Papers by Ganesh Radhakrishna
British Journal of Surgery
Background In line with the NCRI framework, appropriate staging and classification of pancreatic ... more 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 te...
The SCOPE 1 trial closed to recruitment in early 2012 and has demonstrably improved the quality o... more The SCOPE 1 trial closed to recruitment in early 2012 and has demonstrably improved the quality of UK radiotherapy. It has also shown that there is an enthusiastic upper gastrointestinal clinical oncology community that can successfully complete trials and deliver high-quality radiotherapy. Following on from SCOPE 1, this paper, authored by a consensus of leading UK upper gastrointestinal radiotherapy specialists, attempts to define current best practice and the questions to be answered by future clinical studies. The two main roles for chemoradiotherapy (CRT) in the management of potentially curable oesophageal cancer are definitive (dCRT) and neoadjuvant (naCRT). The rates of local failure after dCRT are consistently high, showing the need to evaluate more effective treatments, both in terms of optimal local and systemic therapeutic components. This will be the primary objective of the next planned UK dCRT trial and here we discuss the role of dose escalation and systemic therapeu...
The Patient - Patient-Centered Outcomes Research, 2020
Neoadjuvant chemoradiotherapy for oesophageal cancer significantly improves overall survival but ... more Neoadjuvant chemoradiotherapy for oesophageal cancer significantly improves overall survival but is associated with severe post-operative complications. Proton beam therapy may reduce these toxicities by sparing normal tissues compared with standard radiotherapy. ProtOeus is a proposed randomised phase II study of neoadjuvant chemoradiotherapy in oesophageal cancer that compares proton beam therapy to standard radiotherapy techniques. As proton beam therapy services are often centralised in academic centres in major cities, proton beam therapy trials raise distinct challenges including patient acceptance of travelling for proton beam therapy, coordination of treatments with local centres and ensuring equity of access for patients. Focus groups were held early in the trial development process to establish patients’ views on the trial proposal. Topics discussed include perception of proton beam therapy, patient acceptability of the trial pathway and design, patient-facing materials, a...
British journal of hospital medicine, 2019
This literature review clarifies the role of radiotherapy in the management of low-volume haemopt... more This literature review clarifies the role of radiotherapy in the management of low-volume haemoptysis. Embase and Medline were interrogated, and PRISMA guidelines were then used to select relevant articles. Seventy-eight articles were considered relevant and manually reviewed. The evidence suggests that external beam radiotherapy is more effective than endobronchial brachytherapy at controlling low-volume haemoptysis. There is no evidence to recommend a combination of the two techniques. Different doses and fractionations appear equally effective, with a potential survival advantage of higher dose regimens for fitter patients. Palliative radiotherapy is effective at controlling low-volume haemoptysis. External beam radiotherapy is the first-line treatment, with endobronchial brachytherapy recommended following external beam radiotherapy failure. Choice of dose and fractionation should take into account the patient's performance status.
BACKGROUND: Preclinical data have indicated the anti–epidermal growth factor receptor (EGFR) agen... more BACKGROUND: Preclinical data have indicated the anti–epidermal growth factor receptor (EGFR) agent cetuximab (Erbitux) as a radiosensitizer in pancreatic cancer, but this has not been specifically addressed in a clinical study. We report the results of an original study initiated in 2007, where cetuximab was tested with radiotherapy (RT) alone in locally advanced pancreatic cancer in a phase II trial (PACER). METHODS: Patients (n = 21) received cetuximab loading dose (400 mg/m) and weekly dose (250 mg/m) during RT (50.4 Gy in 28 fractions). Toxicity and disease response end point data were prospectively assessed. A feasibility study of on-trial patient blood and skin sampling was incorporated. RESULTS: Treatment was well tolerated, and toxicity was low; most patients (71%) experienced acute toxicities of grade 2 or less. Six months posttreatment, stable local disease was achieved in 90% of evaluable patients, but only 33% were free from metastatic progression. Median overall surviva...
British Journal of Cancer
The treatment paradigm for borderline and locally advanced pancreatic cancer is evolving with an ... more The treatment paradigm for borderline and locally advanced pancreatic cancer is evolving with an increased shift towards utilising systemic chemotherapy and chemoradiation to potentially facilitate more curative resections. This has been driven by the improved outcomes from the use systemic combination chemotherapy on its own, or sequentially with chemoradiation, resulting in improved resection rates and survival outcomes.
Radiotherapy and Oncology
Radiotherapy and Oncology
Radiotherapy and Oncology
Radiotherapy and Oncology
Radiotherapy and Oncology
British Journal of Hospital Medicine
Radiotherapy and Oncology
Radiotherapy and Oncology
Radiotherapy and Oncology, 2014
Background: Pancreatic cancer is a strong risk factor for deep vein thrombosis (DVT) and pulmonar... more Background: Pancreatic cancer is a strong risk factor for deep vein thrombosis (DVT) and pulmonary embolism (PE), collectively known as venous thromboembolism (VTE). However, the prevalence of symptomatic as well as asymptomatic VTEs in patients with pancreatic cancer or other upper gastrointestinal adenocarcinoma is unknown. We examined the prevalence of VTE at time of cancer diagnosis in these patients. Materials and Methods: All patients admitted to the department of gastroenterological surgery, Aalborg hospital, with a suspected upper GI cancer between February 2008 and September 2009 were offered screening for VTE according to our protocol. The investigational program comprised of clinical examination, plasma D-dimer, flow-doppler ultrasonography with compression of veins in both legs to diagnose DVT, and thoracic CT or PET-CT scan modified also to diagnose PE. Results: We included 158 patients of which 23 were diagnosed to have benign diseases. Of 135 patients with cancer 53 had pancreatic cancer, 9 had cholangiocarcinoma, and 73 had gastric cancer including cancer at the gastroesophageal junction. Only patients with pancreatic cancer or cholangiocarcinoma had a VTE at time of cancer diagnosis. Seven (7 of 53 = 13.2%; 95% CI: 5.5-25.3%) VTEs at time of diagnosis in pancreatic cancer patients comprised of 3 with DVT, 1 with PE and 3 with both DVT and PE. One (1 of 9 = 11.1%; 95% CI: 0.3-48.2%) patient with cholangiocarcinoma had both DVT and PE. Conclusion: Patients with pancreatic cancer had a high prevalence of VTE at time of diagnosis. No VTE was observed in patients with gastric cancer or benign diseases.
Clinical Oncology, 2011
Clinical Oncology, Volume 23, Issue 3, Pages S48, April 2011, Authors:G. Radhakrishna; M. Collins... more Clinical Oncology, Volume 23, Issue 3, Pages S48, April 2011, Authors:G. Radhakrishna; M. Collins; D. Sebag-Montefiore; B. Carey; S. Swift; K. Franks; J. Liley; DW Smith; S. Kirwin; S. Wilson; R. Lindsey; H. Summers; A. Wooley; P. Byrne; N. Roberts; J. Sykes; A. Needham; A ...
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Papers by Ganesh Radhakrishna