Meg Finch-Jones

Publications (9) View all

• Article: Contrast-enhanced intraoperative ultrasound improves detection of liver metastases during surgery for primary colorectal cancer.

  Ankur J Shah, Mark Callaway, Michael G Thomas, Meg D Finch-Jones
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  ABSTRACT: Computed tomography (CT) is the most common staging investigation in colorectal cancer (CRC). Up to 25% of patients are found to have previously undetected hepatic lesions when intraoperative ultrasound (IOUS) of the liver is used during CRC resection. We aimed to assess the ability of IOUS to detect additional liver lesions/metastases at primary colorectal resection, and to evaluate whether contrast-enhanced IOUS (CE-IOUS) improves the detection and characterization of hepatic lesions. We performed a single-centre, prospective pilot study. At CRC resection, patients underwent IOUS of the liver. Contrast-enhanced IOUS of the liver was undertaken using i.v. sulphur hexafluoride micro-bubbles (SonoVue, 4.8 ml). Findings of CT, non-enhanced IOUS and CE-IOUS were compared. Changes in staging or management were noted. Additional lesions were corroborated with iron oxide magnetic resonance imaging (MRI). Among 21 patients, IOUS demonstrated additional lesions in seven (33%). Contrast altered the diagnosis of non-enhanced IOUS in four (20%) and changed the management strategy in three (14%) patients. Thus, IOUS in combination with the contrast agent altered the intraoperative or postoperative management plan in four patients. In the first study of its kind, early results suggest that the ability of IOUS to detect additional metastases is improved by CE-IOUS, and that this may impact on surgical staging and management.
  HPB 04/2010; 12(3):181-7. · 1.60 Impact Factor
• Article: Clinical risk score can be used to select patients for staging laparoscopy and laparoscopic ultrasound for colorectal liver metastases.

  A J Shah, J Phull, M D Finch-Jones
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  ABSTRACT: Despite advanced staging investigations, some patients with potentially resectable colorectal liver metastases (CLM) are unresectable at laparotomy. Staging laparoscopy and laparoscopic ultrasound (Lap + LUS) detects a subset of these unresectable patients before a major laparotomy. Clinical risk scoring may be helpful to identify this subgroup. The goal of our study was to evaluate the role of Lap + LUS and to assess the value of the Memorial Sloan Kettering clinical risk score (CRS) in identifying this subset. Patients were identified from the regional multidisciplinary team (MDT) cancer database and operative records for a 5-year period. All patients whose tumors were deemed resectable proceeded to Lap + LUS. LUS findings were recorded and any change in MDT plan was noted. LUS findings were compared with resectability at open surgery. The CRS (Memorial Sloan-Kettering) based on five factors was calculated. A total of 79 patients were identified. In 15 of 74 patients, LUS prevented an unnecessary laparotomy by predicting the benign nature of lesions or demonstrating unresectability. The CRS ranged from 0 to 4. Lap + LUS prevented an operation in only 7% of patients with a CRS of < or =2. However in patients with a CRS > 2, Lap + LUS prevented an operation in 24% of patients. LUS prevented an unnecessary laparotomy in 20% of patients. This may reduce inpatient stay, morbidity, and mortality, allowing some patients to proceed to palliative treatments earlier. The benefit of Lap + LUS is limited in patients with a CRS of < or =2. It is worth considering selective use of Lap + LUS for the staging of CLM.
  World Journal of Surgery 09/2010; 34(9):2141-5. · 2.36 Impact Factor
• Article: Costs of neoadjuvant chemotherapy and surgery in patients with liver metastases from advanced colorectal cancer

  G Poston, IS Benjamin, T Diamond, M Finch-Jones, RW Parks, JN Primrose, M Rees, DJ Sherlock, S Yeung, P Carita, CJ Nicholls
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  ABSTRACT: Liver metastases are found in 40-70% of patients with colorectal cancer. Surgery is the only treatment for liver metastases that gives potential for long-term survival. Studies with oxaliplatin combination therapy have reported significant reduction of tumour bulk in the liver, allowing resection, with curative intent, of previously unresectable liver metastases. This study uses a simple decision model to estimate average chemotherapy costs and surgical costs of treating advanced colorectal cancer patients with metastases confined to the liver with either oxaliplatin combination therapy, or 5-FU/FA alone. The incremental cost per life-year gained with oxaliplatin combination therapy ranged between £5,489 and £15,624, and treatment could enable between 7.3% and 17.5% extra patients to be resected and therefore gain the chance of long-term survival compared to 5-FU/FA treatment alone. To date, oxaliplatin combination therapy is the only first-line treatment that has shown the possibility of long-term survival in patients with unresectable liver metastases. This long-term survival can be achieved at an acceptable cost.
  12/2008; 4(1-4):167-177.
• Article: More than pancreatitis?

  R Young, H D Roach, M Finch-Jones
  The British journal of radiology 11/2006; 79(946):858-9. · 2.11 Impact Factor
• Article: Predictive factors for the benefit of perioperative FOLFOX for resectable liver metastasis in colorectal cancer patients (EORTC Intergroup Trial 40983).

  Halfdan Sorbye, Murielle Mauer, Thomas Gruenberger, Bengt Glimelius, Graeme J Poston, Peter M Schlag, Philippe Rougier, Wolf O Bechstein, John N Primrose, Euan T Walpole, Meg Finch-Jones, Daniel Jaeck, Darius Mirza, Rowan W Parks, Laurence Collette, Eric Van Cutsem, Werner Scheithauer, Manfred P Lutz, Bernard Nordlinger
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  ABSTRACT: In EORTC study 40983, perioperative FOLFOX increased progression-free survival (PFS) compared with surgery alone for patients with initially 1 to 4 resectable liver metastases from colorectal cancer (CRC). We conducted an exploratory retrospective analysis to identify baseline factors possibly predictive for a benefit of perioperative FOLFOX on PFS. The analysis was based on 237 events from 342 eligible patients. Cox proportional hazards regression models with a significance level of 0.1 were used to build up univariate and multivariate models. After adjustment for identified prognostic factors, moderately (5.1-30 ng/mL) and highly (>30 ng/mL) elevated carcinoembryonic antigen (CEA) serum levels were both predictive for the benefit of perioperative chemotherapy (interaction P = 0.07; hazard ratio [HR] = 0.58 and HR = 0.52 for treatment benefit). For patients with moderately or highly elevated CEA (>5 ng/mL), the 3-year PFS was 35% with perioperative chemotherapy compared to 20% with surgery alone. Performance status (PS) 0 and BMI lower than 30 were also predictive for the benefit of perioperative chemotherapy (interaction P = 0.04 and P = 0.02). However, the number of patients with PS 1 and BMI 30 or higher were limited. The benefit of perioperative therapy was not influenced by the number of metastatic lesions (1 vs 2-4, interaction HR = 0.98). Perioperative FOLFOX seems to benefit in particular patients with resectable liver metastases from CRC when CEA is elevated and when PS is unaffected, regardless of the number of metastatic lesions.ClinicalTrials.gov number NCT00006479.
  Annals of surgery 03/2012; 255(3):534-9. · 7.90 Impact Factor