Christopher Milross

University of Sydney, Sydney, New South Wales, Australia

Are you Christopher Milross?

Claim your profile

Publications (32)118 Total impact

  • Y. Surjan · P. Ostwald · C. Milross · H. Warren-Forward
    [Show abstract] [Hide abstract]
    ABSTRACT: To examine current knowledge and the level of compliance of radiation safety principles in equine veterinary clinics within Australia.
    Radiography 08/2015; 21(3). DOI:10.1016/j.radi.2014.11.007
  • Source
    Puma Sundaresan · Martin R Stockler · Christopher G Milross
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives. Optimal radiation therapy (RT) utilisation rates (RURs) have been defined for various cancer indications through extensive work in Australia and overseas. These benchmarks remain unrealised. The gap between optimal RUR and actual RUR has been attributed to inadequacies in 'RT access'. We aimed to develop a conceptual framework for the consideration of 'RT access' by examining the literature for existing constructs and translating it to the context of RT services. We further aimed to use this framework to identify and examine factors influencing 'RT access'. Methods. Existing models of health care access were reviewed and used to develop a multi-dimensional conceptual framework for 'RT access'. A review of the literature was then conducted to identify factors reported to affect RT access and utilisation. The electronic databases searched, the host platform and date range of the databases searched were Ovid MEDLINE, 1946 to October 2014 and PsycINFO via OvidSP,1806 to October 2014. Results. The framework developed demonstrates that 'RT access' encompasses opportunity for RT as well as the translation of this opportunity to RT utilisation. Opportunity for RT includes availability, affordability, adequacy (quality) and acceptability of RT services. Several factors at the consumer, referrer and RT service levels affect the translation of this opportunity for RT to actual RT utilisation. Conclusion. 'Access' is a term that is widely used in the context of health service related research, planning and political discussions. It is a multi-faceted concept with many descriptions. We propose a conceptual framework for the consideration of 'RT access' so that factors affecting RT access and utilisation may be identified and examined. Understanding these factors, and quantifying them where possible, will allow objective evaluation of their impact on RT utilisation and guide implementation of strategies to modify their effects. What is known about the topic? It is well documented that the use of RT in Australia is well below evidence-based benchmarks. The shortfall in the use of RT has been attributed to problems with access to treatment services. Although considerable attention has been directed (rightly) towards addressing infrastructure needs, access to RT is more than just supply of services. There is currently no specific framework for RT access to comprehensively consider and examine other factors influencing the use of RT. The existing international literature addresses some of the influencing factors. However, there is a need for a detailed review of all actual and potential influencers of RT utilisation. What does this paper add? This paper presents a conceptual framework for the specific consideration of access to RT. A detailed review of various factors affecting access and utilisation of RT has been performed using the aforementioned conceptual framework. To our knowledge this is the first such review and hence we are confident that it adds to the existing international literature on this subject. What are the implications for practitioners? The topic of improving consumers' access to RT is of relevance locally, in Australia, as well as internationally. We feel that the RT access framework proposed herein will be of interest and use to those involved in health services research, delivery and policy, especially those involved with the planning and delivering of cancer services. In addition to compiling evidence on the subject, the review of factors influencing RT utilisation highlights and proposes areas for future translational and implementation research in the areas of health services and treatment-related decision making. Journal compilation Ó AHHA 2015 www.publish.csiro.au/journals/ahr
    Australian health review: a publication of the Australian Hospital Association 06/2015; DOI:10.1071/AH14262 · 1.00 Impact Factor
  • Source
    Puma Sundaresan · Martin R Stockler · Christopher G Milross
  • Source
    J. Lam · T. Cook · S. Foster · R. Poon · C. Milross · P. Sundaresan
    [Show abstract] [Hide abstract]
    ABSTRACT: Radiotherapy utilisation is likely affected by multiple factors pertaining to radiotherapy access. Radiotherapy is an integral component of breast-conserving treatment (BCT) for early breast cancer. We aimed to determine if stepwise improvements in radiotherapy access in regional Australia affected the uptake of BCT and thus radiotherapy. Breast cancer operations in the Central Coast of New South Wales between January 2010 and March 2014 for T1-2N0-1M0 invasive or in situ (≤5 cm) disease in female patients eligible for BCT were examined. BCT uptake was calculated for three 1 year periods: period 1 (local radiotherapy available at cost to user or out of area radiotherapy with travel cost and inconvenience); period 2 (as per period 1 + publicly funded transport and radiotherapy at out of area facilities at no cost to user); period 3 (as per period 1 + publicly funded local radiotherapy at no cost to user). In total, 574 cases met eligibility criteria. BCT declined with increasing distance to publicly funded radiotherapy (P = 0.035). BCT rates for periods 1, 2 and 3 were 63% (113/180), 61% (105/173) and 71% (156/221). There were no statistically significant differences in BCT between periods 1 and 2 in the whole cohort or within age, histology or tumour size subgroups. Overall, there was a 9% increase in BCT in the whole cohort in period 3 compared with periods 1 and 2 (P = 0.031). This increase was statistically significant for women over 70 years (19% increase, P = 0.034), for women with ductal carcinoma in situ (25% increase, P = 0.013) and for women with primary tumours that were ≤10 mm (21% increase, P = 0.016). Improving the affordability of radiotherapy through publicly funded transport and radiotherapy at out of area facilities did not improve BCT uptake in a region where radiotherapy was locally available, albeit at cost to the user. Improving both affordability and convenience through the provision of local publicly funded radiotherapy increased BCT uptake. Service availability and affordability have long been recognised as important determinants of radiotherapy access. Our findings suggest that inconvenience may also influence radiotherapy utilisation. Crown Copyright © 2015. Published by Elsevier Ltd. All rights reserved.
    Clinical Oncology 05/2015; 27(8). DOI:10.1016/j.clon.2015.04.034 · 2.83 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background This study provides Australian data on the characteristics of human papillomavirus (HPV)-related oropharyngeal cancer (OSCC) over the last two decades.Methods The HPV status of 515 OSCC diagnosed between 1987-2010 was determined by HPV E6-targeted multiplex PCR and p16 immunohistochemistry.ResultsThe HPV positivity rate increased from 20.2% (1987-1995) to 63.5% (2006-2010). Among HPV-positive OSCC over the study period, the median age increased from 55.4 years to 59.8 years (p=0.004) and there was a trend of an increasing proportion of never smoker (19.2% to 34.0%). The use of radiation therapy in patients with HPV-positive oropharyngeal cancer increased from 26.9% to 68.1% (p=0.007) and we also observed a trend of improved outcomes.Conclusions Our data show a rising prevalence of HPV-positive OSCC in Australia over the last two decades. These patients with HPV-positive OSCC are now presenting at an older age and about one third have never smoked. This article is protected by copyright. All rights reserved.
    Head & Neck 12/2014; DOI:10.1002/hed.23942 · 3.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This review examines the most commonly reported treatment options for ocular squamous cell carcinoma (OSCC) and periocular squamous cell carcinoma (POSCC) in horses and proposes to conclude on the most viable method based on available published studies in terms of treatment outcome, known side-effects, advantages, disadvantages, and reliability of available evidence. Following a literature search for peer-reviewed published articles, seven most commonly reported on treatments for OSCC/POSCC were identified: surgery, photodynamic therapy, carbon dioxide CO2 laser ablation, radiofrequency hyperthermia, cryotherapy, chemotherapy and radiation therapy. Combination therapies were supported as a most successful recommendation, however, when considering site-specific outcomes, the following conclusions may be drawn; limbal SCC was most effectively treated with surgery and adjunctive therapy including CO2 laser ablation, mitomycin C and brachytherapy; third eyelid SCC reported good outcomes when treated with surgery alone (clear margins) and in combination with brachytherapy for unclear margins; eyelid SCC, surgical resection was usually limited and most reports supported the use of adjunctive brachytherapy although photodynamic therapy appeared to be a promising new treatment. It was deemed unreasonable to conclude on the best treatment for cornea, conjunctivae (palpebral and bulbar) and medial canthi in isolation due to lack of evidence .A consistently favoured treatment for OSCC/POSCC in horses does not currently exist. The presentation of data in the literature and its lack of consistency make it impossible to statistically analyse and make comparative conclusions on treatment outcomes. This review provides a basis for further research to establish a best-practice protocol.
    Journal of Equine Veterinary Science 09/2014; 34(9). DOI:10.1016/j.jevs.2014.04.005 · 0.89 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Radiotherapy (RT) is an essential and cost-effective cancer treatment. It is underutilised in Australia. Bridging the gap between actual and optimal RT utilisation requires not only provision of adequate RT infrastructure but also an understanding of the factors that influence the extent to which this opportunity for RT is utilised. This study explored factors perceived to affect RT-related decision making by consumers and health professionals (HPs). Six semi-structured focus groups (FGs) and 13 interviews were conducted at three geographical locations in NSW, Australia (n = 26 consumers and 30 HPs). Audio recordings of FGs and interviews were transcribed verbatim and analysed thematically. An exhaustive list of issues perceived to affect consumer and HP RT decisions was identified. There were common themes across participant groups and locations. Perceptions of RT and its benefits, as well as accurate communication of the expected benefits and risks of RT, were highlighted as important to decision making. Perceived factors relating to ‘inconvenience’ of RT were multifaceted and included travel, relocation, accommodation, time away from work and financial challenges. Perceived potential barriers to RT referral included knowledge of RT and RT services, availability of a local or visiting RT service, referrer bias, and the low profile of RT. Important drivers during RT decisions appear to include the perceived benefit, risks and inconvenience of RT. Underutilisation of RT may also result from multiple barriers at the referrer level. Further research into whether these factors influence actual RT decisions is needed.
    Journal of Medical Imaging and Radiation Oncology 06/2014; 58(5). DOI:10.1111/1754-9485.12198 · 0.95 Impact Factor
  • International journal of radiation oncology, biology, physics 02/2014; 88(2):465–466. DOI:10.1016/j.ijrobp.2013.11.022 · 4.18 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: It is now clear that the two separate entitles of tonsillar cancer, HPV induced and non-HPV induced (smoking induced), have significantly different presenting stage and outcomes. A significant proportion of patients with human papillomavirus positive tonsillar cancer have had exposure to smoking. We examined the combined effect of human papillomavirus and smoking on the outcomes and determined whether smoking can modify the beneficial effect of human papillomavirus. 403 patients from 9 centres were followed up for recurrence or death for a median of 38 months. Determinants of the rate of loco-regional recurrence, death from tonsillar cancer and overall survival were modelled using Cox regression. Smoking status was a significant predictor of overall survival (p=0.04). There were non-statistically significant trends favoring never smokers for loco-regional recurrence and disease specific survival. In addition, there was no statistically significant interactions between smoking and human papillomavirus (p-values for the interaction were 0.26 for loco-regional recurrence, 0.97 for disease specific survival and 0.73 for overall survival). The effect of smoking on loco-regional recurrence and disease specific survival outcomes was not statistically significant, nor was there significant evidence that the effect of smoking status on these outcomes was modified by HPV status. Irrespective of HPV status however, smokers did have poorer overall survival than never-smokers; presumably due to effects of smoking that are unrelated to the primary cancer. © 2012 Wiley Periodicals, Inc.
    International Journal of Cancer 06/2013; 132(12). DOI:10.1002/ijc.27956 · 5.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND AND PURPOSE: Human papillomavirus (HPV) causes up to 70 % of oropharyngeal cancers (OSCC). HPV positive OSCC has a more favorable outcome, thus HPV status is being used to guide treatment and predict outcome. Combination HPV DNA/p16(ink4) (p16) testing is commonly used for HPV status, but there are no standardized methods, scoring or interpretative criteria. The significance of discordant (HPV DNA positive/p16 negative and HPV DNA negative/p16 positive) cancers is controversial. In this study, 647 OSCCs from 10 Australian centers were tested for HPV DNA/p16 expression. Our aims are to determine p16 distribution by HPV DNA status to inform decisions on p16 scoring and to assess clinical significance of discordant cancers. METHODS: HPV DNA was identified using a multiplex tandem HPV E6 polymerase chain reaction (PCR) assay and p16 expression by semiquantitative immunohistochemistry. RESULTS: p16 distribution was essentially bimodal (42 % of cancers had ≥70 % positive staining, 52 % <5 % positive, 6 % between 5 and 70 %). Cancers with 5 to <50 % staining had similar characteristics to the p16 negative group, and cancers with 50 to <70 % staining were consistent with the ≥70 % group. Using a p16 cut-point of 50 %, there were 25 % HPV DNA positive/p16 negative cancers and 1 % HPV DNA negative/p16 positive cancers. HPV DNA positive/p16 negative cancers had outcomes similar to HPV DNA negative/p16 negative cancers. CONCLUSIONS: 50 % is a reasonable cut-point for p16; HPV DNA positive/p16 negative OSCCs may be treated as HPV negative for clinical purposes; HPV DNA/p16 testing may add no prognostic information over p16 alone.
    Annals of Surgical Oncology 12/2012; 20(S3). DOI:10.1245/s10434-012-2778-4 · 3.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Despite the association with more advanced nodal stage, patients with human papillomavirus (HPV) positive oropharyngeal cancers have better outcomes. We examined whether the HPV can modify the effect of known prognostic factors in tonsillar cancer.Patients and methodsA total of 489 patients from 10 centres were followed up for recurrence or death for a median of 3.2 years. Determinants of the rate of locoregional recurrence, death from tonsillar cancer and overall survival were modelled using Cox regression.ResultsThe prognostic value of T and N stages were modified by HPV as indicated by statistically significant interaction terms. After adjusting for age, gender and treatment, T stage appeared relevant only for HPV-positive cancers (where a higher T stage was associated with worse outcomes). There was some evidence that N stage was a more relevant prognostic factor for HPV-negative than -positive cancers. There was no evidence that the HPV modifies the effect of age, gender or grade on outcomes.Conclusions This study suggests that the prognostic significance of the conventional staging system in tonsillar cancer is modified by HPV.
    Annals of Oncology 08/2012; 24(1). DOI:10.1093/annonc/mds205 · 6.58 Impact Factor
  • Radiotherapy and Oncology 05/2012; 103:S611-S612. DOI:10.1016/S0167-8140(12)71928-X · 4.86 Impact Factor
  • Source
    Michael H Bennett · John Feldmeier · Neil Hampson · Robert Smee · Christopher Milross
    [Show abstract] [Hide abstract]
    ABSTRACT: There is a risk of serious complications developing after radiation treatment for cancer (late radiation tissue injury (LRTI). HBOT involves breathing oxygen in a specially designed chamber. It is used as a treatment to improve oxygen supply to damaged tissue and stimulate healing. We found some evidence that LRTI affecting the head, neck and lower end of the bowel can be improved with HBOT. There is little evidence for or against benefit in other tissues affected by LRTI. Our conclusions are based on 11 randomised trials with a limited number of patients. Further research is needed.
    Cochrane database of systematic reviews (Online) 05/2012; 5(5):CD005005. DOI:10.1002/14651858.CD005005.pub3 · 5.94 Impact Factor
  • Source
    Michael H Bennett · John Feldmeier · Robert Smee · Christopher Milross
    [Show abstract] [Hide abstract]
    ABSTRACT: Cancer is a common disease and radiotherapy is one well-established treatment for some solid tumours. Hyperbaric oxygenation therapy (HBOT) may improve the ability of radiotherapy to kill hypoxic cancer cells, so the administration of radiotherapy while breathing hyperbaric oxygen may result in a reduction in mortality and recurrence. To assess the benefits and harms of radiotherapy while breathing HBO. In March 2011 we searched The Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, Issue 3), MEDLINE, EMBASE, DORCTHIM and reference lists of articles. Randomised and quasi-randomised studies comparing the outcome of malignant tumours following radiation therapy while breathing HBO versus air. Three review authors independently evaluated the quality of the relevant trials and extracted the data from the included trials. Nineteen trials contributed to this review (2286 patients: 1103 allocated to HBOT and 1153 to control). With HBOT, there was a reduction in mortality for head and neck cancers at both one year and five years after therapy (risk ratio (RR) 0.83, P = 0.03, number needed to treat (NNT) = 11; and RR 0.82, P = 0.03, NNT = 5 respectively), as well as improved local tumour control at three months (RR with HBOT 0.58, P = 0.006, NNT = 7). The effect of HBOT varied with different fractionation schemes. Local tumour recurrence was less likely with HBOT at one year (head and neck: RR 0.66, P < 0.0001, NNT = 5), two years (uterine cervix: RR 0.60, P = 0.04, NNT = 5) and five years (head and neck: (RR 0.77, P = 0.01, NNT = 6). Any advantage is achieved at the cost of some adverse effects. There was a significant increase in the rate of both severe radiation tissue injury (RR 2.35, P < 0.0001, (number needed to harm (NNH) = 8) and the chance of seizures during therapy (RR 6.76, P = 0.03, NNH = 22) with HBOT. There is some evidence that HBOT improves local tumour control and mortality for cancers of the head and neck, and local tumour recurrence in cancers of the head and neck, and uterine cervix. These benefits may only occur with unusual fractionation schemes. HBOT is associated with significant adverse effects including oxygen toxic seizures and severe tissue radiation injury. The methodological and reporting inadequacies of the studies included demand a cautious interpretation. More research is needed for head and neck cancer, but is probably not justified for bladder cancer. There is little evidence available concerning malignancies at other anatomical sites on which to base a recommendation.
    Cochrane database of systematic reviews (Online) 01/2012; 4(4):CD005007. DOI:10.1002/14651858.CD005007.pub3 · 5.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We aimed to validate the lymph node ratio (LNR) as an independent prognostic factor in oral squamous cell carcinoma (OSCC) and compare its utility with the current nodal staging system. We conducted a retrospective analysis of 313 patients with OSCC undergoing neck dissection. The LNR was adjusted by relevant covariates in a multivariable Cox regression model. LNR displaced conventional nodal staging and was shown to be an independent predictor of regional failure (p = .020), disease-specific (p = .003) and overall survival (p = .001). Patients with an LNR of 2.5% to 7.5%, 7.5% to 20%, and >20% had 2.6, 3.7, and 4.4 times the risk of death from OSCC, respectively, when compared with patients with an LNR <2.5%. The LNR is an independent prognostic factor in OSCC and may be used in conjunction with the current TNM staging to enable better risk stratification and selection for adjuvant therapy.
    Head & Neck 09/2011; 33(9):1245-51. DOI:10.1002/hed.21600 · 3.01 Impact Factor
  • Yolanda Surjan · Helen Warren-Forward · Christopher Milross
    [Show abstract] [Hide abstract]
    ABSTRACT: Role expansion recognises enlargement of existing scope of practice within radiation therapy (RT). Over the past decade, there has been increasing involvement and movement towards advanced practice in the form of role extension in specialised areas of practice including brachytherapy, image fusion and quality assurance. It is also recognised that radiation therapy expert practitioners exist in the areas of imaging immobilisation, treatment, education and research. The acquisition of additional skills has hastened the need for autonomy within the RT profession and with this comes the responsibility to share our knowledge and specialist abilities with the wider community. Radiation therapy is a highly specialised profession working to treat a commonly encountered ailment like cancer and we should ask ourselves what other community members could benefit from our knowledge and skills.Cancer is not limited to the human population but affects animals as readily and severely. Particular types of cancers have been identified as being comparable with that of humans; one such tumour is squamous cell carcinoma (SCC). Squamous cell carcinoma is the most commonly found tumour of the eye and adnexa in horses. Comparatively, SCC in humans is the most common cancer in Australia. Whilst human treatment is well established with surgery and radiation therapy offering comparable control rates, the treatment within Australia’s Veterinary Oncology field is currently at a standstill. It is reported, however, that the use of interstitial brachytherapy has been shown to be highly effective and thoroughly practiced and established within the United States of America (USA). This paper reviews current literature in readiness for the potential for radiation therapy cross-over into the veterinary sphere with regard to the implementation of treatment and radiation safety protocols for the use of interstitial brachytherapy in horses.
    Radiography 08/2011; 17(3):250-253. DOI:10.1016/j.radi.2011.01.004
  • R Varma · S L Carroll · I V Jacobson · C G Milross · J J Post
    Internal Medicine Journal 05/2011; 41(5):437-8. DOI:10.1111/j.1445-5994.2011.02480.x · 1.70 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: There is increasing use of multiple molecular markers to predict prognosis in human cancer. Our aim was to examine the prognostic significance of cyclin D1 and retinoblastoma (pRb) expression in association with human papillomavirus (HPV) status in oropharyngeal squamous cell carcinoma. Clinical records and specimens of 226 patients with follow-up from 1 to 235 months postdiagnosis were retrieved. Tumor HPV status was determined by HPV E6-targeted multiplex real-time PCR/p16 semiquantitative immunohistochemistry and cyclin D1 and pRb expression by semiquantitative immunohistochemistry. Determinants of recurrence and mortality hazards were modeled using Cox regression with censoring at dates of last follow-up. The HPV-positivity rate was 37% (91% type 16). HPV was a predictor of recurrence, an event (recurrence or death) and death after adjustment for clinicopathological variables. There were inverse relationships between HPV status and cyclin D1 and pRb. On univariate analysis, cyclin D1 predicted locoregional recurrence, event and death and pRb predicted event and death. Within the HPV-positive group, after adjusting for clinicopathological factors, patients with cyclin D1-positive cancers had up to a eightfold increased risk of poor outcome relative to those with cyclin D1-negative tumors. However, within the HPV-negative group, there was only a very small adjusted increased risk. A combination of pRb and HPV did not provide additional prognostic information. Our data provide the first evidence that a combination of HPV and cyclin D1 provides more prognostic information in oropharyngeal cancer than HPV alone. If findings are confirmed, treatment based on HPV and cyclin D1 may improve outcomes.
    International Journal of Cancer 04/2011; 128(7):1532-45. DOI:10.1002/ijc.25479 · 5.01 Impact Factor
  • Michael D Kernohan · Jonathan R Clark · Kan Gao · Ardalan Ebrahimi · Christopher G Milross
    [Show abstract] [Hide abstract]
    ABSTRACT: to describe the clinicopathologic features of oral squamous cell carcinoma in patients who develop locoregional recurrence of disease, to identify factors that predict prognosis in the subset of patients treated with salvage surgery, and to determine the adjusted effect of time to recurrence. cohort study. a head and neck cancer institute in Sydney, New South Wales, Australia. a total of 77 patients who underwent salvage surgery for oral squamous cell carcinoma that had been treated initially by surgery, radiotherapy, or surgery with postoperative radiotherapy. univariable and multivariable analysis of clinical and pathologic risk factors. median time to recurrence from initial treatment was 7.5 months (range, 0.9-143.9 mo), with 86% of recurrences occurring within the first 24 months. Surgical salvage was attempted in 77 patients who had experienced recurrence at the primary site (n = 39), ipsilateral neck (n = 27), and contralateral neck (n = 11). Time to recurrence, initial treatment modality, and site of failure were independent prognostic variables. the relationship of these prognostic variables displays a dynamic interaction. Initial combined-modality treatment and shorter time to recurrence were associated with worse outcome, while the effect of site of recurrence (local vs regional) was dependent on an interaction with the time to recurrence. The result of this interaction was that local recurrence was worse for those who experienced it early (eg, <6 mo after the initial treatment) and nodal recurrence was worse for those who experienced it late (eg, ≥ 6 mo after the intial treatment).
    Archives of otolaryngology--head & neck surgery 12/2010; 136(12):1235-9. DOI:10.1001/archoto.2010.214 · 1.75 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examines the prognostic significance of human papillomavirus (HPV) in patients with locally advanced oropharyngeal squamous cell carcinoma (SCC) treated primarily with surgery or definitive radiotherapy. One hundred and ninety-eight patients with Stage 3/4 SCC were followed up for recurrence in any form or death from any cause for between 1 and 235 months after diagnosis. HPV status was determined using HPV E6-targeted multiplex real-time PCR/p16 immunohistochemistry. Determinants of recurrence and mortality hazards were modelled using Cox's regression with censoring at follow-up dates. Forty-two per cent of cancers were HPV-positive (87% type 16). HPV predicted loco-regional control, event-free survival and overall survival in multivariable analysis. Within the surgery with adjuvant radiotherapy (n=110), definitive radiotherapy-alone (n=24) and definitive radiotherapy with chemotherapy (n=47) groups, patients with HPV-positive cancers were one-third or less as likely to have loco-regional recurrence, an event or to die of any cause as those with HPV-negative cancers after adjusting for age, gender, tumour grade, AJCC stage and primary site. The 14 patients treated with surgery alone were considered too few for multivariable analysis. HPV status predicts better outcome in oropharyngeal cancer treated with surgery plus adjuvant radiotherapy as well as with definitive radiation therapy±chemotherapy.
    British Journal of Cancer 10/2010; 103(10):1510-7. DOI:10.1038/sj.bjc.6605944 · 4.82 Impact Factor

Publication Stats

417 Citations
118.00 Total Impact Points

Institutions

  • 2013–2015
    • University of Sydney
      • Central Clinical School
      Sydney, New South Wales, Australia
  • 2007–2015
    • Royal Prince Alfred Hospital
      • Department of Radiation Oncology
      Camperdown, New South Wales, Australia
  • 2012
    • Sydney Cancer Centre
      Camperdown, New South Wales, Australia
  • 2011
    • PathWest Laboratory Medicine
      Perth City, Western Australia, Australia
  • 2010–2011
    • Sydney Head and Neck Cancer Institute
      Sydney, New South Wales, Australia
  • 2005–2006
    • Prince of Wales Hospital and Community Health Services
      Sydney, New South Wales, Australia
    • University of New South Wales
      • Prince of Wales Hospital
      Kensington, New South Wales, Australia