• Is fulvestrant ("Faslodex") just another selective estrogen receptor modulator?

      Howell, Anthony; Cancer Research UK, Department of Medical Oncology, University of Manchester, Christie Hospital NHS Trust, Manchester, United Kingdom. (2006)
    • Is heterogeneity in stage 3 non-small cell lung cancer obscuring the potential benefits of dose-escalated concurrent chemo-radiotherapy in clinical trials?

      Hudson, Andrew M; Chan, Clara; Woolf, David K; McWilliam, Alan; Hiley, C; O'Connor, James P B; Bayman, Neil A; Blackhall, Fiona H; Faivre-Finn, Corinne; Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK (2018-04)
      The current standard of care for the management of inoperable stage 3 non-small cell lung cancer (NSCLC) is concurrent chemoradiotherapy (cCRT) using radiotherapy dose-fractionation and chemotherapy regimens that were established 3 decades ago. In an attempt to improve the chances of long-term control from cCRT, dose-escalation of the radiotherapy dose was assessed in the RTOG 0617 randomised control study comparing the standard 60 Gy in 30 fractions with a high-dose arm receiving 74 Gy in 37 fractions. Following the publication of this trial the thoracic oncology community were surprised to learn that there was worse survival in the dose-escalated arm and that for now the standard of care must remain with the lower dose. In this article we review the RTOG 0617 paper with subsequent analyses and studies to explore why the use of dose-escalated cCRT in stage 3 NSCLC has not shown the benefits that were expected. The overarching theme of this opinion piece is how heterogeneity between stage 3 NSCLC cases in terms of patient, tumour, and clinical factors may obscure the potential benefits of dose-escalation by causing imbalances in the arms of studies such as RTOG 0617. We also examine recent advances in the staging, management, and technological delivery of radiotherapy in NSCLC and how these may be employed to optimise cCRT trials in the future and ensure that any potential benefits of dose-escalation can be detected.
    • Is intrafraction motion an important consideration in MR guided external beam radiotherapy for cervical cancer?

      Cree, Anthea; Dubec, Michael; Mistry, H; Hoskin, Peter J; Choudhury, Ananya; McWilliam, Alan; The Christie NHS Foundation Trust, Manchester, (2019)
    • Is it safe to insert a testicular prosthesis at the time of radical orchidectomy for testis cancer - an audit of 904 men undergoing radical orchidectomy.

      Robinson, Richard; Tait, C; Clarke, Noel W; Ramani, Vijay A C; Department of Urology, The Christie NHS Foundation Trust, Manchester, United Kingdom; Department of Urology Salford Royal NHS Foundation Trust, Dept. of Urology, Manchester, United Kingdom. (2014-08-28)
      To compare the complication rate associated with synchronous prosthesis insertion at the time of radical orchidectomy with orchidectomy alone.
    • Is it still beneficial to have completion lymphadenectomy following positive sentinel lymph node biopsy?

      Begaj, A; Chu, V; Patel, L; Gajanan, Kantappa; The Mid Yorkshire Hospitals NHS Trust, Wakefield (2018)
    • Is it time to convert the frequency of radiotherapy in small-cell lung cancer? - Authors' reply.

      Faivre-Finn, Corinne; Ryder, W David J; Blackhall, Fiona H; Division of Molecular and Clinical Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester (2017-10)
    • Is it time to look for better prognostic markers and reconsider adjuvant chemotherapy for locally advanced anal cancers?

      King, J; Swinton, Martin; Grant, G; Buckley, Lucy; Lavin, Victoria; Alam, Nooreen; Saunders, Mark P; The Christie Hospital NHS Foundation Trust, Manchester, UK. (2021)
    • Is it time to rethink checkpoint blockade therapy in non-Hodgkin lymphoma?

      Phillips, Elizabeth H; Illidge, Timothy M; Division of Cancer Sciences, University of Manchester, Manchester, UK. (2020)
    • 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.
    • Is maternal growth hormone essential for a normal pregnancy?

      Curran, Andrew J; Peacey, Steven R; Shalet, Stephen M; Department of Endocrinology, Christie Hospital, Manchester, UK. (1998-07)
      OBJECTIVE: It remains uncertain whether there is any disadvantage imposed upon women with pituitary disease who are GH-deficient and become pregnant. The aim of this study was to determine whether maternal GH deficiency adversely affects the outcome of pregnancy. DESIGN: Retrospective study. METHODS: The case notes of 77 female patients with known GH deficiency were examined. Sixteen patients (a total of 25 pregnancies) were identified who had been pregnant whilst known to be GH-deficient. Peak GH response to provocative testing prior to pregnancy, length of gestation, birth weight, maternal well-being and the incidence of maternal and fetal complications of pregnancy were documented. RESULTS: Peak GH response to insulin tolerance test (n = 21 ) or glucagon stimulation test (n = 4) prior to pregnancy was 8.7 (< 1 to 17.3)mU/l (peak < or =9 mU/l in 14 cases). There were 25 pregnancies resulting in 26 live births (including one set of twins and one set of quins) and 4 spontaneous first trimester abortions. Eight pregnancies were achieved by ovulation induction. Median gestation of live births was 39 (33 to 42) weeks. Median birth weight excluding multiple births (n = 19), uncorrected for gestational age, was 3.09 (1.64 to 4.19) kg, and the numbers with birth weights below the 10th, between the 10th and 90th, and above the 90th centiles were five, nine and five respectively. Preeclampsia occurred in two pregnancies and post-partum haemorrhage after one pregnancy. There were three minor congenital abnormalities. CONCLUSIONS: Our data suggest that pregnancy in GH-deficient females is not detrimental to the fetus and the incidence of maternal morbidity is low. We conclude that GH replacement therapy is probably not essential for GH-deficient females during pregnancy.
    • Is monitoring of plasma 5-fluorouracil levels in metastatic / advanced colorectal cancer clinically effective? A systematic review.

      Freeman, Karoline; Saunders, Mark P; Uthman, Olalekan A; Taylor-Phillips, Sian; Connock, Martin; Court, Rachel; Gurung, Tara; Sutcliffe, Paul; Clarke, Aileen; Division of Health Sciences, Medical School, University of Warwick, Gibbet Hill Campus, Coventry, CV4 7AL, UK (2016)
      Pharmacokinetic guided dosing of 5-fluorouracil chemotherapies to bring plasma 5-fluorouracil into a desired therapeutic range may lead to fewer side effects and better patient outcomes. High performance liquid chromatography and a high throughput nanoparticle immunoassay (My5-FU) have been used in conjunction with treatment algorithms to guide dosing. The objective of this study was to assess accuracy, clinical effectiveness and safety of plasma 5-fluorouracil guided dose regimen(s) versus standard regimens based on body surface area in colorectal cancer.
    • Is patient information on palliative care good enough? A literature review and audit

      Taylor, Sally; Wyld, L; Ziegler, L; Bennett, MI; Christie Patient Centred Research, The Christie School of Oncology, The Christie NHS Foundation Trust, Manchester (2018)
    • Is Population Screening for Prostate Cancer Good or Bad?

      Clarke, Noel W; The Christie and Salford Royal Hospitals, Manchester University, Manchester, UK (2011)
    • Is pre-trial quality assurance necessary? Experiences of the CONVERT Phase III randomized trial for good performance status patients with limited-stage small-cell lung cancer.

      Groom, N; Wilson, E; Lyn, E; Faivre-Finn, Corinne; Mount Vernon Cancer Centre, Northwood, UK. (2014-05)
      This study is an analysis of the pre-trial quality assurance (QA) exercises submitted by clinicians from radiotherapy (RT) centres across Europe and Canada to qualify for participation in the CONVERT trial.
    • Is prevention of sterility possible in men?

      Radford, John A; CRC Department of Medical Oncology, Christie Hospital, Manchester, UK. (2000)
    • Is robotic surgery safe and feasible for horseshoe kidneys? A multicentre case series

      Ng, A.; Nathan, A.; Campain, N.; Fortune-Ely, M.; Patki, S.; Yuminaga, Y.; Mumtaz, F.; Gulamhusein, Aziz; Tran, M.; Barod, R.; et al. (2021)
      Introduction & Objectives: Horseshoe kidneys (HSK) are the most common renal fusion abnormality. However, they are only present in 0.2% of the population. Due to anatomical variation in vasculature, ectopia and malrotation, surgery has traditionally been performed via an open approach. Robotic surgery has been widely adopted for other urological procedures due to the superior ergonomics; high definition, 3D stereoscopic vision; and 7 degrees of freedom, providing a viable, less invasive surgical option. We aimed to assess the safety and feasibility of robot-assisted surgery for HSK. Materials & Methods: Retrospective data were collected for consecutive patients with HSK undergoing robotic surgery between 2016 and 2020 across two high-volume centres by experienced robotic surgeons. 3D reconstruction using CT renal angiograms were used to help identify vasculature and tumour location, where appropriate. Results: Seven patients underwent robotic surgery for HSK including three partial nephrectomies and one nephroureterectomy for renal masses and three benign nephrectomies for non-functioning kidneys. The median age was 53 years (IQR 44-57) and median BMI was 25 (IQR 25-26.5). Median tumour size in four patients with renal masses was 36 mm (IQR 25-45). Median console time was 120 minutes (IQR 118-215), median operating time was 170 minutes (IQR 155-247) and median estimated blood loss was 150 mL (IQR 125-250). The median pre-operative eGFR was 76 (IQR 72-90) and median post-operative eGFR was 71 (IQR 60-81). There was no grade III or higher Clavien-Dindo complication. There was one Clavien-Dindo II, wound infection complication, requiring a five-day length of stay. All other operations were uneventful and median length of stay was two days. Negative margins were achieved in 75% of tumour resections, and final histology demonstrated clear cell renal cell carcinoma (RCC), RCC, urothelial sarcomatoid and angiomyolipoma. Conclusions: We report one of the largest series of robotic-assisted surgery on HSK. Robotic surgery is safe and feasible for HSK in centralised high centres with acceptable perioperative outcomes, early oncological outcomes and morbidity comparable to standard renal surgery. A further prospective, multi-centre study is required to evaluate the role of robotic surgery in renal fusion anomalies.
    • Is serum or plasma more appropriate for intersubject comparisons in metabolomic studies? An assessment in patients with small-cell lung cancer.

      Wedge, D C; Allwood, J W; Dunn, W; Vaughan, A A; Simpson, Kathryn L; Brown, M; Priest, Lynsey; Blackhall, Fiona H; Whetton, Anthony D; Dive, Caroline; et al. (2011-09-01)
      In clinical analyses, the most appropriate biofluid should be analyzed for optimal assay performance. For biological fluids, the most readily accessible is blood, and metabolomic analyses can be performed either on plasma or serum. To determine the optimal agent for analysis, metabolic profiles of matched human serum and plasma were assessed by gas chromatography/time-of-flight mass spectrometry and ultrahigh-performance liquid chromatography mass spectrometry (in positive and negative electrospray ionization modes). Comparison of the two metabolomes, in terms of reproducibility, discriminative ability and coverage, indicated that they offered similar analytical opportunities. An analysis of the variation between 29 small-cell lung cancer (SCLC) patients revealed that the differences between individuals are markedly similar for the two biofluids. However, significant differences between the levels of some specific metabolites were identified, as were differences in the intersubject variability of some metabolite levels. Glycerophosphocholines, erythritol, creatinine, hexadecanoic acid, and glutamine in plasma, but not in serum, were shown to correlate with life expectancy for SCLC patients, indicating the utility of metabolomic analyses in clinical prognosis and the particular utility of plasma in relation to the clinical management of SCLC.
    • Is skipped nodal metastasis a phenomenon of cutaneous melanoma?

      El-Omar, Omar; Ragavan, Sharanniyan; Yoon, Won Young; Grant, Megan E; Green, Adèle C; Oudit, Deemesh; The Christie NHS Foundation Trust, Wilmslow Rd, Manchester, (2021)
      Background and methods: Skipped nodal metastasis (SNM) is a recognized phenomenon of visceral cancers when metastases bypass the regional basin and skip to a distant nodal basin without evidence of distant metastases. Its occurrence is undocumented in cutaneous melanoma patients but of potential prognostic significance. We therefore assessed the frequency of SNM in a large series of patients with limb melanomas. Patients and methods: We studied melanoma patients attending a tertiary oncology hospital in northwest England using two approaches. First, we systematically searched medical records of an unselected patient sample treated 2002-2015, and second, we studied lymphoscintigrams of all patients with limb melanoma who underwent sentinel node biopsy 2008-2019. Results: Of 672 melanoma patients whose clinical records were examined, 16 had regional nodal metastases without apparent visceral spread and one appeared to have SNM but further scans were uncovered that showed concurrent pulmonary metastases. Of 667 limb melanoma patients with lymphoscintigrams, 7 showed dual lymphatic drainage patterns to distal as well as regional nodal basins, but none had micro-metastases solely in the distant basin. Conclusion: Occurrence of SNM in cutaneous melanoma is highly unlikely.
    • Is stereotactic ablative radiotherapy equivalent to sublobar resection in high-risk surgical patients with stage I non-small-cell lung cancer?

      Mahmood, S; Bilal, H; Faivre-Finn, Corinne; Shah, R; Royal Oldham Hospital, Oldham, Lancs, UK (2013-11)
      A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'Is stereotactic ablative radiotherapy equivalent to sublobar resection in high-risk surgical patients with Stage I non-small cell lung cancer?'. Altogether over 318 papers were found, of which 18 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Stereotactic ablative radiotherapy (SABR) and sublobar resection (SLR) offer clear survival benefit in the treatment of early-stage non-small-cell lung cancer (NSCLC) in high-risk patients unsuitable for lobectomy and SABR has shown good results in medically operable patients. No randomized data are available comparing SLR and SABR, and therefore, data from prospective studies were compared. Overall survival at 1 year was similar between patients treated with SABR and SLR (81-85.7 vs 92%); however, overall 3-year survival was higher following SLR (87.1 vs 45.1-57.1%). There was no statistically significant difference in local recurrence in patients treated with SABR compared with SLR (3.5-14.5 vs 4.8-20%). Both treatment modalities are associated with complications. Fatigue (31-32.6%), pneumonitis (2.1-12.5%) and chest wall pain (3.1-12%) were common following SABR; however, serious grade 3 and 4 toxicity were rare. Morbidity following SLR was reported between 7.3 and 33.7%. Thirty-day mortality following SABR was 0%, while predicted 30-day mortality following a lung resection, using the thoracoscore predictive model ranges between 1 and 2.6%. Treatment for early-stage NSCLC should be tailored to individual patients. SABR is an acceptable alternative to SLR in high-risk patients but comparative data are required.
    • Is superficial inguinal node dissection adequate for regional control of malignant melanoma in patients with N1 disease?

      Smith, Oliver J; Rimouche, Sofiane; Oudit, Deemesh; Mowatt, David J; Ross, Gary L; Plastic Surgery Department, The Christie, NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom. (2013-02-04)
      INTRODUCTION: The optimum extent of surgery for inguinal nodal metastases due to melanoma remains controversial. Recent evidence suggests a conservative superficial groin dissection (SGD) may provide adequate regional control. AIM: To evaluate patients with N1 stage disease treated with SGD to determine the recurrence rates and to evaluate whether SGD was adequate for regional control in these patients. MATERIALS AND METHODS: Patients undergoing SGD between April 2005 and April 2012 were retrospectively analysed from a prospectively collected database. RESULTS: Sixty patients were treated by SGD of which 40 had palpable disease and 20 had a positive sentinel node. Overall median follow-up was 38 months, with median follow-up for the SNB group being 29 months and that of the PD group 49 months. Three patients (5%) developed groin recurrence following SGD. All patients recurred within the superficial site of surgery; there was no deep inguinal or pelvic recurrence. Distant recurrence occurred in 22 patients (36.7%), with 21 of these patients coming from the PD group and one from the SNB group. This difference was statistically significant (p < 0.05). Overall survival at 5 years was 70.3%. Survival at 5 years in the PD group was 63.8% and in the SNB group it was 90.9%, this difference was approaching significance (p = 0.08). CONCLUSION: SGD appears adequate for local disease control in patients with N1 sentinel node positive disease. Longer term followup for N1 palpable disease is required to determine the suitability of SGD for this group of patients.