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McNair H.A.,Royal Marsden NHS Foundation Trust and Institute of Cancer Research | Elsworthy M.,Bupa Cromwell Hospital | Dean J.,University of Cambridge
Radiography | Year: 2014

Image guided radiotherapy has evolved from two dimensional (2D) megavoltage imaging, which allowed verification with respect to bony anatomy, to three dimensional (3D) kilovoltage imaging which enables soft tissue structures to be used for verification. Alongside the technological developments, treatment delivery techniques have become more sophisticated and the potential to adapt treatment delivery to changes in tumour and/or organs at risk is increasing. This review explores the current status of soft tissue imaging techniques in conjunction with the potential clinical impact. The common tumour sites where the new treatment techniques are being investigated are identified and it is seen that to support the implementation of these techniques, investment in capital equipment and staff training is essential. © 2014 The College of Radiographers.

Omlin A.,Kantonsspital St. Gallen | Sartor O.,Tulane University | Rothermundt C.,Kantonsspital St. Gallen | Cathomas R.,Kantonsspital Graubunden | And 4 more authors.
Clinical Genitourinary Cancer | Year: 2015

Introduction We hypothesized that the adverse event (AE) profile of cabazitaxel with regard to alopecia, nail changes, neuropathy, and dysgeusia differs from docetaxel. Materials and Methods Prospectively collected data on treatment-emergent AEs (frequency and grade [G]) from clinical trial databases of docetaxel every 3 weeks (q3w) (in TAX327 and VENICE) and cabazitaxel q3w (in TROPIC) were analyzed. Results The frequency of new or worsening AEs (all G and G3-4) for 1301 patients was significantly less for alopecia, nail changes, neuropathy, and dysgeusia for cabazitaxel compared with docetaxel. Conclusion Treatment with cabazitaxel might cause less alopecia, nail changes, neuropathy, and dysgeusia compared with docetaxel. © 2015 Elsevier Inc. All rights reserved.

Sherrill B.,RTI Health Solutions | Amonkar M.M.,Glaxosmithkline | Sherif B.,RTI Health Solutions | Maltzman J.,Glaxosmithkline | And 2 more authors.
Oncologist | Year: 2010

Background. A phase III trial compared lapatinib plus letrozole (L + Let) with letrozole plus placebo (Let) as first-line therapy for hormone receptor (HR)+ metastatic breast cancer (MBC) patients. The primary endpoint of progression-free survival (PFS) in patients whose tumors were human epidermal growth factor receptor (HER)-2+ was significantly longer for L + Let than for Let (8.2 months versus 3 months; p=.019). This analysis focuses on quality of life (QOL) in the HER-2+ population. Methods. QOL was assessed at screening, every 12 weeks, and at withdrawal using the Functional Assessment of Cancer Therapy-Breast (FACT-B). Changes from baseline were analyzed and the proportions of patients achieving minimally important differences in QOL scores were compared. Additional exploratory analyses evaluated how QOL changes reflected tumor progression status. Results. Among the 1,286 patients randomized, 219 had HER-2+ tumors. BaselineQOLscores were comparable in the two arms. Mean changes in QOL scores were generally stable over time for patients who stayed on study. The average change from baseline on the FACT-B total score in both arms was positive at all scheduled visits through week 48. There was no significant difference between the two treatment arms in the percentage of QOL responders. Conclusion. The addition of lapatinib to letrozole led to a significantly longer PFS interval while maintaining QOL during treatment, when compared with letrozole alone, thus confirming the clinical benefit of the combination therapy in the HR+ HER-2+ MBC patient population. This all oral regimen provides an effective option in this patient population, delaying the need for chemotherapy and its accompanying side effects. © AlphaMed Press.

Strigari L.,Regina Elena Cancer Institute | Konijnenberg M.,Erasmus University Rotterdam | Chiesa C.,Instituto Nazionale Tumori | Bardies M.,University Paul Sabatier | And 4 more authors.
European Journal of Nuclear Medicine and Molecular Imaging | Year: 2014

Molecular radiotherapy (MRT) has demonstrated unique therapeutic advantages in the treatment of an increasing number of cancers. As with other treatment modalities, there is related toxicity to a number of organs at risk. Despite the large number of clinical trials over the past several decades, considerable uncertainties still remain regarding the optimization of this therapeutic approach and one of the vital issues to be answered is whether an absorbed radiation dose–response exists that could be used to guide personalized treatment. There are only limited and sporadic data investigating MRT dosimetry. The determination of dose–effect relationships for MRT has yet to be the explicit aim of a clinical trial. The aim of this article was to collate and discuss the available evidence for an absorbed radiation dose–effect relationships in MRT through a review of published data. Based on a PubMed search, 92 papers were found. Out of 79 studies investigating dosimetry, an absorbed dose–effect correlation was found in 48. The application of radiobiological modelling to clinical data is of increasing importance and the limited published data on absorbed dose–effect relationships based on these models are also reviewed. Based on National Cancer Institute guideline definition, the studies had a moderate or low rate of clinical relevance due to the limited number of studies investigating overall survival and absorbed dose. Nevertheless, the evidence strongly implies a correlation between the absorbed doses delivered and the response and toxicity, indicating that dosimetry-based personalized treatments would improve outcome and increase survival. © 2014, Springer-Verlag Berlin Heidelberg.

Riches S.F.,Royal Marsden NHS Foundation Trust and Institute of Cancer Research | Payne G.S.,Royal Marsden NHS Foundation Trust and Institute of Cancer Research | Morgan V.A.,Royal Marsden NHS Foundation Trust and Institute of Cancer Research | Dearnaley D.,Royal Marsden NHS Foundation Trust and Institute of Cancer Research | And 6 more authors.
European Radiology | Year: 2015

Objectives: The objectives are determine the optimal combination of MR parameters for discriminating tumour within the prostate using linear discriminant analysis (LDA) and to compare model accuracy with that of an experienced radiologist. Methods: Multiparameter MRIs in 24 patients before prostatectomy were acquired. Tumour outlines from whole-mount histology, T2-defined peripheral zone (PZ), and central gland (CG) were superimposed onto slice-matched parametric maps. T2, Apparent Diffusion Coefficient, initial area under the gadolinium curve, vascular parameters (Ktrans,Kep,Ve), and (choline+polyamines+creatine)/citrate were compared between tumour and non-tumour tissues. Receiver operating characteristic (ROC) curves determined sensitivity and specificity at spectroscopic voxel resolution and per lesion, and LDA determined the optimal multiparametric model for identifying tumours. Accuracy was compared with an expert observer. Results: Tumours were significantly different from PZ and CG for all parameters (all p < 0.001). Area under the ROC curve for discriminating tumour from non-tumour was significantly greater (p < 0.001) for the multiparametric model than for individual parameters; at 90 % specificity, sensitivity was 41 % (MRSI voxel resolution) and 59 % per lesion. At this specificity, an expert observer achieved 28 % and 49 % sensitivity, respectively. Conclusion: The model was more accurate when parameters from all techniques were included and performed better than an expert observer evaluating these data. Key Points: • The combined model increases diagnostic accuracy in prostate cancer compared with individual parameters • The optimal combined model includes parameters from diffusion, spectroscopy, perfusion, and anatominal MRI • The computed model improves tumour detection compared to an expert viewing parametric maps © 2014, European Society of Radiology.

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