Biological surrogate end-points in cancer trials: potential uses, benefits and pitfalls.

New technologies have led to the development of an increasing number of targeted therapies and interest in combining these with conventional therapy to provide individualised patient treatments. New drug or treatment regimens must, however, undergo rigorous testing under strictly controlled conditions before they can be adopted as standard. This can be expensive, time-consuming and inefficient.

Effective treatment of anal cancer in the elderly with low-dose chemoradiotherapy.

Chemoradiotherapy (CRT) is accepted as the standard initial treatment for squamous cell anal cancer. However, frail elderly patients cannot always tolerate full-dose CRT. This paper reports the results of a modified regimen for this group of patients.

The effect of gantry angle on megavoltage photon beam attenuation by a carbon fiber couch insert.

The use of rigid carbon fiber couch inserts in radiotherapy treatment couches is a well-established method of reducing patient set-up errors associated with couch sag. Several published studies have described such inserts as radiotranslucent with negligible attenuation of the radiation field. Most of these studies were conducted with the radiation field normally incident on the couch and there appears to be no evidence in the literature of the effect of the gantry angle on the extent of beam attenuation by the carbon fiber insert alone during external beam radiotherapy.

Oncological aspects of breast reconstruction.

Breast reconstruction has become increasingly popular over the past 20 years. There is concern that it may mask locoregional recurrence or that immediate reconstruction may compromise adjuvant treatments. We review available evidence regarding its oncological safety.

The effect of immediate breast reconstruction on adjuvant chemotherapy.

Immediate breast reconstruction is being increasingly offered to patients requiring mastectomy for breast cancer. An audit was carried out to determine whether it affected time to initiation of chemotherapy, delays during chemotherapy, percentage intended dose and need for support with antibiotics or granulocyte-colony stimulating factor. A total of 44 patients undergoing a variety of reconstructive procedures followed by chemotherapy were identified and patient records were reviewed.

The role of endoscopic ultrasound (EUS) in planning radiotherapy target volumes for oesophageal cancer.

Computed tomography (CT) scanning is the main imaging modality utilised for planning radical oesophageal radiotherapy. Endoscopic ultrasound allows accurate localisation and local staging of oesophageal tumours. A method of incorporating this information into the CT planning process is described.

Treatment of T4 tumours: the role of radiotherapy.

Patients with T4 rectal cancer may be increasingly defined by the use of pelvic MRI. This approach has the potential to classify patients who have tumour extending beyond the mesorectal fascia and those very close to but not beyond the mesorectal fascia (for example 1-2 mm). Prospective studies of MRI are required to validate such an approach.

Breast cancer teams: the impact of constitution, new cancer workload, and methods of operation on their effectiveness.

National guidance and clinical guidelines recommended multidisciplinary teams (MDTs) for cancer services in order to bring specialists in relevant disciplines together, ensure clinical decisions are fully informed, and to coordinate care effectively. However, the effectiveness of cancer teams was not previously evaluated systematically. A random sample of 72 breast cancer teams in England was studied (548 members in six core disciplines), stratified by region and caseload.

Concurrent chemoradiotherapy for squamous cell carcinoma of the anus using a shrinking field radiotherapy technique without a boost.

Chemoradiotherapy (CRT) is now widely accepted as the primary treatment modality for squamous cell cancer of the anus. While randomised trials have clearly shown CRT to be more effective than radiotherapy alone, there remains uncertainty over the optimal integration of chemotherapy and radiation. We describe a series of 50 patients treated by a site specialist gastrointestinal nonsurgical oncologist with CRT at a single UK centre.

Increased incidence of renal parenchymal carcinoma in the Northern and Yorkshire region of England, 1978-1997.

Kidney cancer remains relatively rare, but incidence and mortality rates are reported to be rising steadily across the world. To determine if such increases were occurring in the UK, we examined the rates of incidence and mortality in different histological subtypes of kidney cancer in the Northern and Yorkshire region of England. Details of all 8741 cases diagnosed between 1978 and 1997 were extracted from the population-based Northern and Yorkshire Cancer Registry.

Pre- and post-implant dosimetry: an inter-comparison between UK prostate brachytherapy centres.

The consistency and reliability of five prostate brachytherapy centres performing pre- and post-implant dosimetry were evaluated. Ultrasound based pre-planning protocols and techniques were similar although they may be slightly affected by the chosen seed activity. Computerised tomography-based post-implant dosimetry varied because of differing estimations of the prostate volume.

Impact of prostate volume evaluation by different observers on CT-based post-implant dosimetry.

Purpose: An analysis of computed tomography (CT)-based dosimetry was performed to evaluate the variability of different observers' judgements in marking the prostate gland on CT films, and its effect on the parameters that characterise the prostate implantation quality. Accuracy of data entry by the first author in the process of dosimetry procedure has also been evaluated.

Materials And Methods: Four observers were asked to evaluate the prostate volume on CT films for six different patients.

Lung cancer referral patterns in the former Yorkshire region of the UK.

The purpose of this study was to find out what proportion of patients are referred as lung cancer guidelines assume, whether different referral pathways result in different management and what proportion of patients are seen within recommended time intervals between referral and treatment. A randomly selected sample of 400 lung cancer cases registered with the former Yorkshire Cancer Registry database in 1993 was selected for casenote analysis. Mode of presentation, speciality of initial referral, treatment by specialist, time intervals for key points in the referral pathways were analyzed.

Evaluation of in vivo dose measurements for patients undergoing electron boost treatments.

This study evaluated p-type silicon diodes for use in in vivo dosimetry in clinical electron beams. A calibrated p-type silicon diode detector was used to measure the dose received by the patient in the centre of the field. Readings were corrected for energy, temperature and stand-off of the electron applicator from the patient surface.

Pretreatment prognostic factors for children with hepatoblastoma-- results from the International Society of Paediatric Oncology (SIOP) study SIOPEL 1.

The aim of this study was to investigate the prognostic significance of pretreatment patient and tumour characteristics for overall (OS) and event-free (EFS) survival in 154 children affected by hepatoblastoma (HB) in the first prospective liver tumour study run by the International Society of Paediatric Oncology. The pretreatment characteristics studied were age, alpha-fetoprotein, platelet count, histology; from radiology: intrahepatic tumour extension (PRETEXT), lung metastases, enlarged hilar lymph nodes, vena cava or extrahepatic vena porta tumour extension and tumour focality. Five-year OS was 75% (95% confidence interval (CI) 68-82%) and EFS 66% (95% CI 59-74%).

Exposures at work to ionising radiation due to the use of naturally occurring radioactive materials in industrial processes.

In its role as specialist radiation protection adviser to industries in the United Kingdom, the National Radiological Protection Board has had extensive involvement with industrial users of raw materials with low activity concentrations of naturally occurring radionuclides. The magnitude of the exposure to ionising radiation in these establishments has been investigated. This paper reviews the pathways of exposure and gives estimates of worker dose in the light of revised dose coefficients.