Stephen James Harrow

• Doctor of Medicine
• Consultant at Edinburgh Cancer Centre

15 Background: Metastasis-directed therapy (MDT) for omPC has demonstrated progression-free survival (PFS) benefit in multiple phase 2 randomized clinical trials (RCTs) yet has fallen short of demonstrating benefit for later endpoints. The X-MET collaboration amalgamates IPD from RCTs investigating oligometastatic cancers, incorporating new trials...

Background Emerging randomized data, mostly from phase II trials, have suggested that patients with oligometastatic cancers may benefit from ablative treatments such as stereotactic ablative radiotherapy (SABR). However, phase III data testing this paradigm are lacking, and many studies have examined SABR in the setting of metachronous oligometasta...

Background Emerging randomized data, mostly from phase II trials, have suggested that patients with oligometastatic cancers may benefit from ablative treatments such as stereotactic ablative radiotherapy (SABR). However, phase III data testing this paradigm are lacking, and many studies have examined SABR in the setting of metachronous oligometasta...

TPS8119 Background: Lung cancer is the leading cause of cancer mortality globally, with cases projected to exceed 62,000 by 2035. Outcomes remain poor despite advances in radiotherapy (RT) technologies. Combining novel mechanism-based agents with RT could improve the therapeutic index. DNA inhibition of cellular response to radiation-induced DNA da...

Importance Patients with interstitial lung disease (ILD) and early-stage non–small cell lung cancer (NSCLC) have been reported to be at high risk of toxic effects after stereotactic ablative radiotherapy (SABR), but for many patients, there are limited alternative treatment options. Objective To prospectively assess the benefits and toxic effects...

Background Radiotherapy delivery regimens can vary between a single fraction (SF) and multiple fractions (MF) given daily for up to several weeks depending on the location of the cancer or metastases. With limited evidence comparing fractionation regimens for oligometastases, there is support to explore toxicity levels to nearby organs at risk as a...

Gross pathology photography of surgically resected specimens is an often overlooked modality for the study of medical images that can provide and document useful information about a tumour before it is distorted by slicing. A method for the automatic segmentation of tumour areas in this modality could provide a useful tool for both pathologists and...

Objectives: Pre-trial focus groups of the Early detection of Cancer of the Lung Scotland (ECLS) trial indicated that those at high risk of lung cancer are more likely to engage with community-based recruitment methods. The current study aimed to understand if general practitioner (GP) and community-based recruitment might attract different groups...

Introduction: Stereotactic ablative body radiotherapy (SABR) offers patients with stage I non-small-cell lung cancer (NSCLC) a safe, effective radical therapy option. The impact of introducing SABR at a Scottish regional cancer centre was studied. Methods: The Edinburgh Cancer Centre Lung Cancer Database was assessed. Treatment patterns and outc...

Purpose/Objective(s) There is a lack of consensus around the diagnosis, management and follow-up of radiation pneumonitis (RP). A Delphi consensus process was conducted in this area. Materials/Methods In round 1, open questions were distributed to 31 clinicians treating thoracic malignancy. In round 2, participants rated agreement/disagreement wit...

Purpose/Objective(s) SABR may improve survival in patients with oligometastases, but for some lesions, safe delivery of SABR may require a reduction in delivered dose or target coverage. This study assessed the association between target coverage compromise and oncologic and survival outcomes through a secondary analysis of the SABR-COMET Phase II...

Background: Long-term randomized data assessing the impact of ablative therapies in patients with oligometastases is lacking. The BLINDED-FOR-REVIEW randomized phase II trial was originally designed with 5 years of follow-up, but the trial was amended in 2016 to extend follow-up to 10 years. Herein we report oncologic outcomes beyond 5 years. Metho...

Introduction Pembrolizumab is an established first-line option for patients with advanced non-small-cell lung cancer (NSCLC) expressing programmed death-ligand 1 ≥50%. Durable responses are seen in a subset of patients; however, many derive little clinical benefit. Biomarkers of the systemic inflammatory response predict survival in NSCLC. We evalu...

TITLE The Scottish Inflammatory Prognostic Score (SIPS) identifies poor responders to first-line chemoimmunotherapy in non-small cell lung cancer AUTHORS George Raynes1, Gareth Price2, Xiangfei Yan2, Colin Barrie2, Kirsty Maclennan2, Sorcha Campbell2, Tamasin Evans2, Aisha Tufail2, Stephen Harrow2, Melanie MacKean2, Iain Philips1,2, Mark Stares1,...

The use of stereotactic ablative radiotherapy (SABR) in the UK has expanded over the past decade, in part as the result of several UK clinical trials and a recent NHS England Commissioning through Evaluation programme. A UK SABR Consortium consensus for normal tissue constraints for SABR was published in 2017, based on the existing literature at th...

Purpose: Stereotactic ablative radiotherapy (SABR) may improve survival in patients with oligometastases, but for some lesions, safe delivery of SABR may require a reduction in delivered dose or target coverage. This study assessed the association between target coverage compromise and oncologic and survival outcomes. Methods and Materials: Patient...

Purpose/Objective(s) Radiation pneumonitis (RP) is a dose-limiting toxicity for lung cancer patients undergoing radiotherapy (RT) and systemic therapy. As the optimal practice for diagnosis, management and follow-up for RP is variable, we sought to establish expert consensus recommendations. Materials/Methods International leaders in multidiscipli...

Purpose/Objective(s) Our published economic analysis of the SABR-COMET randomized trial determined that SABR is cost-effective for patients with 1-5 oligometastases, with incremental cost-effectiveness ratios (ICERs) of $37,157 (2018 CAD$) and $54,564 (2018 USD$) for the Canadian and American health care systems, respectively. Long-term outcomes fr...

Introduction: Despite significant advances in systemic anticancer therapy (SACT) for non-small cell lung cancer (NSCLC), many patients still fail to respond to treatment or develop treatment resistance. Albumin, a biomarker of systemic inflammation and malnutrition, predicts survival in many cancers. We evaluated the prognostic significance of albu...

Purpose Thoracic re-irradiation for non-small cell lung cancer (NSCLC) with curative intent is potentially associated with severe toxicity. There are limited prospective data on the best method to deliver this treatment. We sought to develop expert consensus guidance on the safe practice of treating NSCLC with radiotherapy in the setting of prior t...

Purpose The phase II randomized study SABR-COMET demonstrated that in patients with controlled primary tumors and 1-5 oligometastatic lesions, stereotactic ablative radiotherapy (SABR) was associated with improved progression free survival (PFS) compared to standard of care (SoC), but with higher costs and treatment-related toxicities. The aim of t...

Purpose Not all patients with stage III NSCLC are suitable for concurrent chemoradiotherapy (cCRT). Local failure rate is high for sequential CRT and as such, there is a rationale for treatment intensification. Methods and Materials Isotoxic intensity modulated radiotherapy (IMRT) is a multicentre feasibility study that combines different intensif...

Lung cancer is the leading cause of cancer mortality worldwide and most patients are unsuitable for ‘gold standard’ treatment, which is concurrent chemoradiotherapy. CONCORDE is a platform study seeking to establish the toxicity profiles of multiple novel radiosensitisers targeting DNA repair proteins in patients treated with sequential chemoradiot...

PURPOSE The oligometastatic paradigm hypothesizes that patients with a limited number of metastases may achieve long-term disease control, or even cure, if all sites of disease can be ablated. However, long-term randomized data that test this paradigm are lacking. METHODS We enrolled patients with a controlled primary malignancy and 1-5 metastatic...

Background: A recent randomized phase II trial evaluated stereotactic ablative radiotherapy (SABR) in a group of patients with a small burden of oligometastatic disease (mostly with 1-3 metastatic lesions), and found that SABR was associated with a significant improvement in progression-free survival and a trend to an overall survival benefit, sup...

Patients treated with curative-intent lung radiotherapy are in the group at highest risk of severe complications and death from COVID-19. There is therefore an urgent need to reduce the risks associated with multiple hospital visits and their anti-cancer treatment. One recommendation is to consider alternative dose-fractionation schedules or radiot...

Purpose: The oligometastatic paradigm hypothesizes that patients with a limited number of metastases may achieve long-term disease control, or even cure, if all sites of disease can be ablated. However, long-term randomized data testing this paradigm are lacking. Methods: We enrolled patients with a controlled primary malignancy and 1-5 metastatic...

Background: Stereotactic ablative radiotherapy (SABR) has become an established treatment option for medically-inoperable early-stage (Stage I-IIA) non-small cell lung cancer (ES-NSCLC). SABR is able to obtain high rates of local control with low rates of symptomatic toxicity in this patient population. However, in a subset of patients with fibrot...

Aims: Stereotactic ablative body radiotherapy doses for peripheral lung lesions caused high toxicity when used for central non-small cell lung cancer (NSCLC). To determine a safe stereotactic ablative body radiotherapy dose for central tumours, the phase I/II Radiation Therapy Oncology Group RTOG 0813 trial used 50 Gy/five fractions as a baseline....

Background: Stereotactic ablative radiotherapy (SABR) has emerged as a new treatment option for patients with oligometastatic disease. SABR delivers precise, high-dose, hypofractionated radiotherapy, and achieves excellent rates of local control for primary tumors or metastases. A recent randomized phase II trial evaluated SABR in a group of patie...

Purpose: Randomized data assessing the longitudinal quality of life (QoL) impact of stereotactic ablative radiation therapy (SABR) in the oligometastatic setting are lacking. Methods and materials: We enrolled patients who had a controlled primary malignancy with 1 to 5 metastatic lesions, with good performance status and life expectancy >6 mont...

Background: The oligometastatic paradigm suggests that some patients with a limited number of metastases might be cured if all lesions are eradicated. Evidence from randomised controlled trials to support this paradigm is scarce. We aimed to assess the effect of stereotactic ablative radiotherapy (SABR) on survival, oncological outcomes, toxicity,...

Figure S1. ‘Concentric circles of influence’ representation of the Integrated Symptom Response Framework [14]

Data S1. Supporting information

Data S2. Supporting information

Table S1: Participant characteristics

Objective The incidence of lung cancer is four‐times higher in people with Chronic Obstructive Pulmonary Disease (COPD) compared to the general population. Promotion of a shorter time from symptom onset to presentation is one potential strategy for earlier lung cancer diagnosis but distinguishing respiratory symptoms can be difficult. We investigat...