• Treatment of brain metastases in small cell lung cancer: Decision-making amongst a multidisciplinary panel of European experts

      Putora, P. M.; Fischer, G. F.; Fruh, M.; Califano, Raffaele; Faivre-Finn, Corinne; Van Houtte, P.; McDonald, F.; Nestle, U.; Dziadziuszko, R.; Le Pechoux, C.; et al. (2020)
      Background: Brain metastases (BM) are common in patients with small cell lung cancer (SCLC). In recent years, the role of whole brain radiotherapy (WBRT) for brain metastases in lung cancer is being reevaluated, especially in the context of new systemic treatments available for SCLC. With this analysis, we investigate decision-making in SCLC patients with BM among European experts in medical oncology and radiation oncology. Methods: We analyzed decision-making from 13 medical oncologists (selected by IASLC) and 13 radiation oncologists (selected by ESTRO) specialized in SCLC. Management strategies of individual experts were converted into decision trees and analyzed for consensus. Results and conclusion: In asymptomatic patients, chemotherapy alone is the most commonly recommended first line treatment. In asymptomatic patients with limited volume of brain metastases, a higher preference for chemotherapy without WBRT among medical oncologists compared to radiation oncologists was observed. For symptomatic patients, WBRT followed by chemotherapy was recommended most commonly. For limited extent of BM in symptomatic patients, some experts chose stereotactic radiotherapy as an alternative to WBRT. Significant variation in clinical decision-making was observed among European SCLC experts for the first line treatment of patients with SCLC and BM.
    • Treatment of constitutional delay in growth and puberty (CDGP).

      Shalet, Stephen M; Department of Endocrinology, Christie Hospital, Manchester, UK. (1989-07)
    • Treatment of Cushing's disease with low dose radiation therapy.

      Ahmed, S Rafeeq; Shalet, Stephen M; Beardwell, Colin G; Sutton, M L; Christie Hospital and Holt Radium Institute, Withington, Manchester, M20 9BX, UK (1984-09-15)
      Nineteen patients with Cushing's disease were treated with low dose external pituitary irradiation (20 Gy (2000 rad) in eight fractions over 10 days). While awaiting the effects of pituitary irradiation all patients were treated with metyrapone. Seven patients had a complete remission of their disease within six to 12 months of irradiation. They did not require any further treatment and were followed up for a mean of three and a half (range one to eight) years. Another patient had a complete remission after a second course of pituitary irradiation. A further two patients showed a significant biochemical improvement after irradiation, although they were not rendered eucorticoid. There were no complications after this dose of irradiation. These results compare favourably with those reported after pituitary irradiation at conventional doses (40-50 Gy (4000-5000 rad) over four or five weeks) but were not associated with any complications. It is therefore recommended that low dose external pituitary irradiation be used as definitive first line treatment for Cushing's disease.
    • Treatment of cutaneous metastases of breast cancer with electrochemotherapy: what is the magnitude of clinical benefit?

      Campana, L; Galuppo, S; Valpione, Sara; University of Padova, Padua, Italy. (2017-03-08)
    • Treatment of depression in cancer patients

      Maguire, Peter; Hopwood, Penelope; Tarrier, Nicholas; Howell, T; Department of Psychiatry, University Hospital of South Manchester, West Didsbury, Manchester M20 8LR, UK. (1985)
    • Treatment of early stage II carcinoma of the cervix by radium.

      Cole, Moya P; Christie Hospital and Holt Radium Institute, Manchester (1976-09)
    • Treatment of early-stage mycosis fungoides: results from the PROspective Cutaneous Lymphoma International Study (PROCLIPI study)

      Quaglino, P.; Prince, H. M.; Cowan, Richard A; Vermeer, M.; Papadavid, L.; Bagot, M.; Servitjie, O.; Berti, E.; Guenova, E.; Stadler, R.; et al. (2020)
      BACKGROUND: The PROspective Cutaneous Lymphoma International Prognostic Index (PROCLIPI) Study is a prospective analysis of an international database and here we examine front-line treatments and quality-of-life in patients with newly diagnosed Mycosis Fungoides (MF). OBJECTIVES: a) differences in first-line approach according to the TNMB staging; b) parameters related to a first-line systemic approach; c) response rates and quality of life (QoL) measures. PATIENTS AND METHODS: 395 newly diagnosed patients with early-stage MF (IA-IIA) were recruited from 41 centers in 17 countries between 1/1/2015-31/12/2018 following central clinicopathological review. RESULTS: First-line therapy was skin directed therapy (SDT) (81.6%) whilst a smaller percentage (44 cases;11.1%) received systemic therapy. Expectant observation was 7.3%. In univariate analysis, the use of systemic therapy was significantly associated with higher clinical stage (IA: 6%; IB: 14%; IIA:20%; IA-IB vs IIA: p<0.0001), presence of plaques (T1a+T2a: 5%; T1b+T2b: 17%; p<0.001), higher mSWAT (10: 15%; <=10: 7%; p=0.01) and folliculotropic MF (FMF) (24% vs 12%; p=0.001). Multivariate analysis demonstrated significant associations with the presence of plaques (T1b/T2b vs T1a/T2a: OR: 3.07) and FMF (OR: 2.82). The overall response rate (ORR) to first-line SDT was 73% whilst the ORR to first-line systemic treatments was lower (57%) (p=0.027). Health related QoL improved significantly in both patients with responsive and stable disease. CONCLUSIONS: Disease characteristics such as presence of plaques and FMF influence physician treatment choices and that SDT was superior to systemic therapy even in patients with such disease characteristics. Consequently
    • Treatment of endobronchial metastases with intraluminal radiotherapy.

      Quantrill, S J; Burt, Paul A; Barber, Philip V; Stout, Ronald; North West Lung Centre, Manchester, UK. (2000-04)
      Metastasis to the lung occurs quite commonly from certain types of extrapulmonary primary carcinoma. Spread to the bronchial lumen is relatively rare. When this does occur, symptoms resembling those of primary bronchial carcinoma are often present, in association with partial or complete obstruction of the bronchial lumen. Palliation of such symptoms is possible with the use of intraluminal radiotherapy (ILT). Between 1990 and 1998, 37 patients with endobronchial metastases were treated using this modality; a single fraction of radiation was delivered by the remote afterloading high dose rate microSelectron system. Data regarding these patients' characteristics and outcome are presented, following a retrospective review of case notes. The commonest symptoms were dyspnoea, cough and haemoptysis; the commonest primary tumour sites were breast, colorectum, oesophagus and kidney. Twenty-four (64.9%) patients had some improvement in symptoms following treatment. Mean overall survival was 280 days, range 9-1145 days. No serious adverse effects occurred. ILT is a relatively simple, safe and effective treatment in the palliation of symptoms due to endobronchial metastases.
    • Treatment of endotracheal or endobronchial obstruction by non-small cell lung cancer: lack of patients in an MRC randomized trial leaves key questions unanswered. Medical Research Council Lung Cancer Working Party.

      Moghissi, K; Bond, M G; Sambrook, Robert J; Stephens, Richard J; Hopwood, Penelope; Girling, David J; Yorkshire Laser Centre, Goole and District Hospital, Leeds, UK. (1999)
      Symptoms of endotracheal or endobronchial obstruction caused by non-small cell lung cancer (NSCLC) may be relieved with external beam radiotherapy (XRT) or endobronchial treatment. The comparative roles of these two methods need to be established. Patients with predominantly intraluminal obstruction of the trachea, a main bronchus or a lobar bronchus by unresectable NSCLC were randomized to XRT versus the clinician's choice of endobronchial treatment with brachytherapy, laser resection or cryotherapy, according to local availability and practice. Clinicians' assessments included symptoms of obstruction, WHO performance status, lung function tests and adverse effects of treatment. Patients completed a Rotterdam Symptom Checklist at all assessments and a daily diary card to record the severity of major symptoms during the first 4 weeks. To show a difference of 15% in the relief of breathlessness rates at 4 months (from 65% to 80%), 400 patients were required. In spite of our many previously successful lung cancer trials, and initial interest from clinicians in 24 UK centres, who estimated they could randomize 200 patients per year into the present trial, only 75 patients were randomized from seven centres over 3.5 years. Intake to the trial was therefore abandoned in November 1996 although an independent Data Monitoring and Ethics Committee had concluded in April 1996 that the scientific case for the trial was still strong; there were no competing trials; there were no design problems; and much had been done to promote the trial. The main reasons given by centres for the slow intake were: lack of referrals of untreated patients; patients being referred specifically for endobronchial treatment; patients having already received XRT; emergency endobronchial relief of obstruction being necessary; and XRT and endobronchial treatment being considered complementary and not as alternatives. The relative advantages and disadvantages of XRT versus endobronchial treatment remain to be determined. The lack of recruitment to this trial raises the issue of innovative techniques not being given the chance of proving their worth compared with traditional treatments.
    • The treatment of ependymoma of the brain or spinal canal by radiotherapy: a report of 79 cases.

      Read, G R; Department of Radiotherapy, The Christie Hospital and Holt Radium Institute, Withington, Manchester (1984-03)
      Seventy-nine patients (54 adults, 25 children) with ependymomas of the brain or spinal canal were treated by radiotherapy between 1956 and 1980. The survival was 50% at 5 years and 40% at 15 years and was significantly better in adults than in children. Survival did not depend upon the extent of surgical removal, site of tumour or histological grade. Cranio-spinal radiation may improve survival in children.
    • Treatment of HER2-positive metastatic breast cancer with lapatinib and capecitabine in the lapatinib expanded access programme, including efficacy in brain metastases--the UK experience.

      Sutherland, S; Ashley, S; Miles, D; Chan, S; Wardley, Andrew M; Davidson, N; Bhatti, R; Shehata, M; Nouras, H; Camburn, T; et al. (2010-03-16)
      BACKGROUND: The global lapatinib expanded access programme provided access to lapatinib combined with capecitabine for women with HER2-positive metastatic breast cancer (MBC) who previously received anthracycline, taxane and trastuzumab. METHODS: Progression-free survival (PFS) and safety data for 356 patients recruited from the United Kingdom are reported. Efficacy was assessed in 162 patients from the five lead centres, including objective tumour response rate (ORR), time to disease progression (TTP) and efficacy in those with central nervous system (CNS) metastases. Correlation of PFS and ORR with previous capecitabine treatment was also documented. RESULTS: Overall, PFS for the 356 UK patients was 21 weeks (95% CI: 17.6-24.7). In the 162 assessable patients, ORR was 21% (95% CI: 15-27%) and median TTP was 22 weeks (95% CI: 17-27). Efficacy was greater in capecitabine-naive patients (ORR 23 vs 16.3%, P=0.008). For 34 patients with CNS metastases, ORR was 21% (95% CI: 9-39%), with evidence of improvement in neurological symptoms, and median TTP was 22 weeks (95% CI: 15-28). CONCLUSIONS: Lapatinib combined with capecitabine is an active treatment option for women with refractory HER2-positive MBC, including those with progressive CNS disease.
    • Treatment of infections in cancer patients: an update from the neutropenia, infection and myelosuppression study group of the Multinational Association for Supportive Care in Cancer (MASCC)

      Rapoport, B. L.; Cooksley, Timothy J; Johnson, D. B.; Anderson, R.; Shannon, V. R.; Department of Immunology, Faculty of Health Sciences, University of Pretoria , Pretoria, South Africa. (2021)
      Introduction: Patients with hematological and advanced solid malignancies have acquired immune dysfunction, often exacerbated by treatment, posing a significant risk for development of infections. This review evaluates the utility of current clinical and treatment guidelines, in the setting of management of infections in cancer patients. Areas covered: : These include causes of infection in cancer patients, management of patients with high-risk and low-risk febrile neutropenia, management of low-risk patients in an outpatient setting, the role of granulocyte colony-stimulating factor (G-CSF) in the prevention and treatment of neutropenia-related infections, management of lung infections in various clinical settings, and emerging challenges surrounding the risk of infection in cancer patients treated with novel treatments. The literature search was performed by accessing PubMed and other databases, focusing on published clinical trials of relevant anti-cancer agents and diseases, primarily covering the recent past, but also including several key studies published during the last decade and, somewhat earlier in a few cases. Expert review: Notwithstanding the promise of gene therapy/gene editing in hematological malignancies and some types of solid cancers, innovations introduced in clinical practice include more discerning clinical management such as the generalized use of biosimilar formulations G-CSF and the implementation of novel, innovative immunotherapies.
    • Treatment of inoperable hepatocellular carcinoma with pegylated liposomal doxorubicin (PLD): results of a phase II study.

      Valle, Juan W; Dangoor, Adam; Beech, Janette; Sherlock, David J; Lee, Siow Ming; Scarffe, J Howard; Swindell, Ric; Ranson, Malcolm R; Christie Hospital NHS Trust, Manchester, Wilmslow Road, Manchester M20 4BX, UK. juan.valle@christie-tr.nwest.nhs.uk (2005-02-28)
      Monthly intravenous pegylated liposomal doxorubicin (PLD) 50 mg m(-2), although well tolerated, showed almost no activity in this phase II study of 16 patients with advanced hepatocellular carcinoma with a response rate of 0%, stable disease 19%, median time to progression of 2.4 months, 1-year survival of 25% and median survival of 6.5 months.
    • Treatment of limited small cell lung cancer: an old or new challenge?

      Blackhall, Fiona H; Faivre-Finn, Corinne; Department of Medical Oncology, UK bDepartment of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK. (2010-11-22)
      PURPOSE OF REVIEW: This review highlights how progress has been made in treating limited small cell lung cancer and outlines current challenges to overcome for improved cure rates. RECENT FINDINGS: There is a rationale for the tumour, node, metastasis staging system to replace the current convention of limited versus extensive stage. Positron emission tomography may aid in staging but prospective validation in larger series of patients is needed. Cisplatin and etoposide chemotherapy has yet to be superseded by either newer cytotoxic drugs or targeted agents. More progress has been made for radiotherapy but questions of optimal dose, schedule, timing and treatment volume remain unanswered. SUMMARY: Concurrent chemoradiotherapy is associated with a one in four chance of cure. Two ongoing phase III trials have been designed to address the optimal radiotherapy regimen to combine with cisplatin and etoposide. Close collaboration between radiation and medical oncologists is needed to make further progress and to improve patient access to curative intent concurrent chemoradiotherapy regimens.
    • Treatment of lymphoid cell malignancy with In-114m labelled autologous lymphocytes.

      Sharma, Harbans L; Cowan, Richard A; Murby, Brian; Owens, Susan E; Nuttall, Pamela M; Gunton, Deborah; Smith, A M; Chang, James; Crowther, Derek; Department of Medical Biophysics, University of Manchester, U.K. (1997)
      This paper is a preliminary report of a clinical trial for the treatment of patients with refractory chronic lymphocytic leukaemia, using autologous In-114m-labelled lymphocytes. Fourteen patients have been treated so far with doses ranging from 69 to 211 MBq. All patients had progressive low grade NHL, resistant to chemotherapy and conventional radiotherapy. Following the intravenous administration of radiolabelled autologous lymphocytes 53% (range 33-92%) of the activity accumulated in the spleen, 35% (21-64%) in the liver and 5% in the bone marrow. The initial response in all patients was a rapid decrease in lymphocyte count in peripheral blood. 10 of the 14 (72%) patients showed a response to the treatment. In 2 patients, there was a complete response which lasted 24 and 36 months respectively, 8 patients showed a partial response of 2 to 17 months duration. None of the patients experienced any subjective toxicity although myelosuppression was seen in all patients. This is a novel concept for the administration of therapeutic radiation in a selective way for the treatment of lymphoid cell malignancy and has produced significant antitumour effect in patients with highly resistant disease. The trial is ongoing and a full report will be published on its completion.
    • Treatment of malignant pleural effusions with intrapleural Corynebacterium parvum or tetracycline.

      Leahy, B; Honeybourne, D; Brear, S G; Carroll, K B; Thatcher, Nick; Stretton, T B (1985-01)
      Thirty two patients with malignant pleural effusion were randomly allocated to treatment with intrapleural Corynebacterium parvum or tetracycline hydrochloride in an attempt to prevent symptomatic recurrence of pleural fluid. Success in preventing recurrence of fluid at one month, using up to 2 doses of each drug, was 14 of 16 cases for Corynebacterium parvum, 5 of 9 for tetracycline given via an intercostal needle, and 6 of 7 for tetracycline given through an intercostal tube. These difference were not statistically significant. Corynebacterium parvum was significantly more likely to produce pyrexia equal or greater than 38 degrees C (P less than 0.001) and pain requiring analgesia (P less than 0.05) than tetracycline hydrochloride. Corynebacterium parvum is a useful agent for the management of malignant pleural effusion, but is associated with more side effects than tetracycline.
    • The Treatment of Metastases

      Tod, Margaret C; Christie Hospital and Holt Radium Institute, Manchester (1940-05)
    • Treatment of metastatic melanoma by 24-hour DTIC infusions and hemibody irradiation.

      Thatcher, Nick; Anderson, Heather; James, R; Davenport, P; Craig, P; Cancer Research Campaign Department of Medical Oncology, Christie Hospital, Manchester, England. (1986-06-01)
      Forty-three patients with widely metastatic melanoma were studied. Visceral metastases were present in 79% of the patient group, including five patients with brain metastases. No patients were excluded because of "early death," etc., from analysis. All 43 patients received 24-hour DTIC infusions. Dosages for individual patients ranged from 350 mg/M2 to 2.5 g/M2, a maximum of 6 courses being given. A total of 155 courses was administered. Hemibody irradiation (HBI) was delivered after 1 or 3 courses of DTIC to the area of maximum disease in 23 patients. Fourteen of the 43 patients responded to DTIC chemotherapy (with one complete response), a response rate of 33%. Seven of the chemotherapy responders also responded in other sites to subsequent HBI, a response rate of 30% (7/23). No patient responded to HBI and not to DTIC. Median survival was 4 months (range, 1-15), and nine patients are still alive at 3 to 15 months. Toxicity was generally mild, although there was one possible treatment-related death. Further exploration of DTIC infusion chemotherapy and HBI would be of interest.
    • The treatment of nephrotic syndrome caused by primary (light chain) amyloid with vincristine, doxorubicin and dexamethasone.

      Wardley, Andrew M; Jayson, Gordon C; Goldsmith, D J; Venning, M C; Ackrill, P; Scarffe, J Howard; Department of Medical Oncology, Christie Hospital, Withington, Manchester, UK. (1998-09)
      Three out of four patients with primary (light chain) amyloid nephrotic syndrome treated with vincristine, doxorubicin and dexamethasone (VAD) induction obtained a partial response and are alive in continuing remission at 4.1, 6.5 and 9.3 years. These preliminary results are of considerable interest and suggest that prospective evaluation of this regimen is warranted in patients with this condition.