• Sun protection among organ transplant recipients after participation in a skin cancer research study.

      Hartman, R; Green, Adèle C; Gordon, L; Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (2018-06-06)
    • Sunbed use among 11- to 17-year-olds and estimated number of commercial sunbeds in england with implications for a 'buy-back' scheme

      Gordon, L. G.; Hainsworth, R.; Eden, M.; Epton, T.; Lorigan, Paul C; Grant, M.; Green, Adèle C; Payne, K.; Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane Q4006, Australia. (2021)
      Prior to 2011 legislation prohibiting children from using commercial sunbeds, the prevalence of sunbed use in 15- to 17-year-olds in some areas in England was as high as 50%. Despite significant decreases since 2011, children today still practice indoor tanning. We estimated current sunbed use in 11- to 17-year-olds in England, the number of available commercial sunbed units, and the associated cost of a 'buy-back' scheme to remove commercial sunbeds under a potential future policy to ban sunbeds. We undertook a calibration approach based on published prevalence rates in English adults and other sources. Internet searches were undertaken to estimate the number of sunbed providers in Greater Manchester, then we extrapolated this to England. Estimated mean prevalence of sunbed use was 0.6% for 11- to 14-year-olds and 2.5% for 15- to 17-year-olds, equating to 62,130 children using sunbeds in England. A predicted 2958 premises and 17,865 sunbeds exist nationally and a 'buy-back' scheme would cost approximately GBP 21.7 million. Public health concerns remain greatest for 11- to 17-year-olds who are particularly vulnerable to developing skin cancers after high ultraviolet exposure.
    • Sunitinib for advanced pancreatic neuroendocrine tumors.

      Hubner, Richard A; Valle, Juan W; Department of Medical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester, UK. (2011-12)
      Recent recognition of the high prevalence of neuroendocrine tumors in combination with a sustained failure to improve outcomes for patients with advanced disease has elevated their priority for research and drug development. Sunitinib (SU11248, Sutent; Pfizer Inc. NY, USA) potently inhibits multiple-receptor tyrosine kinases, resulting in antiangiogenic effects. A growing body of evidence indicates angiogenesis is a clinically relevant therapeutic target in pancreatic neuroendocrine tumors, culminating in a Phase III randomized study of sunitinib in patients with advanced progressive pancreatic neuroendocrine tumors. Sunitinib has recently gained regulatory approval as a single agent in this setting, and future studies will investigate most appropriate patient selection, and sequencing and combination with other targeted and cytotoxic agents. Here, we discuss in detail the molecular properties, clinical efficacy and safety of sunitinib in the context of pancreatic neuroendocrine tumors.
    • Sunitinib in pancreatic neuroendocrine tumors: updated progression-free survival and final overall survival from a phase III randomized study.

      Faivre, S; Niccoli, P; Castellano, D; Valle, Juan W; Hammel, P; Raoul, J; Vinik, A; Van Cutsem, E; Bang, Y; Lee, S; et al. (2016-11-10)
      In a phase III trial in patients with advanced, well-differentiated, progressive pancreatic neuroendocrine tumors, sunitinib 37.5 mg/day improved investigator-assessed progression-free survival (PFS) versus placebo (11.4 vs. 5.5 months; HR, 0.42; P < 0.001). Here, we present PFS using retrospective blinded independent central review (BICR) and final median overall survival (OS), including an assessment highlighting the impact of patient crossover from placebo to sunitinib.
    • Sunitinib in patients with pancreatic neuroendocrine tumors: update of safety data.

      Valle, Juan W; Borbath, I; Rosbrook, B; Fernandez, K; Raymond, E; Division of Cancer Sciences/Department of Medical Oncology, The Christie NHS Foundation Trust, University of Manchester, Manchester M20 4BX, UK (2019)
      AIM: To describe the long-term safety of sunitinib in patients with progressive, well-differentiated, advanced/metastatic pancreatic neuroendocrine tumors. PATIENTS & METHODS: Sunitinib- and placebo-treated patients from the Phase III study continued to receive sunitinib (37.5 mg on a continuous daily-dosing regimen) in two open-label extension studies. RESULTS: Median (range) treatment exposure: 30.2 (0.7-269.4) and 87.1 (3.9-319.4) weeks for medium-term (n = 41) and long-term-treated (n = 61) populations, respectively. All patients experienced ?1 adverse event (AE); 47 (45.6%) reported serious AEs. Common all-causality AEs: diarrhea (63.1%); neutropenia (43.7%); abdominal pain (40.8%). Fifteen (14.6%) patients discontinued treatment due to treatment-related AEs. CONCLUSION: The safety of extended sunitinib treatment was consistent with the known safety profile of sunitinib in pancreatic neuroendocrine tumors
    • Sunitinib malate for the treatment of pancreatic neuroendocrine tumors.

      Raymond, E; Dahan, L; Raoul, J; Bang, Y; Borbath, I; Lombard-Bohas, C; Valle, Juan W; Metrakos, P; Smith, D; Vinik, A; et al. (2011-02-10)
      The multitargeted tyrosine kinase inhibitor sunitinib has shown activity against pancreatic neuroendocrine tumors in preclinical models and phase 1 and 2 trials.
    • Superficial HDR brachytherapy for skin lesions involving the finger - The Christie experience

      Rembielak, Agata; Bedford, J; Wilson, S.; The Christie NHS Foundation Trust, Clinical Oncology, Manchester (2021)
      Purpose or Objective The standard of care for treatment of skin cancer and refractory precancerous conditions located on the finger is largely surgical management. Surgery usually involves digits/finger amputation or wide local excision with reconstruction. Many patients are elderly and/or frail. Non-invasive methods of treatment are often the preferred option due to favourable cosmetic and/or functional outcomes and improved patient compliance. External beam radiotherapy in finger location is challenging due to depth-dose characteristics in curved surfaces and close target location to joints and bones. HDR brachytherapy (BT) is a well-established non-invasive alternative treatment option delivering high radiation dose to the target with rapid dose fall-off in normal surrounding tissues. We report The Christie experience with HDT BT in the finger location over the past 6 years. Materials and Methods From Jan 2014 to Sept 2020, 13 patients (7 males and 5 females) underwent radical superficial HDR BT to the finger. There were 9 skin SCCs: 5 postoperative and 4 definitive. One patient had BCC and 3 patients had progressive refractory Bowen’s disease. The median age at the time of BT was 71 years (range 52 – 95). The patients were treated with a total dose of 30–34 Gy at 100% isodose in 8 fractions twice a day at least 6 hours apart. Target area was marked out by visual inspection, palpation and high frequency skin ultrasound. All patients were treated with The Christie mould technique: a flap mounted over an individually designed mould composed of a pre-calculated number of layers of thermoplastic material. Patients were followed for at least 2-3 years for treatment toxicity, cosmetic results, and local failures. Acute toxicity was graded using the CTC AE, v. 4.0 and cosmetic outcomes were classified using the RTOG cosmetic rating scale. Results Average follow-up from completion of the treatment was 23.5 months (2-36 months). All patients had an acute reaction to the BT: desquamation, crusting and erythema grade 1 or 2. One patient developed acute grade 3 wet desquamation. All acute toxicity was resolved within 2 months after treatment. Late toxicity was reported in 6 patients: slight/moderate atrophy, pigmentation change and grade 1 or 2 teleangiectasia. No cosmetic or functional results worse than good were observed. 11 patients had no evidence of recurrence in follow-up. 2 patients proceeded to salvage surgery due to either no response to BT or local recurrence at 4 months after BT. 2/11 patients passed away due to non-cancer related causes. Conclusion HDR mould BT is a valid non-invasive alternative to surgical management of skin cancer and refractory precancerous conditions located on the finger. It has its role particularly in elderly where PS and comorbidities may preclude surgery and short treatment duration can help with patient compliance. With appropriate patient selection skin HDR BT with customized surface moulds offers a good outcome and favourable cosmetic results with function preservation.
    • Superiority of reduced-intensity allogeneic transplantation over conventional treatment for relapse of Hodgkin's lymphoma following autologous stem cell transplantation.

      Thomson, Kirsty J; Peggs, Karl S; Smith, P; Cavet, James; Hunter, Ann; Parker, Anne; Pettengell, Ruth; Milligan, Donald W; Morris, Emma C; Goldstone, Anthony H; et al. (2008-05)
      This study compares outcome of reduced-intensity conditioned transplant (RIT) with outcome of conventional non-transplant therapy in patients with Hodgkin's lymphoma relapsing following autograft. There were 72 patients in two groups who had relapsed, and received salvage therapy with chemotherapy+/-radiotherapy. One group (n=38) then underwent alemtuzumab-containing RIT. The second group-historical controls (n=34), relapsing before the advent of RIT-had no further high-dose therapy. This group was required to respond to salvage therapy and live for over 12 months post-relapse, demonstrating potential eligibility for RIT, had this been available. Overall survival (OS) from diagnosis was superior following RIT (48% at 10 years versus 15%; P=0.0014), as was survival from autograft (65% at 5 years versus 15%; P< or =0.0001). For the RIT group, OS at 5 years from allograft was 51%, and in chemoresponsive patients was 58%, with current progression-free survival of 42%. Responses were seen in 8 of 15 patients receiving donor lymphocyte infusions (DLI) for relapse/progression, with durable remission in five patients at median follow-up from DLI of 45 months (28-55). These data demonstrate the potential efficacy of RIT in heavily pre-treated patients whose outlook with conventional therapy is dismal, and provide evidence of a clinically relevant graft-versus-lymphoma effect.
    • Support and information needs for patients with NSCLC receiving concurrent chemo-radiotherapy: findings from the INSIGHT study

      Fenemore, Jackie; Punnett, Grant; Yorke, Janelle; Blackhall, Fiona H; McEntee, Delyth; Eaton, M; Neal, H; Lung Cancer Dept, Medical Oncology, The Christie Hospital NHS Trust, Manchester, UK (2018)
    • Supporting patients with breast cancer through communication and research.

      Mitchell, Helen; The Christie NHS Foundation Trust, Manchester (2018-02-22)
    • Supportive care for new cancer therapies

      Rapoport, B. L.; Cooksley, Timothy J; Johnson, D. B.; Anderson, R.; Department of Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria The Medical Oncology Centre of Rosebank, Johannesburg, South Africa (2021)
      Purpose of review: The past decade has witnessed unprecedented delivery to the clinical arena of a range of novel, innovative, and effective targeted anticancer therapies. These include immunotherapies, most prominently immune checkpoint inhibitors, as well as agents that target growth factors and cancer-related mutations. Many of these new cancer therapies are, however, associated with an array of toxicities, necessitating insight and vigilance on the part of attending physicians to achieve high-quality supportive care alongside toxicity management. In this review, we consider some of the key supportive care issues in toxicity management. Recent findings: Although both supportive care and targeted therapies have brought significant benefits to cancer care, the management of novel cancer therapy toxicities is nevertheless often complex. This is due in large part to the fact that target organs differ widely, particularly in the case of checkpoint inhibitors, with minor dermatological disorders being most common, while others, such as pneumonitis, are more severe and potentially life threatening. Accordingly, efficient management of these immune-related adverse events requires collaboration between multiple medical specialists. Summary: Supportive care is a key component in the management of new cancer therapy toxicities and needs to be incorporated into treatment pathways.
    • Supportive care: an indispensable component of modern oncology

      Berman, Richard; Davies, A.; Cooksley, Timothy J; Gralla, R.; Carter, Louise; Darlington, Emma; Scott�, F.; Higham, Claire E; The Christie NHS Foundation Trust, Manchester, UK. (2020)
      The advent of new cancer therapies, alongside expected growth and ageing of the population, better survival rates and associated costs of care, is uncovering a need to more clearly define and integrate supportive care services across the whole spectrum of the disease. The current focus of cancer care is on initial diagnosis and treatment, and end of life care. The Multinational Association of Supportive Care in Cancer defines supportive care as 'the prevention and management of the adverse effects of cancer and its treatment'. This encompasses the entire cancer journey, and necessitates involvement and integration of most clinical specialties. Optimal supportive care can assist in accurate diagnosis and management, and ultimately improve outcomes. A national strategy to implement supportive care is needed to acknowledge evolving oncology practice, changing disease patterns and the changing patient demographic.
    • Supraorbital neuroma masquerading as local recurrence from a previously excised microcystic adnexal carcinoma.

      Seaward, J R; Kalipershad, Sujala N R; Ross, Gary L; Department of Plastic Surgery, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, United Kingdom. jpras@jseaward.com (2010-03)
      We present a case of a 53 year old gentleman with a previous history of a microcystic adnexal carcinoma in the supraorbital region who represented with pain and tenderness 3 years postoperatively. Although this was thought to represent local recurrence, it proved to be a supraorbital neuroma.
    • Suramin for breast and prostate cancer: a pilot study of intermittent short infusions without adaptive control.

      Woll, Penella J; Ranson, Malcolm R; Margison, Jennifer M; Thomson, Y; Van der Water, L; George, N; Howell, Anthony; CRC Department of Medical Oncology, Christie Hospital, Manchester, UK. (1994-09)
      BACKGROUND: Suramin has shown promising activity against prostate and breast cancer but is severely neurotoxic. Complex adaptive pharmacokinetics have previously been used to adjust doses. We have undertaken a pilot study to assess the feasibility of administering suramin to outpatients with advanced cancer, using simple peak and trough monitoring. PATIENTS AND METHODS: Nine patients with cancer refractory to conventional therapy were studied, eight with breast cancer and one with prostate cancer. Two received continuous infusions of suramin 350 mg/m2/day through an indwelling central venous catheter. Both sustained axillary vein thromboses. Subsequent patients received suramin 500 mg/m2 as a one hour intravenous infusion thrice weekly until a trough serum level of 200 micrograms/ml was achieved. Treatment was repeated at 8 week intervals. Serum suramin levels were checked before and after each dose. RESULTS: Suramin treatment was well tolerated. Despite peak serum levels of up to 506 micrograms/ml, no serious toxicity was seen. No tumour responses were seen. CONCLUSIONS: We conclude that suramin can be safely and conveniently administered to outpatients by intermittent infusion without using complex adaptive dosing strategies. Suramin merits further study in less heavily pretreated breast cancer patients.
    • Surgery and loss of body parts.

      Maguire, Peter; Parkes, C; Christie Hospital, Manchester. (1998-04-04)
    • Surgery in allergic nasal and paranasal disease.

      Jones, P H; Department of Otolaryngology, Withington Hospital, Manchester. (1990-05)
      This paper summarizes an ENT surgeon's view of allergic rhinitis and deals with the presenting complaints and symptoms of allergic and non-allergic rhinitis, suggests the important features of the history and examination and indicates the more important special investigations; the medical and surgical treatments available to deal with the symptoms of rhinitis are discussed.
    • Surgery versus SABR for resectable non-small-cell lung cancer.

      Dearman, C; van As, N; Crellin, A; Slevin, Nicholas J; Sharma, R; Department of Medical Sciences, University of Oxford, Oxford, UK (2015-08)
    • Surgical and radiotherapeutic management of malignant extradural spinal cord compression

      Loblaw, A.; George, K. J.; Misra, Vivek; Sunnybrook Health Sciences Centre, Toronto, Canada. (2020)
      Malignant spinal cord compression is one of the most dreaded complications of advanced malignancy, with patients presenting with progressive paralysis, paresthesia and/or autonomic dysfunction. The choice of management should be guided by the expected prognosis and outcome, not just from a neurological function point-of-view but also from the metastatic cancer itself. The main indications for surgery are: impending cord compression, spinal instability from tumour progression, bony retropulsion, for tissue diagnosis and for pain resistant to conventional therapies. Here, surgical principles, traditional and novel techniques and complications will be reviewed. For radiotherapy, multiple randomised studies have shown that for most patients a single fraction of external radiation has the same functional outcomes compared with multi-fractionation protocols. The experience of a specialised centralised interdisciplinary team will also be discussed. Keywords: Quality of life; radiation; spinal cord compression; surgery; toxicity.