• Abdomino-pelvic computed tomography in the management of ovarian carcinoma.

      Johnson, Richard J; Blackledge, George; Eddleston, Brian; Crowther, Derek; Department of Diagnostic Radiology, Christie Hospital, Manchester, (1983-02)
      121 CT scans were obtained in 75 women with ovarian cancer, including 108 scans of the abdomen and pelvis and 13 of the pelvis alone. 70 patients had epithelial carcinoma. In 48 cases, pelvic CT was performed within 3 weeks after surgery, confirming the operative findings in all but 6. In the abdomen, CT identified intrahepatic deposits and minimal ascites not seen at surgery; however, small peritoneal deposits not usually shown by CT were readily found at surgery. CT was superior to clinical examination, detecting unsuspected disease and delineating areas of known disease more accurately. It was also helpful in assessing suitability for repeat laparotomy. In 7 cases, CT demonstrated an operable lesion which had been thought to be inoperable. In 65 cases (59%), CT contributed additional information which was helpful in management, proving it to be an important noninvasive investigation in patients with ovarian carcinoma.
    • Adjuvant low dose radiation in childhood non-Hodgkin's lymphoma (report from the United Kingdom Childrens' Cancer Study Group--UKCCSG).

      Mott, M G; Eden, Tim O B; Palmer, Michael K; Departments of Child Health and Haematology, Childrens' Hospital, Bristol (1984-10)
      From July 1977 to July 1983, 120 children with non-Hodgkin's Lymphoma entered a randomised trial of combination chemotherapy and radiotherapy. The primary site was abdominal in 42 patients, mediastinal in 27 and in other sites in 51. Failure-free survival (FFS) at 4 years was 74% for the 41 patients with localised disease (Stages I and II) and 51% for the 79 with generalised disease (Stages III and IV). Patients with mediastinal primaries continued to relapse after the completion of 2 years' treatment, but FFS at 4 years for the 93 patients with non-mediastinal primaries was 65% for all stages combined. In the latter group, there was no benefit to patients randomised at the end of induction chemotherapy to receive adjuvant radiation 15 Grays in 10 fractions in 2 weeks to sites of previous bulky disease when compared to those not receiving such radiation (P = 0.6).
    • Comparison of the performance of tracer kinetic model-driven registration for dynamic contrast enhanced MRI using different models of contrast enhancement.

      Buonaccorsi, Giovanni A; Roberts, Caleb; Cheung, Susan; Watson, Yvonne; O'Connor, James P B; Davies, Karen; Jackson, Alan; Jayson, Gordon C; Parker, Geoff J M; Department of Imaging Science and Biomedical Engineering, Stopford Building, Oxford Road, University of Manchester, and Cancer Research UK Department of Medical Oncology, Christie Hospital NHS Trust, UK. giob@manchester.ac.uk (2006-09)
      RATIONALE AND OBJECTIVES: The quantitative analysis of dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) data is subject to model fitting errors caused by motion during the time-series data acquisition. However, the time-varying features that occur as a result of contrast enhancement can confound motion correction techniques based on conventional registration similarity measures. We have therefore developed a heuristic, locally controlled tracer kinetic model-driven registration procedure, in which the model accounts for contrast enhancement, and applied it to the registration of abdominal DCE-MRI data at high temporal resolution. MATERIALS AND METHODS: Using severely motion-corrupted data sets that had been excluded from analysis in a clinical trial of an antiangiogenic agent, we compared the results obtained when using different models to drive the tracer kinetic model-driven registration with those obtained when using a conventional registration against the time series mean image volume. RESULTS: Using tracer kinetic model-driven registration, it was possible to improve model fitting by reducing the sum of squared errors but the improvement was only realized when using a model that adequately described the features of the time series data. The registration against the time series mean significantly distorted the time series data, as did tracer kinetic model-driven registration using a simpler model of contrast enhancement. CONCLUSION: When an appropriate model is used, tracer kinetic model-driven registration influences motion-corrupted model fit parameter estimates and provides significant improvements in localization in three-dimensional parameter maps. This has positive implications for the use of quantitative DCE-MRI for example in clinical trials of antiangiogenic or antivascular agents.
    • Computed tomography (CT) in the staging of patients with Hodgkin's Disease: a report on 136 patients.

      Blackledge, George; Best, J J; Crowther, Derek; Isherwood, I; Cancer Research Campaign Department of Medical Oncology, Manchester University, and Christie Hospital and Holt Radium Institute, Wilmslow Road, Manchester, UK (1980-03)
      One hundred and thirty-six patients with biopsy proven Hodgkin's disease (HD) had conventional staging investigations and CT carried out at presentation. CT did not detect 20 out of 24 positive spleens and did not detect disease at 16 involved lymph node sites proven at laparotomy. In 60 cases in whom lymphography was performed, CT detected all disease shown by lymphography and showed additional disease in 13 other cases (three within the lymphogram area). In 43 patients CT was the only investigation of the abdomen that could be performed and identified 31 unexpected areas of disease in this group. CT altered the stage of the patients in 16% of cases compared with 8% (lymphography) and 34% (laparotomy). The importance of CT as a baseline investigation for the subsequent monitoring of the complete remission of all known disease is discussed, and the routine use of CT when available as the primary non-invasive staging investigation of the abdomen in HD is recommended.
    • Computed tomography of abdomen in staging and clinical management of lymphoma.

      Best, J J; Blackledge, George; Forbes, W S; Todd, Ian D; Eddleston, Brian; Crowther, Derek; Isherwood, I; Christie Hospital, Withington, Manchester, M20 4BX, UK (1978-12-16)
      During July 1976 to Demember 1977, 150 patients with Hodgkin's disease and 138 with non-Hodgkin's lymphoma were examined by computed tomography (CT). In 45 cases 50 repeat examinations were conducted. Concurrent laparotomy and lymphography were performed on 68 and 56 patients respectively. The overall incidence of false-positive CT examinations as confirmed by laparotomy was 7.4%. In 18 patients with non-Hodgkin's lymphoma in the abdomen there was good correlation between the two techniques. Of the 50 patients with Hodgkin's disease who underwent laparotomy, 17 had splenic disease and 14 minimally enlarged lymph nodes in 20 areas; CT, however, detected only four diseased spleens and five minimally enlarged lymph nodes. Nevertheless, CT often detected enlarged lymph nodes missed by lymphography and was 23% more efficient than lymphography in detecting unsuspected disease. CT also detected unsuspected disease in patients with relapse of lymphoma. CT may replace other non-invasive investigations of abdominal disease in patients with lymphoma and give a reliable guide to prognosis. It does not, however, eliminate the need for laparotomy in staging Hodgkin's disease.
    • Computed tomography of abdominal carcinoid tumour.

      Gould, M; Johnson, Richard J (1986-09)
      Ten patients with pathologically proven abdominal carcinoid tumour were assessed by computed tomography (CT). Post-mortem examination correlation was obtained in two cases. Computed tomography demonstrated the extent of intra-abdominal tumour well and is, therefore, a useful staging technique for patients being treated with adjuvant therapy. The appearances of metastatic carcinoid within the mesentery on CT are characteristic and can enable a pre-operative diagnosis to be made.
    • Is laparotomy for small bowel obstruction justified in patients with previously treated malignancy?

      Walsh, H P; Schofield, Philip F; Christie Hospital, Wilmslow Road,Manchester, M20, UK (1984-12)
      We report 53 patients who developed small bowel obstruction some time after the treatment of a primary malignant tumour. Previous treatment of the primary tumour in these patients had been by abdominal surgery (22 patients) or pelvic radiotherapy (20 patients) but 11 of the patients had not received previous abdominal surgery or radiotherapy. All the patients had a laparotomy in an attempt to relieve the obstruction. Seventeen patients had a cause for the obstruction other than secondary malignancy. This was noted particularly when the patients had had pelvic radiotherapy, when radiation change of the ileum causing obstruction was common. Thirty-six patients had obstruction due to secondary tumour and it was found possible to overcome the obstruction in all but two of these. The operative mortality in the patients with secondary malignancy was 19 per cent, but 15 patients (42 per cent) survived for more than a year and the median survival was 11 months. It is concluded that a policy of aggressive surgical intervention is desirable in patients who develop small bowel obstruction after previous treatment for malignant disease.
    • Ovarian failure following abdominal irradiation in childhood.

      Shalet, Stephen M; Beardwell, Colin G; Jones, P H; Pearson, D; Orrell, D (1976-06)
      Ovarian function was studied in 18 female patients treated for abdominal tumours during childhood. All received abdominal radiotherapy as part of their treatment and were studied between 1 and 26 years after irradiation. The serum gonadotrophins and oestradiol levels were consistent with ovarian failure in each case but there was a disproportionate elevation in serum follicle stimulating hormone (FSH) when compared to serum luteinizing hormone (LH) in 16. In 2 patients, the radiotherapeutic field extended downwards only as far as the sacral promontory. However, these 2 girls show similar evidence of ovarian failure to that in the other 16.
    • Ovarian failure following abdominal irradiation in childhood: natural history and prognosis.

      Wallace, W Hamish B; Shalet, Stephen M; Crowne, Elizabeth C; Morris-Jones, P H; Gattamaneni, Rao; Department of Endocrinology, Christie Hospital, Manchester, UK. (1989-11)
      Ovarian function has been reviewed sequentially since 1975 in 53 patients treated in childhood between 1942 and 1985 for an intraabdominal tumour with surgery and external abdominal radiotherapy (XRT). Of 38 patients who received whole abdominal XRT (20-30 Gy), 27 failed to undergo or complete pubertal development (pubertal failure) and a premature menopause (median age 23.5 years) occurred in a further ten. Of 15 patients who received flank XRT (20-30 Gy), ovarian function (median age at last assessment 15.2 years) was normal in all but one in whom pubertal failure occurred. In only one patient, who developed pubertal failure after whole abdominal XRT and required sex steroid replacement therapy (HRT) to achieve normal secondary sexual characteristics, has there been evidence of reversibility of ovarian function with a documented conception at the age of 22.7 years. Five patients who developed pubertal failure required bilateral augmentation mammoplasties despite sex steroid replacement therapy. Four patients have had documented conceptions, all received whole abdominal XRT (20-26.5 Gy) and subsequently developed a premature menopause. There have been no live births, with all miscarriages occurring in the second trimester. The outlook for normal ovarian function following whole abdominal XRT is poor, flank XRT introduced intermittently from 1972, has resulted in less pubertal failure but the possibility of a premature menopause may with time become a reality.
    • Ovarian failure following abdominal irradiation in childhood: the radiosensitivity of the human oocyte.

      Wallace, W Hamish B; Shalet, Stephen M; Hendry, Jolyon H; Morris-Jones, P H; Gattamaneni, Rao; Department of Endocrinology, Christie Hospital, Manchester. (1989-11)
      Ovarian function has been studied sequentially since 1975 in 19 patients treated in childhood for an intra-abdominal tumour with surgery and whole abdominal radiotherapy (total dose 30 Gy). Eleven patients received chemotherapeutic agents that are not known to cause gonadal dysfunction. All but one patient have developed ovarian failure with persistently elevated gonadotrophin levels (FSH and LH greater than 32 IU/litre) and low serum oestradiol values (less than 40 pmol/litre) before the age of 16 years. The majority (n = 12) did not progress beyond breast stage 1 without sex steroid replacement therapy. As the number of oocytes within the ovary declines exponentially by atresia from approximately 2,000,000 at birth to approximately 2000 at the menopause, we have been able to estimate that the LD50 for the human oocyte does not exceed 4 Gy.
    • Preliminary study of oxygen-enhanced longitudinal relaxation in MRI: a potential novel biomarker of oxygenation changes in solid tumors.

      O'Connor, James P B; Naish, Josephine H; Parker, Geoff J M; Waterton, John C; Watson, Yvonne; Jayson, Gordon C; Buonaccorsi, Giovanni A; Cheung, Susan; Buckley, David L; McGrath, Deirdre M; et al. (2009-11-15)
      PURPOSE: There is considerable interest in developing non-invasive methods of mapping tumor hypoxia. Changes in tissue oxygen concentration produce proportional changes in the magnetic resonance imaging (MRI) longitudinal relaxation rate (R(1)). This technique has been used previously to evaluate oxygen delivery to healthy tissues and is distinct from blood oxygenation level-dependent (BOLD) imaging. Here we report application of this method to detect alteration in tumor oxygenation status. METHODS AND MATERIALS: Ten patients with advanced cancer of the abdomen and pelvis underwent serial measurement of tumor R(1) while breathing medical air (21% oxygen) followed by 100% oxygen (oxygen-enhanced MRI). Gadolinium-based dynamic contrast-enhanced MRI was then performed to compare the spatial distribution of perfusion with that of oxygen-induced DeltaR(1). RESULTS: DeltaR(1) showed significant increases of 0.021 to 0.058 s(-1) in eight patients with either locally recurrent tumor from cervical and hepatocellular carcinomas or metastases from ovarian and colorectal carcinomas. In general, there was congruency between perfusion and oxygen concentration. However, regional mismatch was observed in some tumor cores. Here, moderate gadolinium uptake (consistent with moderate perfusion) was associated with low area under the DeltaR(1) curve (consistent with minimal increase in oxygen concentration). CONCLUSIONS: These results provide evidence that oxygen-enhanced longitudinal relaxation can monitor changes in tumor oxygen concentration. The technique shows promise in identifying hypoxic regions within tumors and may enable spatial mapping of change in tumor oxygen concentration.
    • Radiotherapy after chemotherapy for metastatic seminoma--a diminishing role. MRC Testicular Tumour Working Party.

      Duchesne, G; Stenning, S; Aass, N; Mead, G; Fosså, S; Oliver, R; Horwich, A; Read, G; Roberts, I; Rustin, G; et al. (1997-05)
      In a retrospective study, data from 302 patients with metastatic testicular seminoma treated with chemotherapy between 1978 and 1990 in 10 European centres were analysed to evaluate the role, if any, of postchemotherapy treatment with irradiation. The primary endpoint of this study was the progression-free survival rate after chemotherapy with or without additional radiotherapy. This was related to the type of primary chemotherapy, sites and sizes of pre- and postchemotherapy masses, the extent of surgical resection after chemotherapy and the use of radiotherapy. 174 patients had residual disease at the end of chemotherapy. The most important prognostic factors for progression were the presence of any visceral metastases or raised LDH prechemotherapy, and the presence of residual disease at visceral sites after chemotherapy. Approximately half the patients with residual masses underwent postchemotherapy radiotherapy, with selection based predominantly on institutional practice. In patients receiving platinum-based chemotherapy, no significant difference was detected in progression-free survival whether or not radiotherapy was employed. Patients receiving BEP (bleomycin, etoposide and cisplatin) had a progression-free survival rate of 88% (95% CI, 80-96%) uninfluenced by postchemotherapy radiotherapy. In patients with residual masses confined to the abdomen after platinum-based chemotherapy, the absolute benefit to radiotherapy was estimated to be 2.3%. The potential benefit of postchemotherapy radiotherapy is minimal, and so it is concluded that the use of adjuvant radiotherapy to residual masses after platinum-based chemotherapy for metastatic seminoma is unnecessary.
    • Slipped upper femoral epiphysis after radiotherapy.

      Chapman, J A; Deakin, David P; Green, J H; Royal Manchester Children’s Hospital and Christie Hospital and Holt Radium Institute, Manchester (1980-08)
      Eight slipped upper femoral epiphyses in patients who had had radiotherapy are described. These cases involved five patients in an "at risk" population of 48. This increased incidence is highly significant.
    • Unusual sites of lymph node metastases and pitfalls in their detection.

      Moulding, F J; Roach, S C; Carrington, Bernadette M; Department of Diagnostic Radiology, Christie Hospital NHS Trust, Manchester, UK. (2004-07)
    • X-ray volumetric imaging in image-guided radiotherapy: the new standard in on-treatment imaging.

      McBain, Catherine A; Henry, Ann M; Sykes, Jonathan R; Amer, Ali M; Marchant, Thomas E; Moore, Christopher J; Davies, Julie; Stratford, Julia; McCarthy, Claire; Porritt, Bridget; et al. (2006-02-01)
      PURPOSE: X-ray volumetric imaging (XVI) for the first time allows for the on-treatment acquisition of three-dimensional (3D) kV cone beam computed tomography (CT) images. Clinical imaging using the Synergy System (Elekta, Crawley, UK) commenced in July 2003. This study evaluated image quality and dose delivered and assessed clinical utility for treatment verification at a range of anatomic sites. METHODS AND MATERIALS: Single XVIs were acquired from 30 patients undergoing radiotherapy for tumors at 10 different anatomic sites. Patients were imaged in their setup position. Radiation doses received were measured using TLDs on the skin surface. The utility of XVI in verifying target volume coverage was qualitatively assessed by experienced clinicians. RESULTS: X-ray volumetric imaging acquisition was completed in the treatment position at all anatomic sites. At sites where a full gantry rotation was not possible, XVIs were reconstructed from projection images acquired from partial rotations. Soft-tissue definition of organ boundaries allowed direct assessment of 3D target volume coverage at all sites. Individual image quality depended on both imaging parameters and patient characteristics. Radiation dose ranged from 0.003 Gy in the head to 0.03 Gy in the pelvis. CONCLUSIONS: On-treatment XVI provided 3D verification images with soft-tissue definition at all anatomic sites at acceptably low radiation doses. This technology sets a new standard in treatment verification and will facilitate novel adaptive radiotherapy techniques.