density compensation was determined, and detectors were micro-CT imaged to investigate differences between experimentally measured radiation responses and those predicted computationally.Methods.Detectors were tested on- and off-axis, at 5 and 15 cm depths in 6 and 15 MV fields ≥0.5x0.5 cm2. Computational studies were carried out using the EGSnrc/BEAMnrc Monte Carlo radiation transport code. Experimentally, radiation was delivered using a Varian TrueBeam linac and doses absorbed by water were measured using Gafchromic EBT3 film and ionization chambers, and compared with diode readings. Detector response was characterized via thekQclin,Qmsrfclin,fmsrformalism, choosing a 4x4 cm2reference field.Results.For the unmodified 60017 diode, the maximum error in small field doses obtained from diode readings uncorrected bykQclin,Qmsrfclin,fmsrfactors was determined as 11.9% computationally at +0.25 mm off-axis and 5 cm depth in a 15 MV 0.5x0.5 cm2field, and 11.7% experimentally at -0.30 mm off-axis and 5 cm depth in the same field. A detector modified to include a 1.6 mm thick airgap performed best, with maximum computationally and experimentally determined errors of 2.2% and 4.1%. The 1.6 mm airgap deepened the modified dosimeter's effective point of measurement by 0.5 mm. For some detectors significant differences existed between responses in small fields determined computationally and experimentally, micro-CT imaging indicating that these differences were due to within-tolerance variations in the thickness of an epoxy resin layer.Conclusions.The dosimetric performance of a 60017 diode detector was comprehensively improved throughout 6 and 15 MV small photon fields via density compensation. For this approach to work well with good detector-to-detector reproducibility, tolerances on dense component dimensions should be reduced to limit associated variations of response in small fields, or these components should be modified to have more water-like densities.
Keywords: density compensation; detector response; diode; dosimetry; small field.
Link to PubMed record
Author: Georgios Georgiou, Sudhir Kumar, Jan Wuerfel, Tracy S A Underwood, James Thompson, Mark A Hill, Carl Graham Rowbottom, John D Fenwick
Abstract: Purpose.In small megavoltage photon fields, the accuracies of an unmodified PTW 60017-type diode dosimeter and six diodes modified by adding airgaps of thickness 0.6-1.6 mm and diameter 3.6 mm have been comprehensively characterized experimentally and computationally. The optimally thick airgap for density compensation was determined, and detectors were micro-CT imaged to investigate differences between experimentally measured radiation responses and those predicted computationally.Methods.Detectors were tested on- and off-axis, at 5 and 15 cm depths in 6 and 15 MV fields ≥0.5x0.5 cm2. Computational studies were carried out using the EGSnrc/BEAMnrc Monte Carlo radiation transport code. Experimentally, radiation was delivered using a Varian TrueBeam linac and doses absorbed by water were measured using Gafchromic EBT3 film and ionization chambers, and compared with diode readings. Detector response was characterized via thekQclin,Qmsrfclin,fmsrformalism, choosing a 4x4 cm2reference field.Results.For the unmodified 60017 diode, the maximum error in small field doses obtained from diode readings uncorrected bykQclin,Qmsrfclin,fmsrfactors was determined as 11.9% computationally at +0.25 mm off-axis and 5 cm depth in a 15 MV 0.5x0.5 cm2field, and 11.7% experimentally at -0.30 mm off-axis and 5 cm depth in the same field. A detector modified to include a 1.6 mm thick airgap performed best, with maximum computationally and experimentally determined errors of 2.2% and 4.1%. The 1.6 mm airgap deepened the modified dosimeter's effective point of measurement by 0.5 mm. For some detectors significant differences existed between responses in small fields determined computationally and experimentally, micro-CT imaging indicating that these differences were due to within-tolerance variations in the thickness of an epoxy resin layer.Conclusions.The dosimetric performance of a 60017 diode detector was comprehensively improved throughout 6 and 15 MV small photon fields via density compensation. For this approach to work well with good detector-to-detector reproducibility, tolerances on dense component dimensions should be reduced to limit associated variations of response in small fields, or these components should be modified to have more water-like densities.
Keywords: density compensation; detector response; diode; dosimetry; small field.
Link to PubMed record
CCC publication: Reduced Fractionation in Lung Cancer Patients Treated With Curative-intent Radiotherapy During the COVID-19 Pandemic
Citation: Clinical Oncology. 2020, 32(8), 481-9 (2020 May 13 Online ahead of print.)
Author: C Faivre-Finn, J D Fenwick, K N Franks, S Harrow, M Q F Hatton, C Hiley, J J McAleese, F McDonald, J O'Hare, C Peedell, C Powell, T Pope, R Rulach, E Toy
Abstract: Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dose-fractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic.Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should document all deviations from standard protocols, and we urge all colleagues, where possible, to join national/international data collection initiatives (such as COVID-RT Lung) aimed at recording the impact of the COVID-19 pandemic on lung cancer treatment and outcomes.
Link to PubMed record
Author: C Faivre-Finn, J D Fenwick, K N Franks, S Harrow, M Q F Hatton, C Hiley, J J McAleese, F McDonald, J O'Hare, C Peedell, C Powell, T Pope, R Rulach, E Toy
Abstract: Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dose-fractionation schedules or radiotherapy techniques. This would also increase radiotherapy service capacity for operable patients with stage I-III lung cancer, who might be unable to have surgery during the pandemic.Here we identify reduced-fractionation for curative-intent radiotherapy regimes in lung cancer, from a literature search carried out between 20/03/2020 and 30/03/2020 as well as published and unpublished audits of hypofractionated regimes from UK centres. Evidence, practical considerations and limitations are discussed for early-stage NSCLC, stage III NSCLC, early-stage and locally advanced SCLC. We recommend discussion of this guidance document with other specialist lung MDT members to disseminate the potential changes to radiotherapy practices that could be made to reduce pressure on other departments such as thoracic surgery. It is also a crucial part of the consent process to ensure that the risks and benefits of undergoing cancer treatment during the COVID-19 pandemic and the uncertainties surrounding toxicity from reduced fractionation have been adequately discussed with patients. Furthermore, centres should document all deviations from standard protocols, and we urge all colleagues, where possible, to join national/international data collection initiatives (such as COVID-RT Lung) aimed at recording the impact of the COVID-19 pandemic on lung cancer treatment and outcomes.
Link to PubMed record
Thursday 28 May 2020
CCC publication: Trastuzumab Beyond Progression in Advanced Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: UK Practice now and in the Future
Citation: Clinical Oncology. 2020, 32(10), 636-38. [May 2020 Epub ahead of print]
Author: Robinson T, Palmieri C, Braybrooke JP
Author: Robinson T, Palmieri C, Braybrooke JP
CCC publication: Immune Checkpoint Inhibitor-Related Colitis Assessment and Prognosis: Can IBD Scoring Point the Way?
Citation: British Journal of Cancer. 2020, 123(2), 207–15. (2020 May 18 Online ahead of print.)
Author: Vincent Ting Fung Cheung, Tarun Gupta, Anna Olsson-Brown, Sreedhar Subramanian, Sarah Christina Sasson, Jonathan Heseltine, Eve Fryer, Elena Collantes, Joseph J Sacco, Munir Pirmohamed, Alison Simmons, Paul Klenerman, Mark Tuthill, Andrew S Protheroe, Meenali Chitnis, Benjamin Peter Fairfax, Miranda Jane Payne, Mark Ross Middleton, Oliver Brain
Abstract: Background: Immune checkpoint inhibitors (ICI) improve survival but cause immune-related adverse events (irAE). We sought to determine if CTCAE classification, IBD biomarkers/endoscopic/histological scores correlate with irAE colitis outcomes.
Methods: A dual-centre retrospective study was performed on patients receiving ICI for melanoma, NSCLC or urothelial cancer from 2012 to 2018. Demographics, clinical data, endoscopies (reanalysed using Mayo/Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores), histology (scored with Nancy Index) and treatment outcomes were analysed.
Results: In all, 1074 patients were analysed. Twelve percent (134) developed irAE colitis. Median patient age was 66, 59% were male. CTCAE diarrhoea grade does not correlate with steroid/ infliximab use. G3/4 colitis patients are more likely to need infliximab (p < 0.0001) but colitis grade does not correlate with steroid duration. CRP, albumin and haemoglobin do not correlate with severity. The UCEIS (p = 0.008) and Mayo (p = 0.016) scores correlate with severity/infliximab requirement. Patients with higher Nancy indices (3/4) are more likely to require infliximab (p = 0.03).
Conclusions: CTCAE assessment does not accurately reflect colitis severity and our data do not support its use in isolation, as this may negatively impact timely management. Our data support utilising endoscopic scoring for patients with >grade 1 CTCAE disease, and demonstrate the potential prognostic utility of objective histologic scoring.
Link to PubMed record
Author: Vincent Ting Fung Cheung, Tarun Gupta, Anna Olsson-Brown, Sreedhar Subramanian, Sarah Christina Sasson, Jonathan Heseltine, Eve Fryer, Elena Collantes, Joseph J Sacco, Munir Pirmohamed, Alison Simmons, Paul Klenerman, Mark Tuthill, Andrew S Protheroe, Meenali Chitnis, Benjamin Peter Fairfax, Miranda Jane Payne, Mark Ross Middleton, Oliver Brain
Abstract: Background: Immune checkpoint inhibitors (ICI) improve survival but cause immune-related adverse events (irAE). We sought to determine if CTCAE classification, IBD biomarkers/endoscopic/histological scores correlate with irAE colitis outcomes.
Methods: A dual-centre retrospective study was performed on patients receiving ICI for melanoma, NSCLC or urothelial cancer from 2012 to 2018. Demographics, clinical data, endoscopies (reanalysed using Mayo/Ulcerative Colitis Endoscopic Index of Severity (UCEIS) scores), histology (scored with Nancy Index) and treatment outcomes were analysed.
Results: In all, 1074 patients were analysed. Twelve percent (134) developed irAE colitis. Median patient age was 66, 59% were male. CTCAE diarrhoea grade does not correlate with steroid/ infliximab use. G3/4 colitis patients are more likely to need infliximab (p < 0.0001) but colitis grade does not correlate with steroid duration. CRP, albumin and haemoglobin do not correlate with severity. The UCEIS (p = 0.008) and Mayo (p = 0.016) scores correlate with severity/infliximab requirement. Patients with higher Nancy indices (3/4) are more likely to require infliximab (p = 0.03).
Conclusions: CTCAE assessment does not accurately reflect colitis severity and our data do not support its use in isolation, as this may negatively impact timely management. Our data support utilising endoscopic scoring for patients with >grade 1 CTCAE disease, and demonstrate the potential prognostic utility of objective histologic scoring.
Link to PubMed record
CCC publication: Digital support for living with and beyond gynaecological cancer
Citation: Radiography. 2020, 26(4), e270-e276. Epub 2020 May 18
Author: L A Ashmore, H Stewart, D Hutton, K Evans
Abstract: Introduction: Gynae-Radiotherapy places exceptional psychosocial and physical burdens on patients. Technological developments and associated acute toxicity and survival outcomes have improved, however holistic support has not kept pace. Digital technologies have potential to enhance support and patient experience. The project aimed to co-create a prototype of a digital health intervention that could serve the needs of women living with and beyond treatment for gynaecological cancer.
Methods: A multi-disciplinary and co-creation approach was adopted. Four workshops were held, comprising of a number of activities to support participants' expression of views and facilitate discussion. Methods included word cloud generation, prompt cards, empathy maps and persona creation, domain storylines and requirements identification.
Results: Support drops off dramatically once treatment is completed. Patients struggled to adjust to their 'new normal' and felt unprepared for changes post-treatment. Patients felt overwhelmed with leaflets yet wanted instant access to reliable and relevant information in one place, better information on late side effects and improved communication about sexual health and sexuality. Reassurance through a digital intervention was viewed positively and specific ideas for achieving this were suggested through: Sharing experiences; targeted practical advice; peer support and advice/support for significant others.
Conclusion: The co-creation of a prototype generated further discussion and an interactive prototype was developed. Based on workshop findings it is believed that the intervention could provide life-long support for women living with and beyond cancer.
Implications for practice: Increased focus is needed on the late effects of radiotherapy, specifically in supporting psychosocial wellbeing. Co-creation is a rewarding and fulfilling activity that met numerous aims beyond those of the project. It is recommended that mixed staff-patient groups are developed and adopted in more informal ways for the improvement of services.
Keywords: Co-design; Digital intervention; Gynaecological cancer; Patient support; Patient wellbeing; Radiotherapy.
Copyright © 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Link to PubMed record
Author: L A Ashmore, H Stewart, D Hutton, K Evans
Abstract: Introduction: Gynae-Radiotherapy places exceptional psychosocial and physical burdens on patients. Technological developments and associated acute toxicity and survival outcomes have improved, however holistic support has not kept pace. Digital technologies have potential to enhance support and patient experience. The project aimed to co-create a prototype of a digital health intervention that could serve the needs of women living with and beyond treatment for gynaecological cancer.
Methods: A multi-disciplinary and co-creation approach was adopted. Four workshops were held, comprising of a number of activities to support participants' expression of views and facilitate discussion. Methods included word cloud generation, prompt cards, empathy maps and persona creation, domain storylines and requirements identification.
Results: Support drops off dramatically once treatment is completed. Patients struggled to adjust to their 'new normal' and felt unprepared for changes post-treatment. Patients felt overwhelmed with leaflets yet wanted instant access to reliable and relevant information in one place, better information on late side effects and improved communication about sexual health and sexuality. Reassurance through a digital intervention was viewed positively and specific ideas for achieving this were suggested through: Sharing experiences; targeted practical advice; peer support and advice/support for significant others.
Conclusion: The co-creation of a prototype generated further discussion and an interactive prototype was developed. Based on workshop findings it is believed that the intervention could provide life-long support for women living with and beyond cancer.
Implications for practice: Increased focus is needed on the late effects of radiotherapy, specifically in supporting psychosocial wellbeing. Co-creation is a rewarding and fulfilling activity that met numerous aims beyond those of the project. It is recommended that mixed staff-patient groups are developed and adopted in more informal ways for the improvement of services.
Keywords: Co-design; Digital intervention; Gynaecological cancer; Patient support; Patient wellbeing; Radiotherapy.
Copyright © 2020 The College of Radiographers. Published by Elsevier Ltd. All rights reserved.
Link to PubMed record
WUTH publication: Effectiveness of Clinical Examination in Cancer Surveillance: New Paradigm to Cancer Survivorship Beyond the COVID-19 Pandemic
Citation: Clinical Oncology. 2020, 32(10), e216. Epub 2020 May 23
Author: Boon IS, Au Yong TPT, Boon CS
Link to PubMed record
Author: Boon IS, Au Yong TPT, Boon CS
Link to PubMed record
Monday 18 May 2020
WUTH publication: Pituitary hyperplasia with Sertoli cell-only and 47,XYY syndromes: an uncommon triad
Citation: BMJ Case Reports. 2020, 13(5), e233100
Author: Ra AG, Evans PJ, Awasthi A, Srinivas-Shankar U
Abstract: We report the case history of a 32-year-old man with no phenotypical abnormalities who presented with infertility. Semen analysis revealed azoospermia and testicular biopsy confirmed Sertoli cell-only (SCO) syndrome. Karyotyping revealed 47,XYY and pituitary hyperplasia was found on MRI pituitary. In our patient, 47,XYY karyotype is likely to have given rise to SCO syndrome that in turn resulted in pituitary hyperplasia. The patient was evaluated by various members of the multidisciplinary team including the pituitary surgeon, endocrinologist and andrologist. The patient's partner successfully delivered a healthy baby via in vitro fertilisation with donor sperm. This triad of diagnoses (SCO syndrome, 47,XYY karyotype and pituitary hyperplasia) has not been reported previously. SCO syndrome should be considered in the presence of azoospermia, elevated follicle-stimulating hormone, low inhibin-B and normal testosterone levels. Our case report also highlights the importance of excluding genetic causes of infertility even when the patient has no phenotypical abnormalities.
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: endocrinology; genetics; neuroendocrinology; pituitary disorders
Link to PubMed record
Author: Ra AG, Evans PJ, Awasthi A, Srinivas-Shankar U
Abstract: We report the case history of a 32-year-old man with no phenotypical abnormalities who presented with infertility. Semen analysis revealed azoospermia and testicular biopsy confirmed Sertoli cell-only (SCO) syndrome. Karyotyping revealed 47,XYY and pituitary hyperplasia was found on MRI pituitary. In our patient, 47,XYY karyotype is likely to have given rise to SCO syndrome that in turn resulted in pituitary hyperplasia. The patient was evaluated by various members of the multidisciplinary team including the pituitary surgeon, endocrinologist and andrologist. The patient's partner successfully delivered a healthy baby via in vitro fertilisation with donor sperm. This triad of diagnoses (SCO syndrome, 47,XYY karyotype and pituitary hyperplasia) has not been reported previously. SCO syndrome should be considered in the presence of azoospermia, elevated follicle-stimulating hormone, low inhibin-B and normal testosterone levels. Our case report also highlights the importance of excluding genetic causes of infertility even when the patient has no phenotypical abnormalities.
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
KEYWORDS: endocrinology; genetics; neuroendocrinology; pituitary disorders
Link to PubMed record
Friday 15 May 2020
Coronavirus (COVID-19)
Cochrane provides high-quality, relevant, and up-to-date synthesized research evidence to inform health decisions. https://www.cochrane.org/coronavirus-covid-19-cochrane-resources-and-news highlights content relating to the coronavirus (COVID-19) pandemic and the various related activities that Cochrane is undertaking in response.
We will be continually adding updates and additions to this page. Sections include information and resources for:
We will be continually adding updates and additions to this page. Sections include information and resources for:
Thursday 14 May 2020
WUTH publication: Hearing Aid Uptake in Children with Unilateral Microtia and Canal Atresia: A Comparison between a Tertiary Center and Peripheral Centers
Citation: The Journal of International Advanced Otology. 2020, 16(1), 73-76
Author: Kanzara T, Ford A, Fleming E, De S
Abstract: OBJECTIVES: To review the trialing and uptake of hearing aids in children with unilateral microtia or canal atresia, known collectively as congenital unilateral conductive hearing loss (CUCHL), observed in a tertiary hospital and local peripheral services.
MATERIALS AND METHODS: A retrospective review of medical records for patients with CUCHL was conducted using data from a shared audiology database at a tertiary children's hospital.
RESULTS: We identified 45 patients with CUCHL and excluded seven of them due to missing data. Of the 38 patients, 16 (16/38, 42%) did not have any subjective hearing complaints. Furthermore, 32% (12/38) of patients attended audiology at a tertiary centre and 83% (10/12) from this group trialled a hearing aid. In comparison, 46% (12/46) whose audiology care was delivered peripherally trialled aiding. Of the patients from the tertiary center, 58% (7/12) are still using a hearing aid compared to 27% (7/26) of patients from peripheral centers.
CONCLUSION: Our analysis shows that patients with CUCHL are more likely to try hearing aids and continue using them if their audiology care is in a tertiary center. Allowing for a small sample size, this may indicate a health inequality. Agreeing on minimum standards for the management of patients with CUCHL or managing them in a designated center could increase consistency.
Link to PubMed record
Author: Kanzara T, Ford A, Fleming E, De S
Abstract: OBJECTIVES: To review the trialing and uptake of hearing aids in children with unilateral microtia or canal atresia, known collectively as congenital unilateral conductive hearing loss (CUCHL), observed in a tertiary hospital and local peripheral services.
MATERIALS AND METHODS: A retrospective review of medical records for patients with CUCHL was conducted using data from a shared audiology database at a tertiary children's hospital.
RESULTS: We identified 45 patients with CUCHL and excluded seven of them due to missing data. Of the 38 patients, 16 (16/38, 42%) did not have any subjective hearing complaints. Furthermore, 32% (12/38) of patients attended audiology at a tertiary centre and 83% (10/12) from this group trialled a hearing aid. In comparison, 46% (12/46) whose audiology care was delivered peripherally trialled aiding. Of the patients from the tertiary center, 58% (7/12) are still using a hearing aid compared to 27% (7/26) of patients from peripheral centers.
CONCLUSION: Our analysis shows that patients with CUCHL are more likely to try hearing aids and continue using them if their audiology care is in a tertiary center. Allowing for a small sample size, this may indicate a health inequality. Agreeing on minimum standards for the management of patients with CUCHL or managing them in a designated center could increase consistency.
Link to PubMed record
Wednesday 13 May 2020
Neonatal care
If you are interested in new research, evidence and information related to Neonatal care please visit our neonatal current awareness bulletin
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Coronavirus (COVID-19)
Visit https://www.nice.org.uk/covid-19
For information on how NICE is supporting the NHS and social care, view the new rapid guidelines and evidence summaries. Learn about the government response to coronavirus on GOV.UK.
For information on how NICE is supporting the NHS and social care, view the new rapid guidelines and evidence summaries. Learn about the government response to coronavirus on GOV.UK.
Tuesday 12 May 2020
WUTH publication: The Liverpool Peritonsillar abscess Score: Development of a predictive score through a prospective multicentre observational study
Citation: Clinical Otolarygology. 2019, 44(3), 293-98 Epub 2019 Feb 14
Author: Lau AS, Selwyn DM, Yang D, Swainbank L, Ridley P, Carmichael N, Metcalfe C, Watson G, Emerson H
Abstract: OBJECTIVES: While uncommon in the population at large, peritonsillar abscess (PTA) is a common subject of ENT referrals. Missed or uncertain diagnosis is a source of concern for non-specialist referrers. In line with the NHS England Second Sepsis Action Plan, we aimed to develop a predictive score for the presence of PTA. This would help to improve non-specialist colleagues' diagnostic certainty as well as to support ENT surgeons' triage of these referrals.
DESIGN: Prospective, multicentre observational study.
SETTING: Primary and secondary care.
PARTICIPANTS: Patients >16 years with symptoms of sore throat.
DATA: We prospectively collected comprehensive data on patient demographics, symptoms and clinical status. We documented whether the patient had aspiration-proven PTA or not. We performed binary logistic regression analysis, iterative development of a predictive score which we validated internally.
RESULTS: 100 patients were included (46 PTA and 54 tonsillitis). Five variables added significantly to the logistic regression model: unilateral sore throat; trismus; male gender; pharyngeal voice change; and uvular deviation. Using the odds ratio outputs, we developed the Liverpool Peritonsillar abscess Score (LPS) iteratively. We validated the latest (third) iteration of the LPS internally (ie, on the same sample), yielding sensitivity 96%; specificity 85%; positive predictive value 85%; and negative predictive value 96%. The area under the receiver operating characteristics (AUROC) curve was 0.970.
CONCLUSIONS: We have developed the first predictive score for PTA based on symptoms and signs that do not require the user to have specialist experience. Its high negative predictive value may be particularly helpful to non-specialist colleagues.
© 2019 John Wiley & Sons Ltd.
KEYWORDS: peritonsillar abscess; predictive score; sore throat; swallowing; trismus
Link to PubMed record
Author: Lau AS, Selwyn DM, Yang D, Swainbank L, Ridley P, Carmichael N, Metcalfe C, Watson G, Emerson H
Abstract: OBJECTIVES: While uncommon in the population at large, peritonsillar abscess (PTA) is a common subject of ENT referrals. Missed or uncertain diagnosis is a source of concern for non-specialist referrers. In line with the NHS England Second Sepsis Action Plan, we aimed to develop a predictive score for the presence of PTA. This would help to improve non-specialist colleagues' diagnostic certainty as well as to support ENT surgeons' triage of these referrals.
DESIGN: Prospective, multicentre observational study.
SETTING: Primary and secondary care.
PARTICIPANTS: Patients >16 years with symptoms of sore throat.
DATA: We prospectively collected comprehensive data on patient demographics, symptoms and clinical status. We documented whether the patient had aspiration-proven PTA or not. We performed binary logistic regression analysis, iterative development of a predictive score which we validated internally.
RESULTS: 100 patients were included (46 PTA and 54 tonsillitis). Five variables added significantly to the logistic regression model: unilateral sore throat; trismus; male gender; pharyngeal voice change; and uvular deviation. Using the odds ratio outputs, we developed the Liverpool Peritonsillar abscess Score (LPS) iteratively. We validated the latest (third) iteration of the LPS internally (ie, on the same sample), yielding sensitivity 96%; specificity 85%; positive predictive value 85%; and negative predictive value 96%. The area under the receiver operating characteristics (AUROC) curve was 0.970.
CONCLUSIONS: We have developed the first predictive score for PTA based on symptoms and signs that do not require the user to have specialist experience. Its high negative predictive value may be particularly helpful to non-specialist colleagues.
© 2019 John Wiley & Sons Ltd.
KEYWORDS: peritonsillar abscess; predictive score; sore throat; swallowing; trismus
Link to PubMed record
Thursday 7 May 2020
WUTH publication: Radiomics: Quantitative Radiology transforming Oncology Care
Citation: The British Journal of Radiology. 2020 May 6 [Epub ahead of print]
Author: Boon IS, Yap MH, Au Yong TPT, Boon CS
Link to PubMed record
Author: Boon IS, Yap MH, Au Yong TPT, Boon CS
Link to PubMed record
Monday 4 May 2020
WUTH publication: Effect of the COVID-19 Pandemic on Cancer Clinician Decision Making: Known Knowns and Known Unknowns
Citation: Clinical Oncology. 2020, 32(8), 547–48. [2020 Apr 25 Epub ahead of print]
Author: Boon IS, Au Yong TPT, Boon CS
Link to PubMed record
Author: Boon IS, Au Yong TPT, Boon CS
Link to PubMed record
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