IntroductionMesothelioma remains a lethal cancer. To date, systemic therapy with pemetrexed and a platinum drug remains the only licensed standard of care. As the median survival for patients with mesothelioma is 12.1 months, surgery is an important consideration to improve survival and/or quality of life. Currently, only two surgical trials have been performed which found that neither extensive (extra-pleural pneumonectomy) or limited (partial pleurectomy) surgery improved survival (although there was some evidence of improved quality of life). Therefore, clinicians are now looking to evaluate pleurectomy decortication, the only radical treatment option left.Methods and analysisThe MARS 2 study is a UK multicentre open parallel group randomised controlled trial comparing the effectiveness and cost-effectiveness of surgery—(extended) pleurectomy decortication—versus no surgery for the treatment of pleural mesothelioma. The study will test the hypothesis that surgery and chemotherapy is superior to chemotherapy alone with respect to overall survival. Secondary outcomes include health-related quality of life, progression-free survival, measures of safety (adverse events) and resource use to 2 years. The QuinteT Recruitment Intervention is integrated into the trial to optimise recruitment.Ethics and disseminationResearch ethics approval was granted by London – Camberwell St. Giles Research Ethics Committee (reference 13/LO/1481) on 7 November 2013. We will submit the results for publication in a peer-reviewed journal.Trial registration numbersISRCTN—ISRCTN44351742 and ClinicalTrials.gov—NCT02040272.
This paper evaluates the feasibility and tolerance of sequential chemoradiotherapy in patients with squamous cell carcinoma of the head and neck and ascertains whether the use of induction chemotherapy compromises delivery of subsequent radiotherapy with or without concurrent chemotherapy. We also compared sequential chemoradiotherapy treatment adherence between the elderly and younger patients with squamous cell carcinoma of the head and neck. One hundred and ninety-four patients with head and neck squamous cell carcinoma who received induction chemotherapy with cisplatin and 5-fluorouracil were included in this study. Treatment-related death rate from induction chemotherapy was 1.5%. One hundred and ninety-one patients (98.5%) proceeded to radical radiotherapy, with 90.1% also receiving planned concomitant chemotherapy. One hundred and seventy-eight patients (93.2%) completed radiotherapy with no prolongation of the treatment duration. There were no statistical differences in sequential chemoradiotherapy treatment adherence and tolerance between the elderly and younger patients apart from the proportion who required hospitalisation during radiotherapy. Induction chemotherapy in head and neck squamous cell carcinoma does not compromise delivery of definitive radiotherapy with or without concurrent chemotherapy. Elderly patients with head and neck squamous cell carcinoma are able to tolerate aggressive treatments such as sequential chemoradiotherapy. Treatment 'deintensification' based solely on chronological age is not recommended.
results in subsequent investigations and to quantify this further we have reviewed our experiences. Methods Over a 2-year period to end 2010, 236 patients were identified as investigated by PET scan after an initial discussion of all lung cancer patients at multi-disciplinary meeting (MDT). Of these, 21 (11%) had high uptake FDG with potential evidence of extra thoracic disease not previously identified. Mean (range) age for this group was 69 (54e82) years with13 male and eight female. Results Of the 21 patients, 13 included high uptake in the bowel with two in each of breast, thyroid, and musculo-skeletal and one in stomach and parotid. 4 patients were then not investigated further; these included one where PET-FDG findings were ignored after further MDT discussion, one was too unwell to investigate and died shortly thereafter, and two who refused further investigation. Of the remainder, 12 had high uptake FDG in the bowel but all were found to be benign after subsequent investigation, and five confirmed malignant disease of which two had thyroid cancer, two-breast cancer, and one had a prior history of bowel cancer. Over this 2-year time period none of the initially PET negative cases subsequently developed radiological malignancy. Conclusion For extra thoracic disease, our experience with PET-FDG potentially reports sensitivity and a negative predictive power of 100% with a specificity of 95% and a positive predictive value of 29%. Although among our cases 11% had the suggestion of positive extra thoracic disease, the majority (71%) were then found to be benign with a concentration particularly at bowel. Further work will probably be needed to guide future investigation of potentially false positive metabolic or inflammatory findings at this site, but uptake at the other sites, potentially a concurrent primary malignancy or metastases, cannot be ignored. P198 IS THERE A ROLE FOR MRI CRANIAL IMAGING IN PATIENTS WITH NON-SMALL CELL LUNG CANCER BEING CONSIDERED FOR RADICAL TREATMENT?doi: 10.1136/thoraxjnl-2011-201054c.198 D Laws, K Adeniji, N Ranaweera. Royal Bournemouth Hospital, Dorset, UK Introduction Prior to undergoing radical treatment for Non-Small Cell Lung cancer (NSCLC) it is important to have accurate staging and exclude distal metastases to prevent patients undergoing futile inappropriate treatment. Guidelines 1 have recommended consideration of MRI or CT imaging of the brain, especially in stage III disease. However, routine use in non-symptomatic patients has not been studied, particularly in conjunction with PET-CT scanning. In addition it is recognised that MRI is more likely to detect more and smaller lesions than CT brain. Our local policy is to offer MRI cranial imaging in all patients being considered for radical treatment in conjunction with PET scanning. We present a retrospective analysis of all these cases including follow-up and survival. Method All patients discussed at lung cancer multi-disciplinary meeting (MDT) who were considered suitable for radical treatment were identified and...
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