Standard or high dose chemoradiotherapy, with or without the protease inhibitor nelfinavir, in patients with locally advanced pancreatic cancer: The phase 1/randomised phase 2 SCALOP-2 trial.

Background: The multi-centre two-stage SCALOP-2 trial (ISRCTN50083238) assessed whether dose escalation of consolidative chemoradiotherapy (CRT) or concurrent sensitization using the protease inhibitor nelfinavir improve outcomes in locally advanced pancreatic cancer (LAPC) following four cycles of gemcitabine/nab-paclitaxel.

Methods: In stage 1, the maximum tolerated dose (MTD) of nelfinavir concurrent with standard-dose CRT (50.4 Gy in 28 fractions) was identified from a cohort of 27 patients.

SPARC, a phase-I trial of pre-operative, margin intensified, stereotactic body radiation therapy for pancreatic cancer.

Background And Purpose: Following resection of pancreatic cancer, risk of positive margins and local recurrence remain high, especially for borderline-resectable pancreatic cancer (BRPC). We aimed to establish the maximum tolerated dose of a margin-intensified five-fraction stereotactic body radiotherapy (SBRT) regimen designed to treat the region at risk.

Materials And Methods: We conducted a prospective multicentre phase-1 rolling-six dose-escalation study.

Pre- and postoperative prognostic factors for resectable esophageal adenocarcinoma.

Background: Prognostication for esophageal cancer has traditionally relied on postoperative tissue specimens. This study aimed to use a histologically homogenous cohort to investigate the relationship between clinical, pathological or radiological variables and overall survival in patients undergoing esophagectomy for adenocarcinoma.

Methods: A single-centre study of patients who underwent esophagectomy for adenocarcinoma over 10 years in a tertiary centre was performed.

Superior outcomes of nodal metastases compared to visceral sites in oligometastatic colorectal cancer treated with stereotactic ablative radiotherapy.

Background: Stereotactic ablative radiotherapy (SBRT) is a radical option for oligometastatic colorectal cancer (CRC) patients, but most data relate to visceral metastases.

Methods: A prospective, multi-centre database of CRC patients treated with SBRT was interrogated. Inclusion criteria were ECOG PS 0-2, ≤3 sites of disease, a disease free interval of >6 months unless synchronous liver metastases.

Considerations for the treatment of pancreatic cancer during the COVID-19 pandemic: the UK consensus position.

The coronavirus disease 2019 (COVID-19) pandemic epicentre has moved to the USA and Europe, where it is placing unprecedented demands on healthcare resources and staff availability. These service constraints, coupled with concerns relating to an increased incidence and severity of COVID-19 among patients with cancer, should lead to re-consideration of the risk-benefit balance for standard treatment pathways. This is of particular importance to pancreatic cancer, given that standard diagnostic modalities such as endoscopy may be restricted, and that disease biology precludes significant delays in treatment.

Similarly Different: Exploring How Male Nurses in CAMHS Experience Difference in Their Gender Performance.

This article explores concepts of gender difference for nurses working in Child and Adolescent Mental Health Nursing. Inspired by the author's own experiences he emerged ethnographic research data to explore how male nurses replicate a problematic performance sited between representing 'similarity' and yet 'difference' to their female colleagues. In this article, the author discusses how typical dichotomies of sexuality, gender and transformation are troubling for child and adolescent nursing discourses because they privilege particular representations of maleness, narratives of sexual multiplicity and disguise how the equity gaze is a persistent reminder in the minds of many male nurses that theirs is sometimes a prescribed performance of metaphorical sexless, gender nakedness and quietened voice which is disrobed and left like their sex in the locker room.

Systematic review and meta-analysis of small bowel dose-volume and acute toxicity in conventionally-fractionated rectal cancer radiotherapy.

Introduction: The limited radiation tolerance of the small-bowel causes toxicity for patients receiving conventionally-fractionated radiotherapy for rectal cancer. Safe radiotherapy dose-escalation will require a better understanding of such toxicity. We conducted a systematic review and meta-analysis using published datasets of small bowel dose-volume and outcomes to analyse the relationship with acute toxicity.

Stomach Dose-Volume Predicts Acute Gastrointestinal Toxicity in Chemoradiotherapy for Locally Advanced Pancreatic Cancer.

Aims: Gastrointestinal toxicity impedes dose escalation in chemoradiotherapy for hepatobiliary malignancies. Toxicity risk depends on clinical and radiotherapy metrics. We aimed to identify predictive factors using data from two prospective phase II clinical trials of locally advanced pancreatic cancer (LAPC).

Modelling duodenum radiotherapy toxicity using cohort dose-volume-histogram data.

Background And Purpose: Gastro-intestinal toxicity is dose-limiting in abdominal radiotherapy and correlated with duodenum dose-volume parameters. We aimed to derive updated NTCP model parameters using published data and prospective radiotherapy quality-assured cohort data.

Material And Methods: A systematic search identified publications providing duodenum dose-volume histogram (DVH) statistics for clinical studies of conventionally-fractionated radiotherapy.

Conformity analysis to demonstrate reproducibility of target volumes for Margin-Intense Stereotactic Radiotherapy for borderline-resectable pancreatic cancer.

Background And Purpose: Margin-directed neoadjuvant radiotherapy for borderline-resectable pancreatic cancer (BRPC) aims to facilitate clear surgical margins. A systematic method was developed for definition of a boost target volume prior to a formal phase-I study.

Material And Methods: Reference structures were defined by two oncologists and one radiologist, target structures were submitted by eight oncologist investigators and compared using conformity indices.

A phase-I trial of pre-operative, margin intensive, stereotactic body radiation therapy for pancreatic cancer: the 'SPARC' trial protocol.

Background: Standard therapy for borderline-resectable pancreatic cancer in the UK is surgery with adjuvant chemotherapy, but rates of resection with clear margins are unsatisfactory and overall survival remains poor. Meta-analysis of single-arm studies shows the potential of neo-adjuvant chemo-radiotherapy but the relative radio-resistance of pancreatic cancer means the efficacy of conventional dose schedules is limited. Stereotactic radiotherapy achieves sufficient accuracy and precision to enable pre-operative margin-intensive dose escalation with the goal of increasing rates of clear resection margins and local disease control.

Molecular Taxonomy and Tumourigenesis of Colorectal Cancer.

Over the last 5 years there has been a surge in interest in the molecular classification of colorectal cancer. The effect of molecular subtyping on current treatment decisions is limited to avoidance of adjuvant 5-fluorouracil chemotherapy in stage II microsatellite unstable-high disease and avoidance of epidermal growth factor receptor-targeted antibodies in extended RAS mutant tumours. The emergence of specific novel combination therapy for the BRAF-mutant cohort and of the microsatellite unstable-high cohort as a responsive group to immune checkpoint inhibition shows the growing importance of a clinically relevant molecular taxonomy.

Cyberchondria: emerging themes for children's nurses in the internet age.

In many countries, anxious adults and young people are increasingly searching the web for information about their health or ill health and that of their family. This activity often increases their anxiety and confusion. Cyberchondria refers to the resulting match with real or imagined symptoms, and may lead to unnecessary medical consultation.

Once upon a time there was an angry lion: using stories to aid therapeutic care with children.

Storytelling is a useful relationship-building tool to use with children, as demonstrated by the work of 'Johnny' and the author, his nurse. Five stages of narration - purpose, backstory, pivotal events, evaluation of effects and summary - encourage children to recognise and accept feelings such as anger, grief, shame and guilt in a safe way and make small steps towards change. It is feasible to start engaging children with simple everyday stories, and then go on to develop the tale so that the nurse and the child make additions as required.

I spy with my little eye something beginning with O: looking at what the myth of 'doing the observations' means in mental health nursing culture.

Those who are familiar with psychiatric inpatient settings will be aware of the expressions 'doing the obs', 'being on checks' and 'special observations'. That is because the task of observing patients is seen as being pivotal to the mental health nursing role. This paper describes an ethnographic research project that offers a rethinking of psychiatric observation.

Care, compassion and courage: the museum of mental health nursing - an ethnographic archaeology.

Like a museum with carefully positioned exhibits mental health nursing would look different if the display of fashionable dead things in its cultural lineage were viewed through a different lens. This paper has the aim of using transcribed interview data from mental health nurses to explore how their perception of nursing culture represents a particular historical identity (pseudo names given to ensure confidentiality). The paper discusses five themes about the formation of collective identity and concludes that mental health nurses are theoretically well positioned to develop and rethink social recovery models, ideas about fragmented selves and multiple histories that the postmodern age now curates.

Is the doctor-nurse game being played?

Forty years ago, Leonard Stein outlined his theory of the doctor-nurse game. In 1990, he revisited his theory and found that the game he had described no longer existed, mainly because nurses were no longer willing to play. Since the publication of the original theory, attempts have been made to professionalise nursing and to negotiate a sense of identity within the somewhat patriarchal doctor-nurse relationship.

The awkward feeling campaign: confronting poor hand hygiene to improve handwashing.

This article describes how a group of third year child branch student nurses at the University of Wolverhampton examined the way they perceived handwashing. During a three day workshop aimed at focusing on healthcare improvement, the students moved from regarding handwashing as a simple act of hygiene, to seeing it as a social behaviour, which is part of a larger organisational system. Through analysing cultural messages, themes and the idea of organisational power, the students developed a new way of thinking about what health professionals do with their hands.