• Variability of nutritional practices in peritransplant period after allogeneic hematopoietic stem cell transplantation: a survey by the Complications and Quality of Life Working Party of the EBMT.

      Peric, Z; Botti, S; Stringer, Jacqui; Krawczyk, J; van der Werf, S; van Biezen, A; Aljurf, M; Murray, J; Liptrott, S; Greenfield, D; et al. (2018-03-07)
      Recommendations on screening and nutritional support for patients undergoing hematopoietic stem cell transplantation (HSCT) have been presented by international nutritional societies, but nutritional practices remain poorly standardized. Following the general policy of the European Society for Blood and Marrow Transplantation (EBMT) to standardize transplantation procedures, the Complications and Quality of Life Working Party and Nursing Research Group carried out a survey among all EBMT centers about their current nutritional practices. The aim of this study was to better understand current practices, differences from available guidelines, and possible barriers for recommended nutritional therapy. Responses from 90 centers (19%) from 23 countries were received. We observed a marked variability in nutritional care between EBMT centers and a substantial lack of standardized operating procedures in screening patients for malnutrition and management of gastrointestinal GVHD. Furthermore, our study confirmed neutropenic diet as standard of care in most centers as well a preference for parenteral nutritional support over enteral. On the basis of these findings, future EBMT efforts will focus on better implementation of international nutritional guidelines into clinical practice.
    • Variable and fixed costs in NHS radiotherapy; consequences for increasing hypo fractionation

      Spencer, K.; Defourny, N.; Tunstall, D.; Cosgrove, V.; Kirkby, Karen J; Henry, A.; Lievens, Y.; Hall, P.; Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Level 10, Worsley building, Clarendon Way, Leeds, LS2 9LU; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust. (2021)
    • Variable levels of carry over on platelet counts < or = 20 x 10(9)/l with the Bayer Advia 120.

      Mehmood, S; Hinchliffe, R F; Clark, S J; Bellamy, G J; Dennis, Michael; Welch, J C; Vora, Ajay J; Department of Haematology, Christie NHS Trust, Wilmslow Road, Withington, Manchester M20 4BX, UK. (2007-10)
      Accurate platelet counts are essential for the safe management of severe thrombocytopenia (platelet counts < or = 20 x 10(9)/l). The effect of carry over on platelet counting in severe thrombocytopenia was investigated by performing counts before and after saline rinses on three Bayer Advia 120 automated blood counters. Counts were performed in both primary and manual closed tube system modes on two instruments and in manual open tube mode on a third. A total of 194 samples with platelet counts < or = 20 x 10(9)/l were studied. First counts were significantly higher in all groups. The magnitude of the difference varied both by analyser and counting mode. Carry over was minimal with one analyser in primary mode and second counts were on average only 5.5% lower; on a second analyser in manual closed tube system mode second counts were on average 37.7% lower. A first count of > or = 10 x 10(9)/l fell to <10 x 10(9)/l on the second count in 35 of 145 samples (24.1%). In five such samples, all tested on one analyser, the second count was <50% of the value of the first count. Two of 49 (4.1%) first counts of <10 x 10(9)/l increased to > or = 10 x 10(9)/l on repeat. These results show a variable and often potentially clinically important carry-over effect on severely thrombocytopenic samples using the Advia 120.
    • Variables associated with survival in patients with invasive bladder cancer with and without surgery.

      Longdon E; Mistry H; Pratt, O; Donnelly, A; O'Neill, S; Nachlappan, M; Darwin, L; Clarke, Noel W; Hartley, R; Nachiappan, M; et al. (2020)
      We recorded the survival of 141 patients assessed for radical cystectomy, which included cardiopulmonary exercise testing. The median Kaplan-Meier survival estimates were: 1540 days for the whole cohort; 2200 days after cystectomy scheduled (n = 108); and 843 days without surgery. The mortality hazard remained double that expected for a matched general population, but survival was better in patients scheduled for surgery than those who were not: the mortality hazard ratio (95%CI) after cystectomy was 0.43 (0.26-0.73) the mortality hazard without surgery, p = 0.001. The mortality hazard ratios for the three-variable Bayesian Model Averaging survival model for all 141 patients were: referral for surgery (0.5); haemoglobin concentration (0.98); and efficiency of carbon dioxide output (1.05). Efficiency of carbon dioxide output was the single variable in the postoperative model (n = 108), mortality hazard 1.08 (per unit increase). The ratio of observed to expected peak oxygen consumption associated best with mortality in 33 patients not referred for surgery, hazard ratio 0.001. Our results can inform consultations with patients with invasive bladder cancer and suggest that interventions to increase fitness and haemoglobin may improve survival in patients who do and who do not undergo radical cystectomy. Keywords: bladder cancer; cardiopulmonary exercise testing; radical cystectomy; survival; transitional cell carcinoma.
    • Variation in adherence to protocol recommendations for pre- and post-operative treatment of children with Wilms tumour in two consecutive studies in the UK and Ireland

      Tugnait, S.; Al-Saadi, R.; Williams, R.; Oostveen, M.; Dzhuma, K.; Brok, J.; Irtan, S.; Lopez, A.; Weeks, M.; Bate, J.; et al. (2020)
      Background and Aims: Wilms tumour (WT) has excellent event-free and overall survival rates. However, small differences exist between countries participating in the same international study. This led us to examine variation in adherence to protocol recommendations as a potential contributing factor. Methods: Retrospective analysis of all children with unilateral WT treated with pre-operative chemotherapy in the SIOPWT2001 (2002- 11) and IMPORT (2012-18) studies in the UK and Ireland. Pre- and post-operative treatments (including radiotherapy) were classified as: per protocol (PP); deviation (PDEV) - variation for specified clinical rea- sons; violation (PVIOL) - not treated per protocol. Results: 1186 children with WT were registered by 20 centres. 983 (83%) had unilateral WT treated with pre-operative chemotherapy. All had centrally reviewed pathology. Case Report Forms (CRFs) allow- ing categorisation of the whole treatment pathway were available for 564 patients. Overall,58% (209/361) were treated PP in SIOPWT2001 and 67% (137/203) in IMPORT. A further 30% (110/361) and 17% (34/203) respectively classified as PDEV. PVIOL occurred in 12% (42/361) in SIOPWT2001 and 15% (31/203) in IMPORT. Stage III/IV tumours had higher proportion PVIOL (18% SIOPWT2001; 28% IMPORT) compared to stage I/II tumours (8% in both studies). The highest rates of PVIOL were in stage IV (metastatic) IMPORT patients (33%). The most common reasons for PVIOL were not changing to high risk chemotherapy, use of radiotherapy for slow metastatic responders and prolonged duration of pre-operative chemotherapy. For children with stage I/II WT, 92%/91% received PP pre-operative treatment and 79%/82% received PP post-operative treatment in SIOPWT2001/IMPORT respectively. Correlation of protocol adher- ence with survival is planned. Conclusions: Protocol guidelines are followed closely for stage I and II tumours but there is greater variation in more advanced disease. This maybe reduced by the more explicit definitions of metastasis and treat- ment response in the SIOP-RTSG UMBRELLA protocol that succeeded the IMPORT study in 2019
    • Variation in bladder filling for cervical cancer patients undergoing radical radiotherapy

      Nelder, C.; Chuter, R.; Berresford, J.; Benson, R.; Clough, A.; McDaid, L.; Barraclough, L.; Haslett, K.; Hoskin, P.; Choudhury, A.; et al. (2021)
    • Variation in cardiac screening and management of carcinoid geart disease in the UK and Republic of Ireland.

      Dobson, R; Valle, Juan W; Burgess, M I; Poston, G J; Cuthbertson, D J; Neuroendocrine Tumour Group, University Hospital Aintree, Liverpool, UK (2015-07-10)
      Screening for carcinoid heart disease is an important, yet frequently neglected aspect of the management of patients with neuroendocrine tumours (NETs). Screening is advocated in international guidelines, although recommendations on the modality and frequency are poorly defined. We mapped current practice for the screening and management of carcinoid heart disease in specialist NET centres throughout the UK and Republic of Ireland.
    • Variation in GH and IGF-I assays limits the applicability of international consensus criteria to local practice

      Pokrajac, Ana; Wark, G; Ellis, A; Wear, Joanne E; Wieringa, Gilbert E; Trainer, Peter J; Christie Hospital NHS Trust, Department of Endocrinology, Manchester, UK. (2007-07)
      BACKGROUND: There is increasing reliance on consensus criteria for decision making. Recent criteria state that acromegaly is excluded by a nadir GH during an oral glucose tolerance test (OGTT) of < 1 microg/l and a normal level of IGF-I. OBJECTIVE: To study GH and IGF-I assay performance close to cut-off values for active acromegaly. DESIGN AND METHODS: Two serum samples known to give borderline results were sent to all centres participating in the UK National External Quality Assessment Service (NEQAS). Sample A was assigned to be a nadir during an OGTT and sent for GH assessment to 104 centres. Sample B, with a clinical scenario, was sent to 23 centres that measure IGF-I, and these centres were asked to measure IGF-I, interpret the result and provide the source of their reference ranges (RRs). RESULTS: For sample A, the median GH was 2.6 mU/l (range 1.04-3.5 mU/l). Applying a conversion factor (CF) of 2.0 (1 microg/l = 2 mU/l), the most negatively biased method classified 10% of the values consistent with acromegaly, while the most positively biased method classified all values as consistent with the diagnosis. Applying a CF of 3.0 (1 microg/l = 3 mU/l), only 11% of results were consistent with acromegaly. For sample B, the median IGF-I was 50.8 nmol/l (range 24.3-60.9 nmol/l). All centres used age-related RRs. There was a 50% variation in the upper limit of the RRs between centres. Overall, 30% of the IGF-I results were against the diagnosis. There was little agreement in the RRs quoted by centres using the same method. CONCLUSION: Variability in assay performance, coupled with use of inappropriate CFs and RRs, undermines the applicability of international consensus criteria to local practice.
    • The variation in output of symmetric, asymmetric and irregularly shaped wedged radiotherapy fields.

      Hounsell, Alan R; Wilkinson, John M; North Western Medical Physics, Christie Hospital, Manchester, UK. (1996-10)
      A model for calculating the variation in output of symmetric, asymmetric and irregularly shaped wedged radiotherapy fields is presented. The variation in output from the treatment head when a wedge is used is calculated by dividing the output into a primary component and one due to scattered radiation. The scatter component is then further subdivided into contributions from elements which have a 1 cm x 1 cm cross-sectional area at the isocentre. The scatter from each element is determined as the contribution from the head scatter component modified by the presence of the wedge and a contribution due to additional scattered radiation from the wedge. The relative intensity of the scattered radiation from the wedge is modelled using a simple first scatter approximation. In this approximation the magnitude of the scatter is given by a t exp(-mu t) function where t is the thickness of the wedge for the selected element. The magnitude of the primary component and the relative intensity of scatter from each element are then obtained by an iterative fit to measured data. The technique has been applied to two different internally mounted wedge designs, for a standard treatment head, two asymmetric treatment heads and two similar multileaf collimators, over a range of energies between 4 and 20 MV. Calculations agree with measured values over a range of field sizes and shapes to within 1.5%.
    • Variation in the core and branch carbohydrate sequences of serum glycoprotein hormone alpha subunit as determined by lectin affinity chromatography.

      Chapman, A J; Gallagher, John T; Beardwell, Colin G; Shalet, Stephen M; Paterson Laboratories and Radiotherapy Department, CHristie Hospital and Holt Radium Institute, Manchester M20 9BX (1984-10)
      Serum alpha subunits from patients with pituitary tumours and from normal controls were studied for their ability to bind to Lens culinaris agglutinin-Sepharose (LCA), L-phytohaemagglutinin-agarose (L-PHA) and soybean agglutinin-Sepharose (SBA). Serum alpha subunits from normal controls which had previously been shown to bind to Concanavalin A-Sepharose (Con A) were not retained by LCA. In contrast, Con A-reactive alpha subunits from patients with pituitary tumours bound specifically to LCA. Non-Con A-reactive alpha subunits from patients with pituitary tumours were also largely not bound to LCA, but were retained by L-PHA. No alpha subunits from any source bound to SBA. These results indicate that the structural alterations resulting in non-Con A-reactive serum alpha subunits include highly branched complex oligosaccharides in addition to the hybrid-type glycans previously described. The increased branching appears to be associated with fucosylation in the core region of the oligosaccharides. Serum alpha subunit from any source appears to be devoid of terminal N-acetylgalactosamine residues. These structural modifications may be related to the variable biological activity of alpha subunit which has been reported.
    • Variation of expression of the gene for type 2 neurofibromatosis: absence of a gender effect on vestibular schwannomas, but confirmation of a preponderance of meningiomas in females.

      Evans, D Gareth R; Blair, Val; Strachan, T; Lye, R H; Ramsden, R T; Department of Medical Genetics, St Mary's Hospital, Manchester, UK. (1995-09)
      Type 2 neurofibromatosis is a dominantly inherited disorder in which the great majority of sufferers develop bilateral vestibular schwannomas. In a UK study of 183 individuals from 112 families we have previously shown a fairly similar disease course within families, but quite marked inter-familial variation. We have confirmed an increase in severity when the gene is inherited from an affected mother, but evidence that women are more severely affected than men is lacking. Age at onset of symptoms, of deafness and at diagnosis are identical for the entire dataset and for a comparison of 10 male/female sibling pairs. Only three out of 42 pregnancies in symptomatic women were accompanied by a reversible worsening in symptoms due to vestibular schwannomas. Of 328 consecutive cases of unilateral vestibular schwannoma, there was no significant difference in the sex ratio or size. There now appears to be little evidence for a female hormonal effect on vestibular schwannomas. However, females with type 2 neurofibromatosis have significantly more meningiomas.
    • Variations in breast density and mammographic risk factors in different ethnic groups, in "Breast imaging: 13th International Workshop, IWDM 2016, Malmö, Sweden, June 19-22, 2016, proceedings."

      Harkness, E; Bashir, F; Foden, P; Bydder, M; Gadde, S; Wilson, M; Maxwell, A; Hurley, E; Howell, Anthony; Evans, D; et al. (Springer, 2016)
    • Variations in demand across England for the magnetic resonance-linac technology, simulated utilising local-level demographic and cancer data in the Malthus project

      Mee, Thomas; Vickers, Alexander J; Jena, R.; Kirkby, Karen J; Choudhury, Ananya; Kirkby, Norman; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK (2021)
      Aims: Cancer incidence varies across England, which affects the local-level demand for treatments. The magnetic resonance-linac (MR-linac) is a new radiotherapy technology that combines imaging and treatment. Here we model the demand and demand variations for the MR-linac across England. Materials and methods: Initial clinical indications were provided by the MR-linac consortium and introduced into the Malthus radiotherapy clinical decision trees. The Malthus model contains Clinical Commissioning Group (CCG) population, cancer incidence and stage presentation data (for lung and prostate) and simulated the demand for the MR-linac for all CCGs and Radiotherapy Operational Delivery Networks (RODN) across England. Results: Based on the initial target clinical indications, the MR-linac could service 16% of England's fraction burden. The simulated fractions/million population demand/annum varies between 3000 and 10 600 fractions/million at the CCG level. Focussing only on the cancer population, the simulated fractions/1000 cancer cases demand/annum ranges from 1028 to 1195 fractions/1000 cases. If a national average for fractions/million demand was then used, at the RODN level, the variation from actual annual demand ranges from an overestimation of 8400 fractions to an underestimation of 5800 fractions. When using the national average fractions/1000 cases, the RODN demand varies from an overestimation of 3200 fractions to an underestimation of 3000 fractions. Conclusions: Planning cancer services is complex due to regional variations in cancer burden. The variations in simulated demand of the MR-linac highlight the requirement to use local-level data when planning to introduce a new technology.
    • Variations in IMRT demand and delivery across England

      Mee, Thomas; Kirkby, Norman; Burnet, Neil G; Mackay, Ranald I; Gray, R.; Shelton, J; Kirkby, Karen J; University Of Manchester, Division of Cancer Sciences, Manchester, (2020)
      Purpose or Objective Intensity Modulated Radiotherapy (IMRT) is a key radiotherapy (RT) technique used for radical treatments. A 2015 report1 from England suggested that 51.8% of radical RT patients should be treated with IMRT. However, there are variations in the profile of cancer throughout England. This will result in variations in the demand for IMRT and therefore 51.8% may not be applicable at local level. Delivery of IMRT may also vary between RT centres. The English Cancer registries record delivered RT data, including which treatments were IMRT. Here, we compare the recorded IMRT delivered data to a local-level IMRT demand simulations. Material and Methods The future IMRT predictions from the 2015 report were encoded into the Malthus Model2 for every IMRT relevant cancer site. Malthus contains local-level population, incidence and stage presentation data. Malthus simulated the IMRT demand for every clinical commissioning group (CCG) in England. The recorded IMRT delivered data is also at CCG level and was sourced from Public Health England. The recorded IMRT data was converted to a percentage of the simulated demand. A heat map of the results was created for England in Tableau software3. The postcode location of every main RT centre in England was obtained and plotted on the heat map, including information on the number of linacs registered at the centre. Breast IMRT was excluded from the analysis, as it could potentially distort the data, due to current questions around inverse/forward planned IMRT and service targets1. Results There is variation in simulated demand for IMRT across England, ranging from 44.7% to 56.5% of radical RT patients. There is also variation in recorded IMRT delivery, ranging from 21% to 67%. When comparing a CCG’s recorded IMRT to its simulated demand the results range from 55% to 164%. Figure 1 shows the results of the comparison for every CCG in England alongside RT centre location and size information. Conclusion The combination of the future demand figures from the 2015 IMRT report and the Malthus model has produced the regional variations in IMRT demand. The heat map of the comparison of recorded IMRT delivery data to the locallevel demand, highlights regions within England which may be under providing, or over providing, IMRT. These areas should be investigated in detail to identify the reasons for these differences. There may be non-service factors driving the differences, such as data and recording inaccuracies, incidence fluctuations or comorbidities. These are factors which are not currently included in the Malthus model.
    • Variations in single/two stage thyroidectomies for cancer may be due to differences in thyroid fine needle cytology provision.

      Gandhi, A; Ranganathan, B; Thiryayi, S A; Rowland, M; Yap, Beng K; University of Manchester, Manchester Academic Health Sciences Centre, University Hospital of South Manchester, Manchester, UK (2015-04-30)
      Recommended treatment for thyroid cancers >10 mm is single stage total thyroidectomy (SST). Cancers diagnosed by diagnostic lobectomy may need completion surgery resulting in two stage thyroidectomies (TST). We noticed significant variation in numbers of SST and TST between hospitals within our cancer network and explored reasons for this using a prospective database containing all cases from 2004 to 2011 (n = 1030). We therefore conducted a survey of thyroid cytology provision across the network during 2010-2011.
    • Variations in the anatomy of the posterior auricular nerve and its potential as a landmark for identification of the facial nerve trunk: a cadaveric study.

      Smith, O J; Ross, Gary L; The Faculty of Life Sciences, University of Manchester, Manchester, UK. (2012-06)
      The posterior auricular nerve (PAN) is the first extracranial branch of the facial nerve trunk. It innervates the posterior belly of the occipitofrontalis and the auricular muscles and contributes cutaneous sensation from the skin covering the mastoid process and parts of the auricle. This study was carried out to provide a detailed account of its anatomy and to ascertain its reliability as a surgical landmark for the facial nerve. Eleven facial sides from six formalin-fixed cadavers were dissected. The course and arborisation pattern of the PAN was observed, and its position of emergence from the facial nerve trunk (FNT) was measured. The PAN arose from the posterolateral aspect of the FNT 1.6-11.1 mm from the stylomastoid foramen (5.4 ± 3.3 mm). It arose as a single branch (45.4%), or from a common trunk that divided into two (36.4%) or three branches (18.2%), with the other branches passing into the parotid gland. The PAN continued deep (63%), or lateral to the mastoid process (9.1%), or through the tissue of the parotid gland (27.3%). In all cases the PAN ran in a consistent, superficial location posterior to the external auditory meatus. The PAN takes a variable course; however, its consistent location behind the external auditory meatus makes it easily identifiable in superficial dissection, and therefore a potential surgical landmark for identifying the FNT.
    • Variations in the practice of molecular radiotherapy and implementation of dosimetry: results from a European survey.

      Sjögreen Gleisner, K; Spezi, E; Solny, P; Gabina, P; Cicone, F; Stokke, C; Chiesa, C; Paphiti, M; Brans, B; Sandström, M; et al. (2017-12-04)
      Currently, the implementation of dosimetry in molecular radiotherapy (MRT) is not well investigated, and in view of the Council Directive (2013/59/Euratom), there is a need to understand the current availability of dosimetry-based MRT in clinical practice and research studies. The aim of this study was to assess the current practice of MRT and dosimetry across European countries.
    • Vascular biomarkers derived from dynamic contrast-enhanced MRI predict response of vestibular schwannoma to antiangiogenic therapy in type 2 neurofibromatosis.

      Li, K; Djoukhadar, I; Zhu, X; Zhao, S; Lloyd, S; McCabe, M; McBain, Catherine A; Evans, D; Jackson, A; Wolfson Molecular Imaging Centre, The University of Manchester, Manchester, UK (2015-08-26)
      Antiangiogenic therapy of vestibular schwannoma (VS) in type 2 neurofibromatosis can produce tumor shrinkage with response rates of 40%-60%. This study examines the predictive value of parameter-derived MRI in this setting.
    • Vascular effects of aromatase inhibitors: data from clinical trials.

      Howell, Anthony; Cuzick, Jack; CRUK Department of Medical Oncology, University of Manchester, Wilmslow Road, Manchester M20 4BX, UK. anthony.howell@christie-tr.nwest.nhs.uk (2005-05)
      Aromatase inhibitors (AIs) are becoming the endocrine treatment of first choice for postmenopausal women with hormone receptor-positive breast cancer and are under investigation for use in breast cancer prevention. AIs reduce circulating estrogen to barely detectable concentrations. It is possible that such a low concentration will be deleterious to the vascular system since estrogen receptors are known to be in the cell walls of blood vessels and estrogen is thought to be important in maintaining blood vessel integrity. Because most women who present with primary breast cancer are cured by surgery and systemic therapy and the major cause of female death is vascular disease, it is particularly important to investigate the vascular side effects of AIs in current breast cancer adjuvant and prevention trials. In order to set the vascular toxicities of AIs reported in the current adjuvant trials into context, here we compare them with the toxicities seen during treatment with hormone replacement therapy (HRT) and selective estrogen receptor modulators (SERMs). Clinical trial evidence indicates that HRT increases risk of coronary heart disease (CHD) whereas SERMs and AIs (to date) appear to be neutral. Cerebrovascular disease and venous thromboembotic events are increased by HRT and SERMs but appear to be unaffected by treatment with AIs. Cognitive function is also considered here since it may also have a vascular component and is potentially a serious potential side effect/benefit of AIs. Recent studies indicate that HRT has a small detrimental effect on cognitive function and is associated with a doubling of the incidence of dementia. A comprehensive study of the SERM, raloxifene, on cognitive function showed no significant effect. There are no definitive reported studies investigating tamoxifen and none for AIs on cognitive function, although there is one in progress in the context of the IBIS II prevention trial which compares anastrozole to placebo in women at high risk. At present concerns about deleterious vascular side effects are confined to HRT and SERMs. However, we have few long-term data using AIs for the treatment and prevention of breast cancer.
    • Vascular endothelial growth factor (VEGF) expression is a prognostic factor for radiotherapy outcome in advanced carcinoma of the cervix.

      Loncaster, Juliette A; Cooper, Rachel A; Logue, John P; Davidson, Susan E; Hunter, Robin D; West, Catharine M L; CRC Experimental Radiation Oncology Group, Paterson Institute for Cancer Research, Manchester, UK. (2000-09)
      The aim of the study was to evaluate VEGF expression in tumour biopsies as a prognostic factor for radiotherapy outcome in advanced carcinoma of the cervix. A retrospective study was carried out on 100 patients. Pre-treatment tumour VEGF expression was examined immunohistochemically in formalin-fixed, paraffin-embedded biopsies using a widely available commercial antibody. A semi-quantitative analysis was made using a scoring system of 0, 1, 2, and 3, for increasing intensity of staining. High VEGF expression was associated with a poor prognosis. A univariate log rank analysis found a significant relationship with overall survival (P = 0.0008) and metastasis-free survival (P = 0.0062), but not local control (P = 0.23). There was no correlation between VEGF expression and disease stage, tumour differentiation, patient age, or tumour radiosensitivity (SF2). In a Cox multivariate analysis of survival VEGF expression was the most significant independent prognostic factor (P = 0.001). After allowing for VEGF only SF2 was a significant prognostic factor (P = 0.003). In conclusion, immunohistochemical analysis of VEGF expression is a highly significant and independent prognostic indicator of overall and metastasis-free survival for patients treated with radiotherapy for advanced carcinoma of the cervix. It is also a rapid and easy method that could be used in the clinical setting, to identify patients at high risk of failure with conventional radiotherapy who may benefit from novel approaches or chemoradiotherapy.