Epworth Collection:
http://hdl.handle.net/11434/8
2024-03-28T09:54:38ZThe CONFIRM trial protocol: the utility of prostate-specific membrane antigen positron emission tomography/computed tomography in active surveillance for prostate cancer.
http://hdl.handle.net/11434/2284
Title: The CONFIRM trial protocol: the utility of prostate-specific membrane antigen positron emission tomography/computed tomography in active surveillance for prostate cancer.
Epworth Authors: Bagguley, Dominic; McKenzie, Dean; Ong, Sean; Chengodu, Thilakavathi; Woon, Dixon; Sim, Kenneth; Sheldon, James; Lawrentschuk, Nathan
Abstract: Objectives: Primary objectives: To determine the additive value of prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) in the risk stratification of men with newly diagnosed prostate cancer (PCa) who would have otherwise been deemed suitable for active surveillance (AS). Specifically, we aim to determine if PSMA PET/CT can detect a cohort of men on AS that are in fact high risk and likely to experience unfavourable outcomes should they remain on their current treatment pathway.
Secondary objectives: to determine the additive value of PSMA PET/CT to repeat multiparametric magnetic resonance imaging (mpMRI) of the prostate and explore whether a confirmatory biopsy may be avoided in men with a negative PSMA PET/CT and a negative repeat mpMRI of the prostate (Prostate Imaging-Reporting and Data System score of <3). Furthermore, to develop a nomogram combining clinical, imaging and biomarker data to predict the likelihood of failure on AS in men with high-risk features. Also, a blood sample will be taken to perform a Prostate Health Index test at the time of confirmatory biopsy. Furthermore, a portion of this blood will be stored at a biobank for up to 5 years if a follow-up study on molecular biomarkers and genetic assays in this cohort of men is indicated, based on the results from the CONFIRM trial.
Patients and methods: The CONFIRM trial is a prospective, multicentre, pre-test/post-test, cohort study across Victoria, Australia, involving men with newly diagnosed low-risk PCa with high-risk features, considered suitable for AS and undergoing confirmatory biopsy. The trial's goal is to provide high-quality evidence to establish whether PSMA PET/CT has a role in risk-stratifying men deemed suitable for AS despite having high-risk feature(s).
Results: The CONFIRM trial will measure the proportion of men deemed unsuitable for ongoing AS based on pathological upgrading and multidisciplinary team recommendation due to PSMA PET/CT scan and PSMA-targeted confirmatory biopsy. Additionally, the positive and negative predictive values, sensitivity, and specificity of PSMA PET/CT will be calculated in isolation and combined with repeat mpMRI of the prostate.
Conclusions: This trial will provide robust prospective data to determine if PSMA-PET/CT and standard of care (prostate biopsy ± repeat mpMRI) can improve diagnostic certainty in men undergoing confirmatory biopsy for low-grade PCa with high-risk features.2023-01-01T00:00:00ZDeath from mantle cell lymphoma limits sequential therapy, particularly after first relapse: patterns of care and outcomes in a series from Australia and the United Kingdom.
http://hdl.handle.net/11434/2278
Title: Death from mantle cell lymphoma limits sequential therapy, particularly after first relapse: patterns of care and outcomes in a series from Australia and the United Kingdom.
Epworth Authors: Yannakou, Costas
Abstract: Mantle cell lymphoma (MCL) is a B-cell non-Hodgkin lymphoma characterised by a heterogeneous clinical course. Patients can often receive sequential treatments, yet these typically yield diminishing periods of disease control, raising questions about optimal therapy sequencing. Novel agents, such as chimeric antigen receptor T-cell therapies and bispecific antibodies, show promise in relapsed MCL, but are often reserved for later treatment lines, which may underserve patients with aggressive disease phenotypes who die early in the treatment journey. To assess the problem of patient attrition from lymphoma-related death limiting sequential treatment, we performed a multicentre retrospective cohort analysis of 389 patients treated at Australian and UK centres over a 10-year period. Deaths from MCL increased after each treatment line, with 7%, 23% and 26% of patients dying from uncontrolled MCL after first, second and third lines respectively. Patients with older age at diagnosis and early relapse after induction therapy were at particular risk of death after second-line treatment. This limitation of sequential treatment by lymphoma-related death provides support for the trial of novel therapies in earlier treatment lines, particularly in high-risk patient populations.2023-10-01T00:00:00ZCase of the month from University of Melbourne, Australia: refractory chyle leak after retroperitoneal lymph node dissection with updated algorithm.
http://hdl.handle.net/11434/2274
Title: Case of the month from University of Melbourne, Australia: refractory chyle leak after retroperitoneal lymph node dissection with updated algorithm.
Epworth Authors: Lawrentschuk, Nathan
Abstract: Retroperitoneal lymph node dissection (RPLND) is an important part of multimodal therapy for node-positive germ cell malignancy [1-4]. However, due to wide heterogeneity in patient status, disease biology and tumour locations, RPLND can be challenging and risky [1]. One such risk is iatrogenic chylous ascites (CA; 8% of cases) [1]. CA is defined as accumulation of chyle, a lipid-rich lymph fluid in the peritoneal cavity [5]. Morbidity from intra-abdominal chyle extravasation includes delayed wound healing, malnutrition, electrolyte disturbances, and immunosuppression [2, 6]. This morbidity impairs postoperative recovery, delays adjuvant oncological therapy, and detrimentally affects quality of life [2, 4]. Limited reliable data exist to describe the management of this complex condition [1]. We outline a difficult case and then review the literature for treatment strategies and propose a contemporary management algorithm for refractory post-RPLND CA.2023-10-01T00:00:00ZFunctional outcomes after lateral pelvic lymph node dissection for rectal cancer: a systematic review and meta-analysis.
http://hdl.handle.net/11434/2266
Title: Functional outcomes after lateral pelvic lymph node dissection for rectal cancer: a systematic review and meta-analysis.
Epworth Authors: Cribb, Benjamin; Kong, Jospeh; McCormick, Jacob; Warrier, Satish; Heriot, Alexander
Abstract: Purpose: Lateral pelvic lymph node dissection (LPLND) may improve oncological outcomes for select patients with rectal cancer, though functional outcomes may be adversely impacted. The aim of this study is to assess the functional outcomes associated with LPLND for rectal cancer and compare these outcomes with standard surgical resection.
Methods: A systematic search was undertaken to identify relevant studies reporting on urinary dysfunction (UD), sexual dysfunction (SD), and defecatory dysfunction (DD) for patients who underwent LPLND for rectal cancer. Studies comparing functional outcomes in patients who underwent surgery with and without LPLND were assessed. In addition, a comparison of functional outcomes in patients who underwent LPLND before and after the year 2000 was performed.
Results: Twenty-one studies of predominantly non-randomised observational data were included. Ten were comparative studies. Male SD was worse in patients who underwent LPLND compared with those who did not (RR 1.68 (95% CI 1.41-1.99, P < 0.001)). No difference was observed for the rate of UD between treatment groups. The rates of UD and male SD in patients who underwent LPLND after the year 2000 were significantly lower than those who underwent LPLND before the year 2000 ((UD) RR = 4.5, p value = 0.0034; male SD RR = 28.7, p value < 0.001).
Conclusion: Lateral pelvic lymph node dissection is associated with worse male sexual dysfunction compared to standard surgical resection. However, the rates of urine dysfunction and male sexual dysfunction are better in contemporary cohorts which may reflect improved surgical technique and autonomic nerve preservation.2022-03-01T00:00:00Z