ABSTRACT
Purpose: To retrospectively review patients with bladder TCC treated with radical radiotherapy alone in the last 5 years who may have benefited from carbogen +/- nicotinamide radiosentisation at a large cancer centre in the north of England. Method(s): Electronic records were reviewed for 175 patients who had received radiotherapy to the bladder for TCC between 2017 and 2022. Patients who had radical radiotherapy (RT) alone without radiosensitisation were scrutinised to ascertain whether they would have been candidates for carbogen and nicotinamide using the inclusion/exclusion criteria previously defined in the BCON trial [1]. Result(s): We analysed 175 patients. Of these, 133 had radical RT without radiosensitisation. The most common reason for not offering radiosensitisation was the presence of co-morbidities (27.8%). Of interest, the proportion of patients having chemotherapy radiosensitisation did not change after COVID-19 in March 2020 (21.5% pre- versus 27.5% post;P = 0.32 chi2). Conversely, the proportion of patients receiving neoadjuvant chemotherapy reduced, but failed to reach significance (12.6% pre- versus 5% post;P = 0.08 chi2). After review of the notes and criteria from the original BCON trial, 106 patients (79.6%) could have benefited from carbogen +/- nicotinamide. Of these, 14 patients (13.2%) could have been offered carbogen alone due to poor renal function. The most common reason for not being eligible for BCON was respiratory disease with reduced respiratory drive (44%). Conclusion(s): NICE state that all radical radiotherapy for bladder TCC should be with a radiosensitiser. Due to logistical and departmental issues, the BCON regimen is not currently offered as a standard alternative to radiosensitisation with chemotherapy. BCON has been shown to be tolerable and, whilst updated follow-up data failed to demonstrate statistical significance for overall survival, meta-analysis of hypoxia modification has shown significant improvement in overall survival compared to RT alone [2] Hypoxia modification with carbogen +/- nicotinamide should be considered for all patients unsuitable for chemotherapy radiosensitisation. References [1] Hoskin PJ, Rojas AM, Saunders MI, Bentzen SM, Motohashi KJ. Carbogen and nicotinamide in locally advanced bladder cancer: early results of a phase-III randomized trial. Radiother Oncol 2009;91(1):120-5. [2] Overgaard J. Hypoxic radiosensitization: adored and ignored. J Clin Oncol 2007;25(26):4066-74. Copyright © 2022 The Royal College of Radiologists
ABSTRACT
The coronavirus disease 2019 (COVID-19) pandemic continues its global spread. Coordinated effort on a vast scale is required to halt its progression and to save lives. Electronic health record (EHR) data are a valuable resource to mitigate the COVID-19 pandemic. We review how the EHR could be used for disease surveillance and contact tracing. When linked to "omics" data, the EHR could facilitate identification of genetic susceptibility variants, leading to insights into risk factors, disease complications, and drug repurposing. Real-time monitoring of patients could enable early detection of potential complications, informing appropriate interventions and therapy. We reviewed relevant articles from PubMed, MEDLINE, and Google Scholar searches as well as preprint servers, given the rapidly evolving understanding of the COVID-19 pandemic.