O-P09  PACT-UK: PAncreatic Cancer reporting Template - a national pan-specialty collaborative consensus project to develop a standardised radiological reporting proforma for pancreatic cancer

Abstract Background In line with the NCRI framework, appropriate staging and classification of pancreatic cancer, with particular relevance to vascular involvement, is essential to ensure patients are offered all potential treatment options both at diagnosis and post-neoadjuvant therapy. This pan-specialty national collaborative consensus project, supported by PCUK,AUGIS,PSGBI,RCSEng,NCRI,RCR and BSGAR, aimed to develop a succinct radiological reporting template to allow a more consistent and standardized means of detailing all clinically-relevant aspects of pancreatic cancer, which, in addition to the aforementioned benefits, will allow more efficient MDT review, improved ability to audit national practice, and optimized clinical trial design. Methods In stage one, a core group of stakeholders from surgery, radiology and oncology was formed to establish current practice and determine the optimal data-set for a template. This included a blinded radiological validation study of established templates in use (Beth-Israel, PROTRACT and Glasgow proformas), and national survey of consultant surgeons on the PSGBI mailing list. Thereafter, consensus meetings led to the development of a provisional template. In stage two, representatives from surgery, radiology and oncology at all UK HPB units attended a consensus meeting to discuss and finalise the first official template draft, with subsequent trial utilisation in clinical practice. Results In stage one, the radiological assessment highlighted a significant variation in reporting of vascular involvement, with 100% concordance in only 30% of cases. Within the surgeon survey, amongst various tumour-related factors, most notably a significant majority preferred a specific range of degrees of vascular involvement, and specific information regarding tributary involvement and associated narrowing/occlusion/thrombosis. Both processes, and subsequent national consensus meetings in stage two, helped establish the ideal factors required in a template with respect to usability, clinical relevance, applicability and IT-factors, resulting in the generation of the PACT-UK proforma that will be presented at the congress. Conclusions This pan-specialty collaborative consensus project has successfully produced the first nationally-developed pancreatic cancer radiological reporting template. In stage three, the PACT-UK group aim to continue trialing the proforma nationally, with upcoming workshops facilitated by RCR/BSGAR to ensure buy-in from radiologists at all HPB units. Further representation from all units is welcomed, with the philosophy that template data-points can and will continue to evolve on the basis of ongoing feedback from consensus meetings, and following the development of more aggressive surgical techniques and novel neoadjuvant therapies. Plans for the use of PACT-UK within national audit and clinical trials is under-way.

Download Full-text

Improving Outcomes with Surgical Resection and Other Ablative Therapies in HCC

International Journal of Hepatology ◽

10.4061/2011/686074 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 6

Author(s):

Rahul Deshpande ◽

Derek O'Reilly ◽

David Sherlock

Keyword(s):

Treatment Plan ◽

Treatment Options ◽

Surgical Techniques ◽

Related Factors ◽

Ablative Therapies ◽

Recent Emergence ◽

Staging Systems ◽

Small Hccs ◽

Ablative Techniques ◽

Surgical Treatments

With rising incidence and emergence of effective treatment options, the management of hepatocellular carcinoma (HCC) is a complex multidisciplinary process. There is still little consensus and uniformity about clinicopathological staging systems. Resection and liver transplantation have been the cornerstone of curative surgical treatments with recent emergence of ablative techniques. Improvements in diagnostics, surgical techniques, and postoperative care have lead to dramatically improved results over the years. The most appropriate treatment plan has to be individualised and depends on a variety of patient and tumour-related factors. Very small HCCs discovered on surveillance have the best outcomes. Patients with advanced cirrhosis and tumours within Milan criteria should be offered transplantation. Resection is best for small solitary tumours with preserved liver function. Ablative techniques are suitable for low volume tumours in patients unfit for either resection or transplantation. The role of downstaging and bridging therapy is not clearly established.

Download Full-text

Adjuvant Therapy in Operable Pancreatic Cancer

Swiss Surgery ◽

10.1024/1023-9332.8.2.74 ◽

2002 ◽

Vol 8 (2) ◽

pp. 74-80

Author(s):

Wente ◽

Büchler ◽

Friess ◽

Büchler

Keyword(s):

Pancreatic Cancer ◽

Adjuvant Therapy ◽

Controlled Trial ◽

Treatment Options ◽

Survival Rates ◽

Surgical Techniques ◽

Additional Treatment ◽

Adjuvant Chemoradiotherapy ◽

European Organization ◽

Adenocarcinoma Of The Pancreas

Adenocarcinoma of the pancreas remains a highly lethal disease with one of the worst mean survival rates of all solid malignancies. Even with improvements in surgical techniques in the last decades, the five-year survival rate of patients following resection is still under 20 percent. Various additional treatment concepts have been introduced based on encouraging results for adjuvant chemoradiotherapy obtained in a small randomized-controlled trial more than 15 years ago. The purpose of this article is to review the results of several trials investigating adjuvant therapy for pancreatic cancer. We will discuss recent studies of EORTC (European Organization for Research and Treatment of Cancer), ESPAC (European Study Group for Pancreatic Cancer) and others and will also focus on future alternative treatment options for pancreatic cancer.

Download Full-text

A Theoretical Mathematical Model to Estimate Blood Volume in Clinical Practice

Biological Research For Nursing ◽

10.1177/1099800414555410 ◽

2014 ◽

Vol 17 (5) ◽

pp. 478-486 ◽

Cited By ~ 3

Author(s):

Matthew D’Angelo ◽

R. Kyle Hodgen ◽

Kenneth Wofford ◽

Charles Vacchiano

Keyword(s):

Mathematical Model ◽

Blood Volume ◽

Fluid Management ◽

Surgical Techniques ◽

Vital Signs ◽

Data Set ◽

Anesthetic Agents ◽

Before And After ◽

Data Points ◽

Highly Correlated

Perioperative intravenous (IV) fluid management is controversial. Fluid therapy is guided by inaccurate algorithms and changes in the patient’s vital signs that are nonspecific for changes to the patient’s blood volume (BV). Anesthetic agents, patient comorbidities, and surgical techniques interact and further confound clinical assessment of volume status. Through adaptation of existing acute normovolemic hemodilution algorithms, it may be possible to predict patient’s BV by measuring hematocrit (HcT) before and after hemodilution. Our proposed mathematical model requires the following four data points to estimate a patient’s total BV: ideal BV, baseline HcT, a known fluid bolus (FB), and a second HcT following the FB. To test our method, we obtained 10 ideal and 10 actual subject BV data measures from 9 unique subjects derived from a commercially used Food and Drug Administration-approved, semi-automated, BV analyzer. With these data, we calculated the theoretical BV change following a FB. Using the four required data points, we predicted BVs (BVp) and compared our predictions with the actual BV (BVa) measures provided by the data set. The BVp calculated using our model highly correlated with the BVa provided by the BV analyzer data set ( df = 8, r = .99). Our calculations suggest that, with accurate HcT measurement, this method shows promise for the identification of abnormal BV states such as hyper- and hypovolemia and may prove to be a reliable method for titrating IV fluid.

Download Full-text

Calling for improved quality in the registration of traditional Chinese medicine during the public health emergency: a survey of trial registries for COVID-19, H1N1, and SARS

Trials ◽

10.1186/s13063-021-05113-y ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhuoran Kuang ◽

◽

Xiaoyan Li ◽

Jianxiong Cai ◽

Yaolong Chen ◽

...

Keyword(s):

Clinical Trial ◽

Clinical Trials ◽

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Secondary Outcome ◽

Specific Information ◽

Clinical Trial Registry ◽

Data Set ◽

Diagnosis Criteria

Abstract Objective To assess the registration quality of traditional Chinese medicine (TCM) clinical trials for COVID-19, H1N1, and SARS. Method We searched for clinical trial registrations of TCM in the WHO International Clinical Trials Registry Platform (ICTRP) and Chinese Clinical Trial Registry (ChiCTR) on April 30, 2020. The registration quality assessment is based on the WHO Trial Registration Data Set (Version 1.3.1) and extra items for TCM information, including TCM background, theoretical origin, specific diagnosis criteria, description of intervention, and outcomes. Results A total of 136 records were examined, including 129 severe acute respiratory syndrome coronavirus 2 (COVID-19) and 7 H1N1 influenza (H1N1) patients. The deficiencies in the registration of TCM clinical trials (CTs) mainly focus on a low percentage reporting detailed information about interventions (46.6%), primary outcome(s) (37.7%), and key secondary outcome(s) (18.4%) and a lack of summary result (0%). For the TCM items, none of the clinical trial registrations reported the TCM background and rationale; only 6.6% provided the TCM diagnosis criteria or a description of the TCM intervention; and 27.9% provided TCM outcome(s). Conclusion Overall, although the number of registrations of TCM CTs increased, the registration quality was low. The registration quality of TCM CTs should be improved by more detailed reporting of interventions and outcomes, TCM-specific information, and sharing of the result data.

Download Full-text

Liquid Biopsy Analysis in Clinical Practice: Focus on Lung Cancer

Journal of Molecular Pathology ◽

10.3390/jmp2030021 ◽

2021 ◽

Vol 2 (3) ◽

pp. 241-254

Author(s):

Pasquale Pisapia ◽

Francesco Pepe ◽

Antonino Iaccarino ◽

Roberta Sgariglia ◽

Mariantonia Nacchio ◽

...

Keyword(s):

Lung Cancer ◽

Liquid Biopsy ◽

Treatment Options ◽

Molecular Testing ◽

Specific Information ◽

Sample Collection ◽

Timely Manner ◽

Oncology Practice ◽

Nsclc Patients ◽

To Receive

Lung cancer is the leading cause of cancer death worldwide. Despite the emergence of highly effective targeted therapies, up to 30% of advanced stage non-small cell lung cancer (NSCLC) patients do not undergo tissue molecular testing because of scarce tissue availability. Liquid biopsy, on the other hand, offers these patients a valuable opportunity to receive the best treatment options in a timely manner. Indeed, besides being much faster and less invasive than conventional tissue-based analysis, it can also yield specific information about the genetic make-up and evolution of patients’ tumors. However, several issues, including lack of standardized protocols for sample collection, processing, and interpretation, still need to be addressed before liquid biopsy can be fully incorporated into routine oncology practice. Here, we reviewed the most important challenges hindering the implementation of liquid biopsy in oncology practice, as well as the great advantages of this approach for the treatment of NSCLC patients.

Download Full-text

Measuring Congestion and Reliability Impacts of Safety Projects

Transportation Research Record Journal of the Transportation Research Board ◽

10.1177/03611981211006729 ◽

2021 ◽

pp. 036119812110067

Author(s):

Simona Babiceanu ◽

Sanhita Lahiri ◽

Mena Lockwood

Keyword(s):

Performance Measures ◽

Positive Impact ◽

Operating Conditions ◽

Vehicle Miles Traveled ◽

Data Set ◽

Data Points ◽

Practical Recommendations

This study uses a suite of performance measures that was developed by taking into consideration various aspects of congestion and reliability, to assess impacts of safety projects on congestion. Safety projects are necessary to help move Virginia’s roadways toward safer operation, but can contribute to congestion and unreliability during execution, and can affect operations after execution. However, safety projects are assessed primarily for safety improvements, not for congestion. This study identifies an appropriate suite of measures, and quantifies and compares the congestion and reliability impacts of safety projects on roadways for the periods before, during, and after project execution. The paper presents the performance measures, examines their sensitivity based on operating conditions, defines thresholds for congestion and reliability, and demonstrates the measures using a set of Virginia safety projects. The data set consists of 10 projects totalling 92 mi and more than 1M data points. The study found that, overall, safety projects tended to have a positive impact on congestion and reliability after completion, and the congestion variability measures were sensitive to the threshold of reliability. The study concludes with practical recommendations for primary measures that may be used to measure overall impacts of safety projects: percent vehicle miles traveled (VMT) reliable with a customized threshold for Virginia; percent VMT delayed; and time to travel 10 mi. However, caution should be used when applying the results directly to other situations, because of the limited number of projects used in the study.

Download Full-text

The Study of Multiple Classes Boosting Classification Method Based on Local Similarity

Algorithms ◽

10.3390/a14020037 ◽

2021 ◽

Vol 14 (2) ◽

pp. 37

Author(s):

Shixun Wang ◽

Qiang Chen

Keyword(s):

Image Retrieval ◽

Loss Function ◽

Single Mode ◽

Local Similarity ◽

Text And Image ◽

Data Set ◽

Standard Data ◽

Weak Learner ◽

Great Progress ◽

Data Points

Boosting of the ensemble learning model has made great progress, but most of the methods are Boosting the single mode. For this reason, based on the simple multiclass enhancement framework that uses local similarity as a weak learner, it is extended to multimodal multiclass enhancement Boosting. First, based on the local similarity as a weak learner, the loss function is used to find the basic loss, and the logarithmic data points are binarized. Then, we find the optimal local similarity and find the corresponding loss. Compared with the basic loss, the smaller one is the best so far. Second, the local similarity of the two points is calculated, and then the loss is calculated by the local similarity of the two points. Finally, the text and image are retrieved from each other, and the correct rate of text and image retrieval is obtained, respectively. The experimental results show that the multimodal multi-class enhancement framework with local similarity as the weak learner is evaluated on the standard data set and compared with other most advanced methods, showing the experience proficiency of this method.

Download Full-text

Biomarkers in Pancreatic Cancer as Analytic Targets for Nanomediated Imaging and Therapy

Materials ◽

10.3390/ma14113083 ◽

2021 ◽

Vol 14 (11) ◽

pp. 3083

Author(s):

Cristiana Maria Grapa ◽

Lucian Mocan ◽

Dana Crisan ◽

Mira Florea ◽

Teodora Mocan

Keyword(s):

Drug Delivery ◽

Pancreatic Cancer ◽

Targeted Delivery ◽

Drug Toxicity ◽

Treatment Options ◽

Tumor Stroma ◽

Chemotherapy Response ◽

Rising Incidence ◽

Tumor Accumulation ◽

Accumulation Ability

As the increase in therapeutic and imaging technologies is swiftly improving survival chances for cancer patients, pancreatic cancer (PC) still has a grim prognosis and a rising incidence. Practically everything distinguishing for this type of malignancy makes it challenging to treat: no approved method for early detection, extended asymptomatic state, limited treatment options, poor chemotherapy response and dense tumor stroma that impedes drug delivery. We provide a narrative review of our main findings in the field of nanoparticle directed treatment for PC, with a focus on biomarker targeted delivery. By reducing drug toxicity, increasing their tumor accumulation, ability to modulate tumor microenvironment and even improve imaging contrast, it seems that nanotechnology may one day give hope for better outcome in pancreatic cancer. Further conjugating nanoparticles with biomarkers that are overexpressed amplifies the benefits mentioned, with potential increase in survival and treatment response.

Download Full-text

Clinical Perspective on Proteomic and Glycomic Biomarkers for Diagnosis, Prognosis, and Prediction of Pancreatic Cancer

International Journal of Molecular Sciences ◽

10.3390/ijms22052655 ◽

2021 ◽

Vol 22 (5) ◽

pp. 2655

Author(s):

Randa G. Hanna-Sawires ◽

Jorinde H. Schiphuis ◽

Manfred Wuhrer ◽

Hans F. A. Vasen ◽

Monique E. van Leerdam ◽

...

Keyword(s):

Pancreatic Cancer ◽

Surgical Techniques ◽

Protein Glycosylation ◽

Ductal Adenocarcinoma ◽

Careful Study ◽

Prognosis And Prediction ◽

Prognostic Stratification ◽

Neo Adjuvant Chemotherapy ◽

New Biomarkers ◽

Study Designs

Pancreatic ductal adenocarcinoma (PDAC) is known as a highly aggressive malignant disease. Prognosis for patients is notoriously poor, despite improvements in surgical techniques and new (neo)adjuvant chemotherapy regimens. Early detection of PDAC may increase the overall survival. It is furthermore foreseen that precision medicine will provide improved prognostic stratification and prediction of therapeutic response. In this review, omics-based discovery efforts are presented that aim for novel diagnostic and prognostic biomarkers of PDAC. For this purpose, we systematically evaluated the literature published between 1999 and 2020 with a focus on protein- and protein-glycosylation biomarkers in pancreatic cancer patients. Besides genomic and transcriptomic approaches, mass spectrometry (MS)-based proteomics and glycomics of blood- and tissue-derived samples from PDAC patients have yielded new candidates with biomarker potential. However, for reasons discussed in this review, the validation and clinical translation of these candidate markers has not been successful. Consequently, there has been a change of mindset from initial efforts to identify new unimarkers into the current hypothesis that a combination of biomarkers better suits a diagnostic or prognostic panel. With continuing development of current research methods and available techniques combined with careful study designs, new biomarkers could contribute to improved detection, prognosis, and prediction of pancreatic cancer.

Download Full-text