124 results found
Sun Myint A, Dhadda A, Stewart A, et al., 2023, The Role of Contact X-Ray Brachytherapy in Early Rectal Cancer – Who, when and How?, Clinical Oncology, Vol: 35, Pages: 87-96, ISSN: 0936-6555
The National Institute for Health and Care Excellence (NICE) has recommended the use of contact X-ray brachytherapy (CXB) for rectal cancer patients who are not suitable for surgery. At present, patients with early rectal cancer who wish to avoid major surgery and a stoma are not usually offered CXB as an alternative treatment option to surgery. The main reason for this has been a lack of large, randomised trial evidence, hence NICE encouraged provision of this evidence in their recommendation. In 2015, the OPERA (Organ Preservation in Early rectal Adenocarcinoma) trial was set up and the 3-year organ-preservation results were presented at the American Society of Clinical Oncology (ASCO) meeting in Chicago on 4 June 2022. We are now awaiting full publication of the OPERA results. Most rectal cancer patients who are not suitable for surgery are currently offered external beam radiotherapy (EBRT) with or without chemotherapy after the multidisciplinary discussions. Clinical complete response (cCR) rates vary between 20 and 50% after EBRT. Those who achieve cCR usually adopt a ‘watch and wait’ policy, but patients who have residual disease are often not offered any additional treatment. We hypothesised that dose escalation with a CXB boost could achieve a higher cCR and therefore lead to improved organ-preservation rates. This was the rationale behind the OPERA trial, which randomised patients between standard of care [EBRT with chemotherapy (EBCRT)] followed by an EBRT boost against EBCRT with a CXB boost to evaluate the role of CXB in dose escalation. In 1993, the first CXB centre was established in the UK at Clatterbridge Cancer Centre. There are now four centres offering CXB in the UK and 10 centres in Europe. Patients should be provided with full information during the consent discussion and offered all the treatment options that are available, so that they can share in decision making and be empowered to make treatment decisions of their choice after
Bibi S, Edilbe MW, Rao C, 2023, The Cost-effectiveness of Watch and Wait for Rectal Cancer., Clin Oncol (R Coll Radiol), Vol: 35, Pages: 132-137
The existing literature suggests with a high degree of certainty that watch and wait is more cost-effective than initial total mesorectal excision. However, it is heavily reliant on poor-quality health-related quality of life data. Furthermore, the cost-effectiveness of organ preservation from a broader societal perspective has not been studied. Finally, the cost-effectiveness of emerging adjuncts to watch and wait for organ preservation, such as contact X-ray brachytherapy, local excision and total neoadjuvant therapy, need to be characterised.
Shamsiddinova A, Deputy M, Worley G, et al., 2023, P362 Systematic review: Oncological outcomes of patients with Inflammatory Bowel Disease undergoing segmental colonic resections for colorectal cancer and dysplasia, Publisher: Oxford University Press (OUP), Pages: i494-i495, ISSN: 1873-9946
<jats:title>Abstract</jats:title> <jats:sec> <jats:title>Background</jats:title> <jats:p>Current international guidelines recommend that patients with inflammatory bowel disease (IBD) diagnosed with high grade dysplasia (HGD), or colorectal cancer undergo a proctocolectomy, and that proctocolectomy is considered within a shared decision-making framework with the patient in cases of low grade (LGD) or indeterminate (IND) dysplasia. However, segmental colectomy (surgical resection leaving remaining colon or rectum) is considered by some as a valid alternative, with less physiological stress, stoma avoidance and thus acceptability to patients. This systematic review aims to assess oncological and post-operative outcomes in studies reporting on segmental colectomy or proctocolectomy for patients with IBD and colonic or rectal dysplasia and cancer.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>This systematic review was prospectively registered with PROSPERO (CRD42021292891) and carried out in line with the PRISMA guidelines. Studies published between 1990 and 2022 reporting on oncological and surgical outcomes of adult patients undergoing segmental resection and/or proctocolectomy that included at least three cases of neoplasia were included. Descriptive statistics were used in the context of significant heterogeneity. A meta-analysis was performed for outcomes with at least three results.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The search returned 2178 results, and after screening 12 studies were included in the final analysis. A total 12,701 patients were included reporting on outcomes of 10,386 segmental resections and 2,315 proctoco
Rao C, 2023, Appeal Panel Decision: Tafasitamab with lenalidomide for treating relapsed or refractory diffuse large B-cell lymphoma [ID3795], Appeal Panel Decision: Tafasitamab with lenalidomide for treating relapsed or refractory diffuse large B-cell lymphoma, London, Publisher: National Institute of Health and Care Excellence, ID3795
Fahy MR, Kelly ME, Aalbers AGJ, et al., 2022, Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline, BRITISH JOURNAL OF SURGERY, Vol: 109, Pages: 1251-1263, ISSN: 0007-1323
- Author Web Link
- Citations: 1
Myint AS, Dhadda AS, Stewart A, et al., 2022, New hope from <scp>OPERA</scp> trial for surgically fit rectal cancer patients who wish to have organ preservation, Colorectal Disease, ISSN: 1462-8910
Logan R, Rao C, Hunt N, et al., 2022, O8 Duplicate FIT testing as a safety netting strategy for patients at risk of colorectal cancer, Abstracts of the BSG Annual Meeting, 20–23 June 2022, Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology
Hunt N, Rao C, Logan R, et al., 2022, A cohort study of duplicate faecal immunochemical testing in patients at risk of colorectal cancer from North-West England, BMJ Open, Vol: 12, Pages: 1-7, ISSN: 2044-6055
Objectives We sought to investigate if duplicate faecal immunochemical testing (FIT) sampling improves the negative and positive predictive value of patients thought to be at risk of colorectal cancer (CRC). Specifically, we aimed to investigate whether the proportion of FIT-negative CRC missed by a single FIT test in symptomatic patients could be reduced by duplicate FIT testing.Design A retrospective service evaluation cohort study of the diagnostic accuracy of duplicate FIT testing.Setting Patients referred from primary care with suspected CRC to four secondary care trusts in North-West England.Participants 28 622 patients over 18-years-old with lower gastrointestinal symptoms suggestive of CRC who completed two FIT samples.Primary and secondary outcome measures The performance of duplicate FIT for detecting CRC at a threshold of 10 µgHb/g.Results The sensitivity if either test was >10 µgHb/g was 0.978 (0.955–0.989), specificity was 0.662 (0.657–0.668), positive predictive value 0.031 (0.028–0.035) and negative predictive value 1.00 (0.999–1.00). Despite two-thirds of patients (18952) being negative following two tests, at this threshold only seven CRC were missed over a 26-month period. All seven patients had other high-risk features which should have prompted investigation.Conclusions This study suggests that in routine NHS practice, a duplicate FIT sample strategy together with clinical evaluation for evidence of anaemia and weight loss is superior to a single FIT sample alone and would allow sym
Kelly ME, 2022, Contemporary management of locally advanced and recurrent rectal cancer: views from the PelvEx collaborative, Cancers, Vol: 14, ISSN: 2072-6694
Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments
Sun Myint A, Rao C, Dhadda AS, et al., 2022, Improved organ preservation with dose escalation using contact X-ray brachytherapy for good responders following external beam chemoradiotherapy: Long-term outcomes from a single institution., Publisher: American Society of Clinical Oncology (ASCO), Pages: 131-131, ISSN: 0732-183X
<jats:p> 131 </jats:p><jats:p> Background: We previously reported the benefit of Contact X-ray Brachytherapy boost (CXB) in achieving a higher clinical complete response (cCR) following partial response to external beam chemoradiotherapy (EBCRT). We now update our report on the organ preservation rate and long-term durability of the cCR in this cohort. Methods: Outcome data for rectal cancer patients referred to our institution from 2003 to 2012 were retrieved from an institutional database after an audit approval. These patients were referred after initial local multidisciplinary team discussion. All patients had EBCRT 45Gy/25/5 weeks with capecitabine 825mg/m2 (Mon-Fri). Those who respond well but has a small residual tumour were offered CXB boost of 90Gy in 3 fractions over 4-6 weeks as they were not suitable or unwilling to undergo completion surgery. Following treatment, patients had close 3 monthly follow-ups with DRE, endoscopy, and MRI in the first 2 years, then 6 monthly up to 5 years. Results: Of 345 consecutive patients with rectal cancer referred to us, 83 patients who responded well to EBCRT but with small suspicious residual disease (≤3 cm) were offered CXB boost. Median age was 72 years (range 36–87) and 58 (69.9%) were males. Initial MRI tumor stages were cT2 (n = 28), cT3 (n = 55) and 54.2% were node positive. The median follow up of surviving patients was 6.4 years (range 2-11 years). cCR was achieved after CXB boost in 53/83 (64%). After achieving cCR, 8/53 (15%) developed local regrowth. However, all patients successfully underwent curative surgery with R(0) resection rate of 24/30 (80%) and only 21/83 (25%) had stoma. Organ preservation was achieved in 62/83 (75%). 12/53 (14%) patients developed metastatic disease. At the end of the study period, 64/83(77%) were cancer free. Conclusions: Our long-term data suggests dose escalation with CXB boost following EBCRT can achieved high organ preservation rate with excellent l
Mansuri A, Tan KL, Kaul S, et al., 2022, Is management of rectal cancer using watch-and-wait approach feasible, safe, and effective in a publicly funded general hospital?, Publisher: Elsevier BV, Pages: e102-e103, ISSN: 0748-7983
Kaul S, Rao C, Mane R, et al., 2021, Is the Management of Rectal Cancer Using a Watch and Wait Approach Feasible, Safe and Effective in a Publicly Funded General Hospital?, CLINICAL ONCOLOGY, Vol: 34, Pages: E25-E34, ISSN: 0936-6555
- Author Web Link
- Citations: 1
Rao C, 2021, Appeal Panel Decision: Avelumab for maintenance treatment of locally advanced or metastatic urothelial cancer after platinum-based chemotherapy [TA788], Appeal Panel Decision: Avelumab for maintenance treatment of locally advanced or metastatic urothelial cancer after platinum-based chemotherapy, London, Publisher: National Institute of Health and Care Excellence, TA788
Rao C, 2021, Appeal Panel Decision: Tafamidis for treating transthyretin amyloidosis with cardiomyopathy [TA696], Appeal Panel Decision: Tafamidis for treating transthyretin amyloidosis with cardiomyopathy, London, Publisher: National Institute of Health and Care Excellence, TA696
Deputy M, Rao C, Worley G, et al., 2021, Effect of the SARS-CoV-2 pandemic on mortality related to high-risk emergency and major elective surgery, BRITISH JOURNAL OF SURGERY, Vol: 108, Pages: 754-759, ISSN: 0007-1323
- Author Web Link
- Citations: 6
Gash K, Vaughan-Shaw PG, Brown J, et al., 2021, Factors impacting time to ileostomy closure after anterior resection: the UK closure of ileostomy timing cohort study (CLOSE-IT), Colorectal Disease, Pages: 1-11, ISSN: 1462-8910
AimDelay to closure of ileostomy following anterior resection for rectal cancer may impair postoperative bowel function and quality of life. We analysed time to ileostomy closure across the UK and investigated factors delaying closure.MethodsFor the retrospective cohort we assessed time to closure and incidence of non‐closure for patients who underwent anterior resection with defunctioning ileostomy during 2015. Multivariate linear/Cox regression analyses were performed. For the prospective cohort we captured patients undergoing ileostomy closure during a 3‐month period in 2018 to validate retrospective findings.ResultsThe retrospective cohort involved 788 patients of whom 669 (84.9%) had bowel continuity restored, median time to closure 259 days. Recognized factors associated with delay and risk of non‐closure included anastomotic leak (hazard ratio [HR] 3.65, 2.61–5.08), chemotherapy (HR 2.62, 2.17–3.15) and cancer progression (HR 2.05, 1.62–2.58). Crucially, specific aspects of the surgical pathway were associated with time to closure; for example, waiting list entry prior to outpatient clinic review/imaging was associated with an estimated 133‐day shorter interval to closure (P < 0.001). In the prospective cohort 288 patients underwent closure, at a median of 271 days. Chemotherapy use and cancer progression were associated with delay to closure while listing for surgery prior to clinic and imaging was associated with an estimated shorter interval to closure of 168 days (P = 0.008).ConclusionsDelays to closure of ileostomy are common in the UK. Listing patients for surgery only after follow‐up outpatient appointment, imaging or chemotherapy delays closure. Findings will inform consensus guidelines towards an optimum treatment pathway to reduce delay and improve post‐closure quality of life.
Sun Myint A, Dhadda A, Rao C, et al., 2020, Will GRECCAR 2 be a game changer for the management of rectal cancer?, COLORECTAL DISEASE, Vol: 22, Pages: 2330-2330, ISSN: 1462-8910
- Author Web Link
- Citations: 1
Rao C, 2020, Appeal Panel Decision: Erenumab for preventing migraine [TA682], Appeal Panel Decision: Erenumab for preventing migraine, London, Publisher: National Institute of Health and Care Excellence, TA682
O'Donohoe N, Chandak P, Likos-Corbett M, et al., 2019, Follow up colonoscopy may be omissible in uncomplicated left-ided acute diverticulitis diagnosed with CT- a retrospective cohort study, Scientific Reports, Vol: 9, Pages: 1-4, ISSN: 2045-2322
International guidelines recommend colonoscopy following hospitalisation for acute diverticulitis. There is a paucity of evidence supporting the efficacy of colonoscopy in this context, particularly for patients with CT-diagnosed uncomplicated left-sided diverticulitis. This study aims to investigate the frequency that colorectal cancer (CRC) and advanced adenomas (AA) are identified during follow-up colonoscopy after hospitalisation with CT-proven left-sided diverticulitis for the first time in a UK population. In this single-centre retrospective-cohort study all patients presenting with CT-diagnosed uncomplicated left-sided diverticulitis between 2014 and 2017 were identified. The incidence of histologically confirmed CRC and AA identified at follow-up colonoscopy 4–6 weeks following discharge was assessed. 204 patients with CT proven uncomplicated left-sided diverticulitis underwent follow-up colonoscopy. 72% were female and the median age was 63 years. There were no major complications. 22% of patients were found to have incidental hyperplastic polyps or adenomas with low-grade dysplasia. No CRC or AA were found. Routine colonoscopy following acute diverticulitis in this cohort did not identify a single CRC or AA and could arguably have been omitted. This would significantly reduce cost and pressure on endoscopy departments, in addition to the pain and discomfort that is commonly associated with colonoscopy.
Myint AS, Dhadda A, Rao C, et al., 2019, Re: Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery, COLORECTAL DISEASE, Vol: 21, Pages: 119-120, ISSN: 1462-8910
Rao C, Stewartz A, Martin AP, et al., 2018, Contact X-ray Brachytherapy as an Adjunct to a Watch and Wait Approach is an Affordable Alternative to Standard Surgical Management of Rectal Cancer for Patients with a Partial Clinical Response to Chemoradiotherapy, CLINICAL ONCOLOGY, Vol: 30, Pages: 625-633, ISSN: 0936-6555
- Author Web Link
- Citations: 4
Abou-Saleh H, Zouein FA, El-Yazbi A, et al., 2018, The march of pluripotent stem cells in cardiovascular regenerative medicine, Stem Cell Research and Therapy, Vol: 9, ISSN: 1757-6512
Cardiovascular disease (CVD) continues to be the leading cause of global morbidity and mortality. Heart failure remains a major contributor to this mortality. Despite major therapeutic advances over the past decades, a better understanding of molecular and cellular mechanisms of CVD as well as improved therapeutic strategies for the management or treatment of heart failure are increasingly needed. Loss of myocardium is a major driver of heart failure. An attractive approach that appears to provide promising results in reducing cardiac degeneration is stem cell therapy (SCT). In this review, we describe different types of stem cells, including embryonic and adult stem cells, and we provide a detailed discussion of the properties of induced pluripotent stem cells (iPSCs). We also present and critically discuss the key methods used for converting somatic cells to pluripotent cells and iPSCs to cardiomyocytes (CMs), along with their advantages and limitations. Integrating and non-integrating reprogramming methods as well as characterization of iPSCs and iPSC-derived CMs are discussed. Furthermore, we critically present various methods of differentiating iPSCs to CMs. The value of iPSC-CMs in regenerative medicine as well as myocardial disease modeling and cardiac regeneration are emphasized.
Sun Myint A, Smith FM, Gollins S, et al., 2018, In Reply to Habr-Gama et al., Int J Radiat Oncol Biol Phys, Vol: 101, Pages: 743-744
Rao C, Smith FM, Martin AP, et al., 2018, Contact x-ray brachytherapy for rectal cancer following chemoradiotherapy is cost-effective, 37th Meeting of the European-Society-for-Radiotherapy-and-Oncology (ESTRO), Publisher: ELSEVIER IRELAND LTD, Pages: E577-E578, ISSN: 0167-8140
Rao C, Smith FM, Martin AP, et al., 2018, A Cost-Effectiveness Analysis of Contact X-ray Brachytherapy for the Treatment of Patients with Rectal Cancer Following a Partial Response to Chemoradiotherapy, CLINICAL ONCOLOGY, Vol: 30, Pages: 166-177, ISSN: 0936-6555
- Author Web Link
- Citations: 5
Myint AS, Smith F, Wong H, et al., 2018, Salvage surgery for local regrowth following external beam radiotherapy followed by contact X-ray brachytherapy and 'watch & wait' for rectal cancer. Do we compromise the chance of cure?, Publisher: Elsevier BV, Pages: S28-S28, ISSN: 0748-7983
Rao C, Lean Smith FM, Martin AP, et al., 2018, A cost-effectiveness analysis of contact X-ray brachytherapy for treatment of patients with a partial response to chemoradiotherapy for locally advanced rectal cancer, Publisher: Elsevier BV, Pages: S14-S14, ISSN: 0748-7983
Association BM, Limited DK, Staff DKP, 2018, Anatomy Researcher and Advisor: What's Wrong With Me? The Easy Way to Identify Medical Problems, ISBN: 9780241287248
A series of head-to-toe visual diagnostic guides help you to identify suspected conditions or injuries and once you've narrowed it down, a cross-reference takes you to easy-to-follow descriptions of the condition at the back of the book.
Glasbey J, Sinclair P, Mohan H, et al., 2017, 40-4-40: educational and economic outcomes of a free, international surgical training event, Postgraduate Medical Journal, Vol: 93, Pages: 730-735, ISSN: 0032-5473
Purpose of study To demonstrate a model for delivery of an international surgical training event, and demonstrate its educational and economic outcomes.Study design The Association of Surgeons in Training (ASiT) ran a course series on 16 January 2016 across the UK and Ireland. A mandatory, self-reported, online questionnaire collected delegate feedback, using 5-point Likert Scales, and a NetPromoter feedback tool. Precourse and postcourse matched questionnaires were collected for ‘Foundation Skills in Surgery’ (FSS) courses. Paired economic analysis was performed. Statistical analysis was carried out using RStudio (V.3.1.1 Boston, Massachusetts, USA).Results Forty courses were held across the UK and Ireland (65.0% technical, 35.0% non-technical), with 184 faculty members. Of 570 delegates, 529 fully completed the feedback survey (92.8% response rate); 56.5% were male. The median age was 26 years (range: 18–67 years). The mean overall course NetPromoter Score was 8.7 out of 10. On logistic regression high NetPromoter Score was associated with completing a Foundation Skills in Surgery course (R=0.44, OR: 1.49, p=0.025) and having clear learning outcomes (R=0.72, OR: 2.04, p=0.029) but not associated with specialty, course style or teaching style. For Foundation Skills in Surgery courses, delegates reported increased commitment to a career in surgery (p<0.001), confidence with basic surgical skills (p<0.001) and confidence with assisting in theatre (p<0.001). A comparable cost saving of £231,462.37 was calculated across the 40 courses.Conclusion The ASiT ‘40-4-40’ event demonstrated the diversity and depth of surgical training, with 40 synchronous technical and non-technical courses, demonstrable educational benefit and a significant cost saving to surgical trainees.
Myint AS, Smith F, Wong H, et al., 2017, Salvage surgery for local regrowth following external beam radiotherapy followed by contact X-ray brachytherapy and ‘Watch & wait’ for rectal cancer. Do we compromise the chance of cure?, Publisher: Elsevier BV, Pages: 2226-2226, ISSN: 0748-7983
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