• A retrospective multicentre evaluation of the outcomes and management of carcinoid heart disease in patients with advanced midgut NETs: A NET-CONNECT descriptive study

      Spada, F; Laskaratos, F; Crona, J; Oleinikov, K; Zandee, W; Lamarca, Angela; Gordoa, TA; Frassoni, S; Munir, A; Liu, M; et al. (2020)
    • A retrospective real world evidence study to review the current treatment pathways for myelofibrosis from across the United Kingdom (The REALISM UK Study))

      Mead, A; Butt, N; Nagi, W; Whiteway, A; Kirkpatrick, S; Rinaldi, C; Roughley, C; Ackroyd, S; Ewing, J; Neelakantan, P; et al. (2019)
    • A retrospective study of bladder morbidity in patients receiving intracavitary brachytherapy as all or part of their treatment for cervix cancer.

      Wilkinson, James M; Harris, Maggie A; Davidson, Susan E; Welch, Richard; Hunter, Robin D; Swindell, Ric; North Western Medical Physics, Christie Hospital NHS Trust, Manchester M20 4BX, UK. (2003-12)
      A retrospective study has been undertaken in an attempt to identify physical parameters that could confidently be used to predict an enhanced risk of bladder morbidity following intracavitary brachytherapy. 366 women received brachytherapy as all, or part, of their treatment for cervical cancer at the Christie Hospital in 1990 and 1991, and of these, 60 patients developed identifiable bladder morbidity (graded on a scale of 1-4 using the Franco-Italian glossary). These were age and stage matched with 60 asymptomatic women who were also treated for cervical cancer by brachytherapy during the same time period. The sizes of applicators used in the two groups were noted and compared. The two groups were also compared with respect to the heights of the applicator set above the symphysis pubis, the degree of anteversion or retroversion of the applicator sets and where possible, the doses at the International Commission on Radiation Units and Measurements (ICRU) bladder reference point. Where CT scans of the applications were available, these were reviewed to see if any differences in the size, shape or location of the bladder were apparent. No significant difference was found between the two groups of patients for any of the parameters investigated. The physical factors investigated in this study cannot be used to reliably predict bladder complications. There was a significant correlation between bladder morbidity and morbidity in other pelvic sites.
    • Retrospective study of radiotherapy in early carcinoma of the prostate.

      Read, G; Pointon, R C S; Department of Radiotherapy, Christie Hospital, Manchester. (1989-02)
      During the years 1978 to 1983 there was a 10-fold increase in the number of patients with T1-T4 NX M0 carcinoma of the prostate referred to the Christie Hospital for radical radiotherapy. A retrospective survey of 170 patients treated during this period showed an overall age-corrected 5-year survival rate of 49%. The survival of patients in whom referral for radiotherapy had been delayed was 37% compared with 56% for those given immediate treatment. Patients with poorly differentiated tumours had a significantly reduced survival compared with those with well differentiated tumours. The overall complication rate from radiotherapy was 4% and this low rate is attributed to the small volume used uniformly for treatment.
    • A retrospective study of thirty-two patients with small-cell bronchogenic carcinoma and inappropriate secretion of antidiuretic hormone.

      Lockton, J A; Thatcher, Nick; School of Medicine, Manchester University, Manchester, UK. (1986-01)
      Thirty-two patients with inappropriate secretion of antidiuretic hormone (ADH) complicating small-cell carcinoma of the bronchus were identified from a total of 226 patients with small-cell carcinoma of the bronchus treated at the Christie Hospital, Manchester, between 1978 and 1984. Basic data were collected from patients' files concerning the extent of the tumour, symptoms of inappopriate secretion of antidiuretic hormone, biochemical findings, treatment, the course of the inappropriate secretion of ADH and that of the underlying tumour. The data were then analysed and compared with results of previous studies. The response of the inappropriate secretion of ADH to treatment was found to be a significant prognostic factor. Further data were collected to determine the reason for this but it was difficult to drawn any firm conclusions.
    • Retrospective study on mixed neuroendocrine non-neuroendocrine neoplasms from five European centres

      Frizziero, Melissa; Wang, Xin; Chakrabarty, Bipasha; Childs, A; Luong, TV; Walter, T; Khan, MS; Morgan, M; Christian, A; Elshafie, M; et al. (2019)
      AIM: To investigate clinical-pathological characteristics, treatment modalities and survival outcomes of a retrospective cohort of patients with a diagnosis of MiNEN. METHODS: Consecutive patients with a histologically proven diagnosis of MiNEN were identified at 5 European centres. Patient data were retrospectively collected from medical records. Pathological samples were reviewed to ascertain compliance with the 2017 World Health Organisation definition of MiNEN. Tumour responses to systemic treatment were assessed according to the Response Evaluation Criteria in Solid Tumours 1.1. Kaplan-Meier analysis was applied to estimate survival outcomes. Associations between clinical-pathological characteristics and survival outcomes were explored using Log-rank test for equality of survivors functions (univariate) and Cox-regression analysis (multivariable). RESULTS: Sixty-nine consecutive patients identified; Median age at diagnosis: 64 years. Males: 63.8%. Localised disease (curable): 53.6%. Commonest sites of origin: colon-rectum (43.5%) and oesophagus/oesophagogastric junction (15.9%). The neuroendocrine component was; predominant in 58.6%, poorly differentiated in 86.3%, and large cell in 81.25%, of cases analysed. Most distant metastases analysed (73.4%) were occupied only by a poorly differentiated neuroendocrine component. Ninety-four percent of patients with localised disease underwent curative surgery; 53% also received perioperative treatment, most often in line with protocols for adenocarcinomas from the same sites of origin. Chemotherapy was offered to most patients (68.1%) with advanced disease, and followed protocols for pure neuroendocrine carcinomas or adenocarcinomas in equal proportion. In localised cases, median recurrence free survival (RFS); 14.0 mo (95%CI: 9.2-24.4), and median overall survival (OS): 28.6 mo (95%CI: 18.3-41.1). On univariate analysis, receipt of perioperative treatment (vs surgery alone) did not improve RFS (P = 0.375), or OS (P = 0.240). In advanced cases, median progression free survival (PFS); 5.6 mo (95%CI: 4.4-7.4), and median OS; 9.0 mo (95%CI: 5.2-13.4). On univariate analysis, receipt of palliative active treatment (vs best supportive care) prolonged PFS and OS (both, P < 0.001). CONCLUSION: MiNEN is most commonly driven by a poorly differentiated neuroendocrine component, and has poor prognosis. Advances in its biological understanding are needed to identify effective treatments and improve patient outcomes.
    • Return to TRI: Winston Churchill Fellow and Salford University Scholar travel to Miami and the Keys.

      Stringer, Jacqui; Mackereth, Peter A; Christie Hospital NHS Trust, Wilmslow Road, Withington M20 4BX, UK. (2003-11)
      During May and June 2003, the 2 authors visited the internationally renowned Touch Research Institute based at the University of Miami and Jackson Memorial Hospital. For one of the authors, Peter Mackereth, this was a return visit. Both authors are Ph.D. students who have successfully obtained travel scholarships to participate in seminars and laboratory work. The paper will report on the experience of their visit, the current and future work of the TRI and its collaborators. Jacqui took the opportunity to spend time at the Dolphin Research Centre, this provided insight into the therapeutic value of interacting with these amazing mammals. Peter also took the opportunity to visit a group of massage therapists working in Key West.
    • Returning-to-practice using a preceptorship and Kawa Mode.

      Woods, Jennifer; Bowker, Helen; Bradley, Belinda; The Christie Hospital NHS Foundation Trust Manchester (2017)
    • A review of astrocytoma in childhood.

      Kibirige, M S; Birch, Jillian M; Campbell, Richard H A; Gattamaneni, Rao; Blair, Val; Paediatric Department, Royal Albert Edward Infirmary, United Kingdom. (1989)
      Between 1954 and 1984, 282 children with astrocytoma were included in the Manchester Children's Tumour Registry (MCTR), giving an overall incidence of 9.3 per million person-years. There were 110 children with adult astrocytoma and 172 children with juvenile astrocytoma. The five-year survival for adult astrocytoma was 15% and 75% for juvenile astrocytoma. There were no significant improvements in survival with time. There were 21 children with neurofibromatosis (NF) and 4 children had tuberous sclerosis. Some children had other recognized syndromes and others had major or minor abnormalities. Nine children had second tumors, mainly associated with NF, and seven siblings had malignant tumors. A number of mothers of these children were found to have breast cancer. Some of these families may represent examples of the Li-Fraumeni cancer family syndrome. We conclude that astrocytomas is an important problem in childhood and that a proportion of cases may have a genetic origin.
    • A review of chemotherapy use in metastatic prostate cancer.

      Morrison, Siobhan; Lyons, Jeanette; Conroy, Ruth; The Christie NHS Foundation Trust, Manchester, UK (2018-03)
    • A review of health and access to health information in Bhutan.

      Glover, Steven W; Dema, Rinchen; Yangzon, Pema; Sonam, Karma; Gleghorn, Colette; Christie Hospital NHS Trust, Manchester, UK. sglover@picr.man.ac.uk (2006-12)
    • Review of metastatic colorectal cancer treatment pathways and early clinical experience of trifluridine/tipiracil in the UK named patient programme

      Iveson, T; Carter, AM; Shiu, KK; Spooner, C; Stevens, D; Mullamitha, Saifee A; University Hospital Southampton NHS Foundation Trust, Southampton, UK (2020)
      BACKGROUND: The standard first- and second- line chemotherapy backbone regimens for metastatic colorectal cancer (mCRC) are 5-fluorouracil (5-FU)/capecitabine-based with addition of irinotecan or oxaliplatin. Until recently, evidence for optimal sequencing post second-line was sparse. Trifluridine/tipiracil (indicated for mCRC and gastric cancer after standard chemotherapies) was made available to UK patients via a named patient programme (NPP) before receiving marketing authorisation in Europe in 2016, allowing characterisation of UK treatment pathways, and evaluation of trifluridine/tipiracil in a UK non-trial population. METHODS: Data collected routinely for the NPP were analysed to describe the patient demographics, clinical characteristics and treatment pathways. Patients eligible for the programme were adults (?18?years) with histologically or cytologically confirmed mCRC who had previously received chemotherapy treatment(s). RESULTS: Of the 250 eligible patients enrolled in the NPP, 194 patients received ?1 dose of trifluridine/tipiracil and 56 patients did not receive trifluridine/tipiracil. The following results are reported first for patients who received trifluridine/tipiracil and second for those who did not receive trifluridine/tipiracil: median (IQR) age was 63.0 (54.0-69.0) and 62.0 (54.8-69.0) years; Eastern Cooperative Oncology Group performance status score was 0 for 28 and 14%, 1 for 65 and 70%, 2 for 7 and 16%. In terms of previous systemic treatments 47 and 43% had 2 prior lines of therapy. FOLFOX-, FOLFIRI- and CAPOX-based therapies were the most common first-line regimens in patients receiving trifluridine/tipiracil (37, 35 and 21%, respectively), and in patients not receiving trifluridine/tipiracil (41, 30 and 20%, respectively). Second-line treatment regimens in patients receiving and not receiving trifluridine/tipiracil were most commonly FOLFIRI-based (48 and 41%, respectively) and FOLFOX-based (19 and 21%, respectively). Patients received a median of 2?cycles of trifluridine/tipiracil with a median treatment duration of 1.8 (95% CI: 1.8-2.4) months. In patients who discontinued treatment due to disease progression, the median progression-free duration was 2.8 (95% CI: 2.4-2.9) months. CONCLUSIONS: The results highlight the number of treatment pathways used to treat mCRC in routine UK clinical practice prior to the marketing authorisation and National Institute for Health and Care Excellence approval of trifluridine/tipiracil and highlight the lack of clinical guidelines for mCRC.
    • A review of occupational exposure in the North-Western Region.

      Pratt, T A; Sweeney, J K; Regional Department of Medical Physics and Bioengineering, Christie Hospital, Manchester. (1989-08)
      The Ionizing Radiations Regulations 1985 require employers to monitor all classified persons and to demonstrate that all non-classified persons who work in controlled areas do not exceed three-tenths (i.e. the classification level) of any relevant annual dose limit. A review of occupational doses was undertaken to ascertain whether any person needed to be designated as a classified person and to demonstrate compliance with the Regulation regarding non-classified staff working in controlled areas. The occupational-dose data for 1986 were compared with data for 1981 to identify any areas where changes in workload, equipment or techniques had led to increases in whole-body or organ doses. The results demonstrate that the level of whole-body occupational dose received by the vast majority of NHS employees in the North-Western Regional Health Authority is, as expected, extremely low. However, two specific areas were identified where occupational doses are relatively high and need to be carefully monitored. The review has also led to a number of operational changes being implemented by the Approved Dosimetry Service.
    • A review of patient reported toxicity following surgery and adjuvant vaginal vault brachytherapy for endometrial cancer at a UK cancer centre

      Conroy, Ruth; Whittaker, E; Routledge, Jacqueline A; Swindell, Ric; Livsey, Jacqueline E; Davidson, Susan E; Barraclough, Lisa H; The Christie NHS Foundation Trust, Clinical Oncology, Manchester (2015)
    • Review of recent trials of chemotherapy for advanced breast cancer: studies excluding taxanes.

      Clemons, Mark; Leahy, Michael G; Valle, Juan W; Jayson, Gordon C; Ranson, Malcolm R; Hayes, S; Howell, Anthony; CRC Department of Medical Oncology, Christie Hospital, Manchester, U.K. (1997-11)
    • Review of recent trials of chemotherapy for advanced breast cancer: the taxanes.

      Clemons, Mark; Leahy, Michael G; Valle, Juan W; Jayson, Gordon C; Ranson, Malcolm R; Howell, Anthony; CRC Department of Medical Oncology, Christie Hospital, Manchester, U.K. (1997-11)
    • A review of the efficacy of anastrozole in postmenopausal women with advanced breast cancer with visceral metastases.

      Howell, Anthony; Robertson, John F R; Vergote, I; Cancer Research UK Department of Medical Oncology, Christie CRC Research Hospital, Christie Hospital National Health Service Trust, University of Manchester, Manchester, UK. maria.parker@christie-tr.nwest.nhs.uk (2003-12)
      Tumors that have spread to the liver or lungs (visceral metastases) are associated with a worse prognosis than tumors in soft tissue and bone only. Here we review available efficacy data to address whether or not anastrozole, a non-steroidal aromatase inhibitor (AI), is effective in postmenopausal patients with advanced breast cancer (ABC) and visceral metastases. We include data from Phase III clinical trials, comparing clinical benefit (CB) with anastrozole versus tamoxifen as a first-line treatment, and versus megestrol acetate (MA) or fulvestrant as a second-line therapy. Patients in these trials had adequate organ function and the volume of disease had to be minimal or moderate for them to be eligible for inclusion. First-line treatment of patients with or without visceral metastases in the overall population resulted in CB rates of 49.5 and 62.3%, respectively, for anastrozole and 46.9 and 55.9%, respectively, for tamoxifen. In patients with confirmed hormone receptor (HR)-positive tumors, the CB rate was 51.9 and 65.7%, respectively, for anastrozole and 41.6 and 58.7%, respectively, for tamoxifen. In patients with or without visceral metastases, second-line treatment with anastrozole resulted in a CB rate of 31.4 and 51.8%, respectively, compared with 31.9 and 47.1%, respectively, for those treated with MA. Patients in the overall population with and without visceral metastases treated with anastrozole obtained a CB rate of 37.4 and 43.8%, respectively, while those treated with fulvestrant obtained a CB rate of 38.2 and 47.6%, respectively. In patients with confirmed HR-positive tumors, CB was seen in 37.6 and 41.5%, respectively, of patients treated with anastrozole and in 37.3 and 47.0%, respectively, of patients treated with fulvestrant. The results reveal anastrozole to be an effective and valuable first- and second-line therapy in postmenopausal women with ABC and visceral metastases, showing similar CB to other endocrine therapies.
    • A review of the high-concentration capsaicin patch and experience in its use in the management of neuropathic pain.

      Baranidharan, G; Das, S; Bhaskar, Arun K; Leeds Teaching Hospitals NHS Trust, Leeds Pain and Neuromodulation Centre, Seacroft Hospital, Leeds LS14 6UH, UK. (2013-09)
      In the European Union, the high-concentration capsaicin patch is licensed for the management of neuropathic pain conditions in nondiabetic patients, including postherpetic neuralgia (PHN) and HIV-associated distal sensory polyneuropathy (HIV-DSP). However, in the USA, the Food and Drug Administration approved its use only in PHN patients. Capsaicin is a transient receptor potential vanilloid-1 agonist, which increases the intracellular calcium ion concentration. This triggers calcium-dependent protease enzymes causing cytoskeletal breakdown and leads to the loss of cellular integrity and 'defunctionalization' of nociceptor fibres. Efficacy and therapeutic effect has been shown in several clinical studies of PHN and HIV-DSP. The high-concentration capsaicin patch and its practical application are different from low-concentration creams; one application can help for up to 3 months. The process of setting up of a service to use the capsaicin 8% patch is also discussed.
    • A review of the latest clinical compounds to inhibit VEGF in pathological angiogenesis.

      Baka, Sofia; Clamp, Andrew R; Jayson, Gordon C; Christie Hospital, Manchester, M20 4BX, UK. bakasofia@hotmail.com (2006-12)
      Angiogenesis plays an important role in the formation of new blood vessels and is crucial for tumour development and progression. Imbalance between pro- and antiangiogenesis factors regulates the biological process of angiogenesis. The best characterised of the proangiogenic factors and the most potent is vascular endothelial growth factor (VEGF). The binding of VEGF to one of its transmembrane tyrosine kinase receptors, which are predominantly found on endothelial cells, results in receptor dimerisation, activation and autophosphorylation of the tyrosine kinase domain. This triggers a cascade of complex downstream signalling pathways. Several strategies targeting the VEGF signalling pathway have been developed. These include neutralising antibodies to VEGF (bevacizumab) or VEGF receptors (VEGFRs) (DC101), soluble VEGFR/VEGFR hybrids (VEGF-Trap), and tyrosine kinase inhibitors of VEGFRs (BAY43-9006, SU11248, ZD6474, AZD2171, PTK/ZK and others). Several of these agents are now being investigated in clinical trials.
    • A review of the management of the male breast carcinoma based on an analysis of 420 treated cases.

      Ribeiro, G; Swindell, Ric; Harris, Martin; Banerjee, Saumitra S; Cramer, Angela; Christie Hospital Trust, Manchester UK (1996)